Cost analysis of robotic versus open hepatectomy: Is the robotic platform more expensive?

The robotic platform is perceived to be more expensive when compared to laparoscopic and open operations. We aimed to compare the perioperative costs of robotic vs. open hepatectomy for the treatment of liver tumors at our facility. We followed 370 patients undergoing robotic and open hepatectomy for benign and malignant liver tumors. Demographic, perioperative, cost and payment data were collected and analyzed. For illustrative purposes, the data were presented as median (mean ± SD). Two hundred sixty-seven robotic and 104 open hepatectomies were analyzed. There were no significant differences in perioperative variables between the two cohorts. The robotic group had a significantly lower estimated blood loss (EBL) (135 [208 ± 244.8] vs 300 [427 ± 502.5] ml, p < 0.0001), smaller lesion size (4 [5 ± 3.6] vs 5[6 ± 4.9] cm, p = 0.0052), shorter length of stay (LOS) (4 [4 ± 3.4] vs 6[8 ± 5.7] days, p < 0.0001) and decreased 90-day mortality (3 vs 7 p = 0.0028). There were no significant differences between the two groups any cost variable. The open group received significantly higher reimbursement ($29,297 [62,962 ± 75,377.96] vs $19,102 [38,975 ± 39,362.11], p < 0.001) and profit ($5005 [30,981 ± 79,541.09] vs $- 6682 [6146 ± 40,949.65], p < 0.001). Robotic hepatectomy is associated with lower EBL, shorter LOS and less mortality. There was no greater cost associated with the robotic platform despite a reduced reimbursement and profit.