Robotic Urologic Surgery Linked to Better Outcomes Than Open

Emma Hitt, PhD

March 28, 2012

March 28, 2012 — The use of robotic surgery in urological procedures results in comparable postoperative outcomes to laparoscopic surgery, and both have outcomes superior to open surgery, according to a new report.

The researchers also found that the higher cost of robotic surgery is associated with the initial purchase of the robot, as well as its annual maintenance and cost of disposable equipment. However, robotic surgery may have a reduced learning curve compared with laparoscopic surgery.

Kamran Ahmed, MBBS, MRCS, research registrar from the Guy's and St Thomas' Hospitals, Urology Centre, London, United Kingdom, and colleagues reported their findings in an article published online March 22 in BJU International.

"Robotic surgery is becoming increasingly common in pelvic urological procedures such as radical prostatectomy and cystectomy," according to the authors. However, some studies claim that robot-assisted surgery adds from $1000 to $2500 in costs to a procedure.

The authors of the current study sought to systematically evaluate the evidence regarding cost-effectiveness of open and laparoscopic surgery in relation to robotic surgery.

They identified 13 studies that met the selection criteria in the Medline, Embase, and Web of Science databases.

The authors found that laparoscopic and robot-assisted radical prostatectomy were superior with respect to a reduction in hospital stay (range, 1 - 1.76 days and 1 - 5.5 days, respectively) and blood loss (range, 482 - 780 mL and 227 - 234 mL, respectively) compared with open surgery (range, 2 - 8 days and 1015 mL for reduction in hospital stay and blood loss, respectively).

In comparison, robotic radical prostatectomy was found to be more expensive (total cost, $2000 - $39,215) compared with either laparoscopic (range, $740 - $29,771) or open radical prostatectomy (range, $1870 - $31,518).

"This difference is due to the cost of robot purchase, maintenance and instruments," the authors point out. "The reduced length of stay in hospital (range 1 - 1.5 days) and length of surgery (range 102 - 360 min) are unable to compensate for the excess costs."

However, robotic surgery may require a shorter learning curve (20 - 40 cases) compared with the other techniques, although the evidence is inconclusive, they note.

"Ever growing demands for robotic surgery should be accompanied with studies looking at the actual cost of the procedures as a whole which includes the patient journey within the hospital," the authors conclude.

The authors have disclosed no relevant financial relationships.

BJU Int. Published online March 22, 2012. Abstract

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