title: Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Robotic surgery is a complex technology offering technical advantages over conventional methods. Still, clinical outcomes and financial issues have been subjects of debate. Several studies have demonstrated higher costs for robotic surgery when compared to laparoscopy or open surgery. However, other studies showed fewer costly anastomotic complications after robotic Roux-en-Y gastric bypass (RYGBP) when compared to laparoscopy.
  
  
  METHODS
  We collected data for our gastric bypass patients who underwent open, laparoscopic, or robotic surgery from June 1997 to July 2010. Demographic data, BMI, complications, mortality, intensive care unit stay, hospitalization, and operating room (OR) costs were analyzed and a cost projection completed. Sensitivity analyses were performed for varied leak rates during laparoscopy, number of robotic cases per month, number of additional staplers during robotic surgery, and varied OR times for robotic cases.
  
  
  RESULTS
  Nine-hundred ninety patients underwent gastric bypass surgery at the University Hospital Geneva from June 1997 to July 2010. There were 524 open, 323 laparoscopic, and 143 robotic cases. Significantly fewer anastomotic complications occurred after open and robotic RYGBP when compared to laparoscopy. OR material costs were slightly less for robotic surgery (USD 5,427) than for laparoscopy (USD 5,494), but more than for the open procedure (USD 2,251). Overall, robotic gastric bypass (USD 19,363) was cheaper when compared to laparoscopy (USD 21,697) and open surgery (USD 23,000).
  
  
  CONCLUSIONS
  Robotic RYGBP can be cost effective due to balancing greater robotic overhead costs with the savings associated with avoiding stapler use and costly anastomotic complications.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. monikahagen@aol.com
authors.forename: Monika E
authors.initials: ME
authors.lastname: Hagen
authors.forename: Francois
authors.initials: F
authors.lastname: Pugin
authors.forename: Gilles
authors.initials: G
authors.lastname: Chassot
authors.forename: Olivier
authors.initials: O
authors.lastname: Huber
authors.forename: Nicolas
authors.initials: N
authors.lastname: Buchs
authors.forename: Pouya
authors.initials: P
authors.lastname: Iranmanesh
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics* / Q000517:prevention & control; D011446:Prospective Studies; D012371:Robotics / Q000191:economics*; D013528:Surgical Staplers / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult