title: Cost analysis of robot-assisted laparoscopic versus hand-assisted laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  To perform a cost comparison of three approaches to partial nephrectomy (PN): Open (OPN), hand-assisted laparoscopic (HALPN), and robot-assisted (RAPN).
  
  
  METHODS
  We retrospectively evaluated cost and clinical data from patients undergoing OPN, HALPN, and RAPN from 2007 to 2010 (n=89). Baseline demographic data, patient comorbidities, R.E.N.A.L. nephrometry score, and perioperative outcomes were assessed. Costs and subcosts from the operating room (OR) and hospital were evaluated using nonparametric statistical analyses.
  
  
  RESULTS
  Patient demographics and tumor characteristics were similar between HALPN and RAPN, while OPN patients had more comorbidities and more difficult-to-resect tumors. Thus, HALPN and RAPN were directly compared, while OPNs were excluded from the analysis. No difference was found in overall costs between HALPN and RAPN ($13,560 vs $13,439, P=0.29). OR costs were higher for RAPN ($7276 vs $5708, P=0.0001) because of the higher robotic capital and reusable equipment costs that outweighed higher disposable costs in the HALPN group. OR time-related costs were similar between groups. RAPN patients had a shorter length of stay (LOS), which decreased postoperative hospital costs ($4371 vs $5984, P=0.002).
  
  
  CONCLUSIONS
  No difference in overall cost was found between RAPN and HALPN. Robot allocation, OR equipment use, and LOS are important determinants of total cost. Further study regarding recovery and quality of life may reveal added benefits to minimally invasive approaches and increase use of nephron-sparing surgery.
authors.affiliation: Department of Surgery, Division of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7235, USA. jefergus@unch.unc.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Ferguson
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Goyal
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Raynor
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.forename: Paul M
authors.initials: PM
authors.lastname: Brown
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000191:economics* / Q000379:methods*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics* / Q000379:methods*; D009873:Operating Rooms / Q000191:economics; D011182:Postoperative Care / Q000191:economics; D012371:Robotics / Q000191:economics* / Q000379:methods*