Surgical Endoscopy

, Volume 32, Issue 3, pp 1223–1227 | Cite as

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

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



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.


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.


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).


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.


Robotic surgery Choledochotomy Common bile duct exploration Gallstones Cost Health technology assessment 



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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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Ahmed Almamar
    • 1
    • 2
  • Nawar A. Alkhamesi
    • 1
    • 2
  • Ward T. Davies
    • 1
    • 2
  • Christopher M. Schlachta
    • 1
    • 2
  1. 1.Department of Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  2. 2.Canadian Surgical Technologies and Advanced Robotics (CSTAR)London Health Sciences CentreLondonCanada

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