title: Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution.
abstract: BACKGROUND
  One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution.
  
  
  METHODS
  Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs.
  
  
  RESULTS
  Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique.
  
  
  CONCLUSIONS
  Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Despoina
authors.initials: D
authors.lastname: Daskalaki
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonzalez-Heredia
authors.affiliation: 2 AlixPartners, Chicago, Illinois.
authors.forename: Marc
authors.initials: M
authors.lastname: Brown
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Bianco
authors.affiliation: 3 Division of Transplantation, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Ivo
authors.initials: I
authors.lastname: Tzvetanov
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Myriam
authors.initials: M
authors.lastname: Davis
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Jihun
authors.initials: J
authors.lastname: Kim
authors.affiliation: 3 Division of Transplantation, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.affiliation: 1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Pier C
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs; D006498:Hepatectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: cost; liver surgery; robotic surgery