title: Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis.
abstract: BACKGROUND
  This study presents a cost analysis of the standard cervical, gasless transaxillary endoscopic, and gasless transaxillary robotic thyroidectomy approaches based on medical costs in the United States.
  
  
  METHODS
  A retrospective review of 140 patients who underwent standard cervical, transaxillary endoscopic, or transaxillary robotic thyroidectomy at 2 tertiary centers was conducted. The cost model included operating room charges, anesthesia fee, consumables cost, equipment depreciation, and maintenance cost. Sensitivity analyses assessed individual cost variables.
  
  
  RESULTS
  The mean operative times for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were 121 ± 18.9, 185 ± 26.0, and 166 ± 29.4 minutes, respectively. The total cost for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were $9,028 ± $891, $12,505 ± $1,222, and $13,670 ± $1,384, respectively. Transaxillary approaches were significantly more expensive than the standard cervical technique (standard cervical/transaxillary endoscopic, P < .0001; standard cervical/transaxillary robotic, P < .0001; and transaxillary endoscopic/transaxillary robotic, P = .001). The transaxillary and standard cervical techniques became equivalent in cost when transaxillary endoscopic operative time decreased to 111 minutes and transaxillary robotic operative time decreased to 68 minutes. Increasing the case load did not resolve the cost difference.
  
  
  CONCLUSIONS
  Transaxillary endoscopic and transaxillary robotic thyroidectomies are significantly more expensive than the standard cervical approach. Decreasing operative times reduces this cost difference. The greater expense may be prohibitive in countries with a flat reimbursement schedule.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA. jennycabot@gmail.com
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Cabot
authors.forename: Cho Rok
authors.initials: CR
authors.lastname: Lee
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.forename: David A
authors.initials: DA
authors.lastname: Kleiman
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000328:Adult; D001365:Axilla; D002291:Carcinoma, Papillary / Q000601:surgery; D003365:Costs and Cost Analysis; D004724:Endoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012371:Robotics / Q000191:economics* / Q000379:methods; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics* / Q000379:methods