Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms.
Pelvic organ prolapse
Robotic surgery
Sacrocolpopexy
Surgical costs
Journal
International urogynecology journal
ISSN: 1433-3023
Titre abrégé: Int Urogynecol J
Pays: England
ID NLM: 101567041
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
18
07
2022
accepted:
27
09
2022
pubmed:
26
10
2022
medline:
14
1
2023
entrez:
25
10
2022
Statut:
ppublish
Résumé
Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5 ± 9.7, BMI 27.9 ± 4.7, and parity 2.5 ± 1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ = 32.1 min, p = 0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p > 0.05). On univariable analysis, costs were similar (Senhance $5368.31 ± 1486.89, DaVinci $5741.76 ± 1197.20, p = 0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p > 0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p = 0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.
Identifiants
pubmed: 36282303
doi: 10.1007/s00192-022-05391-3
pii: 10.1007/s00192-022-05391-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
87-91Informations de copyright
© 2022. The International Urogynecological Association.
Références
Freeman RM, Pantazis K, Thomson A, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24(3):377–84. https://doi.org/10.1007/S00192-012-1885-X .
doi: 10.1007/S00192-012-1885-X
Coolen ALWM, van Oudheusden AMJ, Mol BWJ, van Eijndhoven HWF, Roovers JPWR, Bongers MY. Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial. Int Urogynecol J. 2017;28(10):1469–79. https://doi.org/10.1007/S00192-017-3296-5/TABLES/5 .
doi: 10.1007/S00192-017-3296-5/TABLES/5
Miller K, Benden M, Pickens A, Shipp E, Zheng Q. Ergonomics principles associated with laparoscopic surgeon injury/illness. Hum Factors. 2012;54(6):1087–92. https://doi.org/10.1177/0018720812451046 .
doi: 10.1177/0018720812451046
Wee IJY, Kuo LJ, Ngu JCY. A systematic review of the true benefit of robotic surgery: Ergonomics. Int J Med Robot. 2020;16(4). https://doi.org/10.1002/RCS.2113 .
Tarr ME, Brancato SJ, Cunkelman JA, Polcari A, Nutter B, Kenton K. Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol. 2015;22(2):234–8. https://doi.org/10.1016/J.JMIG.2014.10.004 .
doi: 10.1016/J.JMIG.2014.10.004
Sinha R, Sanjay M, Rupa B, Kumari S. Robotic surgery in gynecology. J Minim Access Surg. 2015;11(1):50–9. https://doi.org/10.4103/0972-9941.147690 .
doi: 10.4103/0972-9941.147690
Elliott CS, Hsieh MH, Sokol ER, Comiter C, v. Payne CK, Chen B. Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis. J Urol. 2012;187(2):638–43. https://doi.org/10.1016/J.JURO.2011.09.160 .
doi: 10.1016/J.JURO.2011.09.160
Paraiso MFR, Jelovsek JE, Frick A, Chen CCG, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13. https://doi.org/10.1097/AOG.0b013e318231537c .
doi: 10.1097/AOG.0b013e318231537c
Anger JT, Mueller ER, Tarnay C, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5–12. https://doi.org/10.1097/AOG.0000000000000006 .
doi: 10.1097/AOG.0000000000000006
Sassani JC, Clark SG, McGough CE, Shepherd JP, Bonidie M. Sacrocolpopexy experience with a novel robotic surgical platform. Int Urogynecol J. 2022. Published online. https://doi.org/10.1007/S00192-022-05155-Z .
Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3(1):e1918911. https://doi.org/10.1001/JAMANETWORKOPEN.2019.18911 .
doi: 10.1001/JAMANETWORKOPEN.2019.18911
Bodenheimer T. High and rising health care costs. Part 1: seeking an explanation. Ann Intern Med. 2005;142(10):847–54. https://doi.org/10.7326/0003-4819-142-10-200505170-00010 .
doi: 10.7326/0003-4819-142-10-200505170-00010
Coussons H, Feldstein J, McCarus S. Senhance surgical system in benign hysterectomy: A real-world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic-assisted vaginal hysterectomy procedures. Int J Med Robot. 2021;17(4):e2261. https://doi.org/10.1002/RCS.2261 .
Asensus Surgical building bridge from laparoscopy to robotic surgery — BioTuesdays. Accessed June 6, 2022. https://biotuesdays.com/2021/07/20/asensus-surgical-building-bridge-from-laparoscopy-to-robotic-surgery/ .
Luo G, Liao D, Lin W, Chen L, Chen X, Yao D. Cost analysis of supply chain management of Da Vinci surgical instruments: a retrospective study. Technol Health Care. 2022:1–9. Published online May 20. https://doi.org/10.3233/THC-213563 .
Sanchez A, Herrera L, Teixeira A, et al. Robotic surgery: financial impact of surgical trays optimization in bariatric and thoracic surgery. J Robot Surg. 2022. Published online. https://doi.org/10.1007/S11701-022-01412-X .