PMID- 37247050 OWN - NLM STAT- MEDLINE DCOM- 20230531 LR - 20240121 IS - 1435-2451 (Electronic) IS - 1435-2443 (Print) IS - 1435-2443 (Linking) VI - 408 IP - 1 DP - 2023 May 29 TI - Robotic versus laparoscopic versus open major hepatectomy - an analysis of costs and postoperative outcomes in a single-center setting. PG - 214 LID - 10.1007/s00423-023-02953-x [doi] LID - 214 AB - PURPOSE: In the era of minimal-invasive surgery, the introduction of robotic liver surgery (RS) was accompanied by concerns about the increased financial expenses of the robotic technique in comparison to the established laparoscopic (LS) and conventional open surgery (OS). Therefore, we aimed to evaluate the cost-effectiveness of RS, LS and OS for major hepatectomies in this study. METHODS: We analyzed financial and clinical data on patients who underwent major liver resection for benign and malign lesions from 2017 to 2019 at our department. Patients were grouped according to the technical approach in RS, LS, and OS. For better comparability, only cases stratified to the Diagnosis Related Groups (DRG) H01A and H01B were included in this study. Financial expenses were compared between RS, LS, and OS. A binary logistic regression model was used to identify parameters associated with increased costs. RESULTS: RS, LS and OS accounted for median daily costs of 1,725 euro, 1,633 euro and 1,205 euro, respectively (p < 0.0001). Median daily (p = 0.420) and total costs (16,648 euro vs. 14,578 euro, p = 0.076) were comparable between RS and LS. Increased financial expenses for RS were mainly caused by intraoperative costs (7,592 euro, p < 0.0001). Length of procedure (hazard ratio [HR] = 5.4, 95% confidence interval [CI] = 1.7-16.9, p = 0.004), length of stay (HR [95% CI] = 8.8 [1.9-41.6], p = 0.006) and development of major complications (HR [95% CI] = 2.9 [1.7-5.1], p < 0.0001) were independently associated with higher costs. CONCLUSIONS: From an economic perspective, RS may be considered a valid alternative to LS for major liver resections. CI - (c) 2023. The Author(s). FAU - Knitter, Sebastian AU - Knitter S AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. sebastian.knitter@charite.de. FAU - Feldbrugge, Linda AU - Feldbrugge L AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Nevermann, Nora AU - Nevermann N AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Globke, Brigitta AU - Globke B AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Galindo, Santiago Andres Ortiz AU - Galindo SAO AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Winklmann, Thomas AU - Winklmann T AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Krenzien, Felix AU - Krenzien F AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Haber, Philipp K AU - Haber PK AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Malinka, Thomas AU - Malinka T AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Lurje, Georg AU - Lurje G AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Schoning, Wenzel AU - Schoning W AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Pratschke, Johann AU - Pratschke J AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. FAU - Schmelzle, Moritz AU - Schmelzle M AD - Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. LA - eng PT - Journal Article DEP - 20230529 PL - Germany TA - Langenbecks Arch Surg JT - Langenbeck's archives of surgery JID - 9808285 SB - IM MH - Humans MH - Hepatectomy/methods MH - *Robotic Surgical Procedures/methods MH - *Robotics MH - Liver MH - *Laparoscopy/methods PMC - PMC10226911 OTO - NOTNLM OT - Cost analysis OT - Laparoscopic liver resection OT - Liver resection OT - Liver surgery OT - Robotic liver surgery OT - Robotic-assisted liver surgery COIS- Sebastian Knitter, Linda Feldbrugge, Nora Nevermann, Brigitta Globke, Thomas Winklmann, Felix Krenzien, Philipp K. Haber, Georg Lurje, Wenzel Schoning: None declared; Thomas Malinka: Intuitive Surgical Inc.; Johann Pratschke: Intuitive Surgical Inc., Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, promedicis; Moritz Schmelzle: Merck, Bayer AG, Amgen Inc., Johnson & Johnson, ERBE Elektromedizin GmbH, Takeda Pharmaceutical Limited, Olympus K.K., Medtronic, Intuitive Surgical Inc. EDAT- 2023/05/29 13:04 MHDA- 2023/05/31 06:41 PMCR- 2023/05/29 CRDT- 2023/05/29 11:07 PHST- 2022/04/16 00:00 [received] PHST- 2023/05/22 00:00 [accepted] PHST- 2023/05/31 06:41 [medline] PHST- 2023/05/29 13:04 [pubmed] PHST- 2023/05/29 11:07 [entrez] PHST- 2023/05/29 00:00 [pmc-release] AID - 10.1007/s00423-023-02953-x [pii] AID - 2953 [pii] AID - 10.1007/s00423-023-02953-x [doi] PST - epublish SO - Langenbecks Arch Surg. 2023 May 29;408(1):214. doi: 10.1007/s00423-023-02953-x.