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Cost analysis of robot-assisted choledochotomy and common bile duct exploration as an option for complex choledocholithiasis

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Abstract

Aim

The aim of this study is to evaluate the clinical outcomes and cost-effectiveness of elective, robot-assisted choledochotomy and common bile duct exploration (RCD/CBDE) compared to open surgery for ERCP refractory choledocholithiasis.

Method

A prospective database of all RCD/CBDE has been maintained since our first procedure in April 2007 though April 2016. With ethics approval, this database was compared with all contemporaneous elective open procedures (OCD/CBDE) performed since March 2005. Emergency procedures were excluded from analysis. Cost analysis was calculated using a micro-costing approach. Outcomes were analyzed on the basis of intent-to-treat. A p value of 0.05 denoted statistical significance.

Results

A total of 80 cases were performed since 2005 compromising 50 consecutive, unselected RCD/CBDE and 30 OCD/CBDE. Comparing RCD/CBDE to OCD/CBDE there were no significant differences between groups with respect to age (65 ± 20 vs. 67 ± 18 years, p = 0.09), gender (14/30 vs. 16/25 male/female, p = 0.52), ASA class or co-morbidities. The mean duration of surgery for RCD/CBDE trended longer compared to OCD/CBDE (205 ± 70 min vs. 174 ± 73 min, p = 0.08). However, there was significant reduction in postoperative complications with RCD/CBDE versus OCD/CBDE (22% vs. 56%, p = 0.002). Median hospital stay was also significantly reduced (6 vs 12 days, p = 0.01). The net overall hospital cost for RCD/CBDE was lower ($8449.88 CAD vs. $11671.2 CAD).

Conclusion

In this single-centre, cohort study, robotic-assisted CD/CBDE for ERCP refractory common bile duct stones provides the dominating strategy of improved patient outcomes with a reduction of overall cost.

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Authors and Affiliations

  1. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada

    Ahmed Almamar, Nawar A. Alkhamesi, Ward T. Davies & Christopher M. Schlachta

  2. Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, 339 Windermere Road, P. O. Box 5339, London, Canada

    Ahmed Almamar, Nawar A. Alkhamesi, Ward T. Davies & Christopher M. Schlachta

Authors
  1. Ahmed Almamar
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  2. Nawar A. Alkhamesi
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  3. Ward T. Davies
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  4. Christopher M. Schlachta
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Corresponding author

Correspondence to Christopher M. Schlachta.

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Disclosures

Ahmed Almamar, Nawar A. Alkhamesi, Ward T Davies and Christopher M. Schlachta have no conflicts of interest or financial ties to disclose.

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Almamar, A., Alkhamesi, N.A., Davies, W.T. et al. Cost analysis of robot-assisted choledochotomy and common bile duct exploration as an option for complex choledocholithiasis. Surg Endosc 32, 1223–1227 (2018). https://doi.org/10.1007/s00464-017-5795-3

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  • DOI: https://doi.org/10.1007/s00464-017-5795-3

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