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Azimuddin AM, Hirata Y, Boyev A, Jain AJ, Ayabe R, Ajith J, Schmeisser JA, Newhook TE, Ikoma N, Tzeng CWD, Chun YS, Vauthey JN, Tran Cao HS. A propensity score matched cost analysis of robotic versus open hepatectomy. HPB (Oxford) 2024:S1365-182X(24)02228-7. [PMID: 39198140 DOI: 10.1016/j.hpb.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Cost-effectiveness of Robotic-assisted hepatectomy compared to the open approach is scrutinized. We compared the costs of robotic versus open hepatectomy at a large cancer center. METHODS Patients undergoing hepatectomy (1/2019-2/2022) were collected from a prospectively maintained database and 1:1 propensity score matched for 61 robotic and 61 open hepatectomy patients by complexity, tumor diagnosis, and age >65. Financial data was collected and converted to a ratio of service cost to average OR cost. Short-term and economic outcomes were compared. RESULTS Median length of stay (2 vs. 3 days), major complication rates (0% vs. 8.2%), and 90-day readmission rates (3.3% vs. 11.5%) were lower for robotic hepatectomy (all p < 0.05). Total 90-day perioperative costs were lower by 19.5% for the robotic cohort (mean 6.89 vs 8.56; p < 0.01). Intraoperative costs were higher in the robotic cohort (mean 2.75 vs. 2.44; p < 0.01). Cost reduction drivers during postoperative care were supplies (mean 0.26 vs. 0.75), laboratory (mean 0.27 vs. 0.49), regular surgery unit (mean 0.19 vs. 0.32), recovery room (mean 0.26 vs. 0.29) and pharmacy cost (median 0.21 vs. 0.32; all p < 0.05). CONCLUSION Hospital costs of robotic hepatectomy were lower than those of open hepatectomy due to significantly reduced postoperative costs.
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Affiliation(s)
- Ahad M Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Texas A&M School of Medicine, Houston, TX, USA
| | - Yuki Hirata
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Artem Boyev
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reed Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeeva Ajith
- Financial Planning and Analysis, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Schmeisser
- Financial Planning and Analysis, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun-Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Kelly KJ. Editorial: Updating the Operative Standards for Cancer Surgery Key Questions. Ann Surg Oncol 2022; 29:6511-6514. [PMID: 35980552 DOI: 10.1245/s10434-022-12417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kaitlyn J Kelly
- Division of Surgical Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
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Ayabe RI, Azimuddin A, Tran Cao HS. Robot-assisted liver resection: the real benefit so far. Langenbecks Arch Surg 2022; 407:1779-1787. [PMID: 35488913 DOI: 10.1007/s00423-022-02523-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive liver resection is associated with lower perioperative morbidity and shorter hospital stay. However, the added benefit of the robotic platform over conventional laparoscopy is a matter of ongoing investigation. PURPOSE The purpose of this narrative review is to provide an up-to-date and balanced evaluation of the benefits and shortcomings of robotic liver surgery for the modern hepatobiliary surgeon. CONCLUSIONS Advantages of a robotic approach to liver resection include a shortened learning curve, the ability to complete more extensive or complex minimally invasive operations, and integrated fluorescence guidance. However, the robotic platform remains limited by a paucity of parenchymal transection devices, complete lack of haptic feedback, and added operating time associated with docking and instrument exchange. Like laparoscopic hepatectomy, robotic hepatectomy may provide patients with more rapid recovery and a shorter hospital stay, which can help offset the substantial costs of robot acquisition and maintenance. The oncologic outcomes of robotic hepatectomy appear to be equivalent to laparoscopic and open hepatectomy for appropriately selected patients.
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Affiliation(s)
- Reed I Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Ahad Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA.
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Crafa F, Vanella S, Coppola Bottazzi E, Noviello A, Miro A, Palma T, Apicella I. ASO Author Reflections: Thoraco-Abdominal Approach with Phrenotomy for Large Liver Tumor in Close Contact with the Vena Cava and the Hepatocaval Confluence. Ann Surg Oncol 2021; 29:962-963. [PMID: 34467502 DOI: 10.1245/s10434-021-10696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- F Crafa
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy.
| | - S Vanella
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - E Coppola Bottazzi
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - A Noviello
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - A Miro
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - T Palma
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - I Apicella
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
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