title: Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense?
abstract: BACKGROUND
  The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic urologic surgery. We sought to examine the best current available evidence for the cost effectiveness of robotic urologic surgery.
  
  
  METHODS
  Comprehensive electronic literature searches were conducted without language restriction to identify reports of published studies within PubMed/Medline, SCOPUS and Web of Science. Relevant articles were examined and reference lists cross referenced to find additional pertinent publications.
  
  
  RESULTS
  PubMed literature searches of "robot urology cost" (304 articles) "robotic prostatectomy cost" (215 articles), "robotic nephrectomy cost" (87 articles), "robotic cystectomy cost" (44 articles) and "robotic pyeloplasty cost" (41 articles) were initially reviewed in abstract form to find appropriate articles for inclusion. Given that robotic cystectomy (559 articles), robotic pyeloplasty (344 articles) robotic retroperitoneal lymph node dissection (59 articles) are less frequently performed than robotic prostatectomy, all available articles published from January 1st 2000 until July 31st 2016 were reviewed for potential inclusion. After excluding duplicates, appropriate articles were pulled for full text review. 49 articles were used for the final analysis.
  
  
  CONCLUSIONS
  The available literature on the cost effectiveness of robotic urologic surgery is somewhat limited by heterogeneity of research methods, local cost variations and methods for determining costs associated with surgical outcomes. The introduction of the robotic surgical platform has led to a dramatic change in the availability and utilization of laparoscopic surgery and is associated with both favorable perioperative outcomes as well as significantly greater fixed costs related to instrumentation and equipment expenses. Well-designed trials comparing open and robotic approaches in the contemporary era of widespread robotic adoption with quality of life and validated economic metrics will be necessary to provide evidence for continued use of this valuable technology.
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL, USA - rdobbs@uic.edu.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Dobbs
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Brenden P
authors.initials: BP
authors.lastname: Magnan
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Nikita
authors.initials: N
authors.lastname: Abhyankar
authors.affiliation: Department of Urology, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
authors.affiliation: Department of Urology, Guy's and Thomas' NHS Foundation Trust and KCL, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Challacombe
authors.affiliation: Department of Urology, Lefrak Center for Robotic Surgery, Presbyterian Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Urology, Guy's and Thomas' NHS Foundation Trust and KCL, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Unit of Urology, Department of Oncology, &quot;San Luigi&quot; University Hospital, Orbassano, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Simone
authors.initials: S
authors.lastname: Crivellaro
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000295:instrumentation* / Q000379:methods