Complete daVinci versus laparoscopic pyeloplasty: cost analysis.
OBJECTIVE
Computer-assisted pyeloplasty with the daVinci system is an emerging technique to treat ureteropelvic junction (UPJ) obstruction. A relative cost analysis was performed assessing this technology in comparison with purely laparoscopic pyeloplasty.


METHODS
Eight patients underwent computer-assisted (daVinci) dismembered pyeloplasty (CP) via a transperitoneal four-port approach. They were compared with 13 patients who underwent purely laparoscopic pyeloplasty (LP). All patients had a primary UPJ obstruction and were matched for age, sex, and body mass index. The cost of equipment and capital depreciation for both procedures, as well as assessment of room set-up time, takedown time, and personnel were analyzed. Surgeons and nursing staff for both groups were experienced in both laparoscopy and daVinci procedures. One- and two-way financial analysis was performed to assess relative costs.


RESULTS
The mean set-up and takedown time was 71 minutes for CP and 49 minutes for LP. The mean length of stay was 2.3 days for CP and 2.5 days for LP. The mean operating room (OR) times for CP and LP were 176 and 210 minutes, respectively. There were no complications in either group. One-way cost analysis with an economic model showed that LP is more cost effective than CP at our hospital if LP OR time is <338 minutes. With adjustment to a volume of 500 daVinci cases/year, CP is still not as cost effective as LP. Two-way sensitivity analysis shows that in-room time must still be <130 minutes and yearly cases must be >500 to obtain cost equivalence for CP.


CONCLUSIONS
Perioperative parameters for CP are encouraging. However, the costs are a clear disadvantage. In our hospital, it is more cost effective to teach and perform LP than to perform CP.
Bhayani
Sam B
SB
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Jefferson Building 161, Baltimore, MD 21287, USA.
Link
Richard E
RE
Varkarakis
John M
JM
Kavoussi
Louis R
LR
D000328:Adult; D000704:Analysis of Variance; D003251:Constriction, Pathologic / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007682:Kidney Pelvis / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014481:United States; D014517:Ureteral Obstruction / Q000191:economics / Q000601:surgery