Abstract
Background
Multiport laparoscopy is the gold-standard approach for cholecystectomy, and single-port laparoscopy has been developed to further reduce its invasiveness. A specific robotic single-port platform (da Vinci single-site, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2011, which could technically facilitate single-site cholecystectomy. Current data show its feasibility; however, detailed short- and long-term analyses of costs and comparisons relative to multiport laparoscopy are not available to date.
Methods
Patients who underwent robotic single-site cholecystectomy for benign, clinically noninflammatory disease between 2011 and 2015 were matched for disease, age, gender, BMI, ASA classification, diagnosis, and elapsed year of surgery to a cohort of multiport cholecystectomies. Demographic, perioperative, and long-term data were collected retrospectively and analyzed. Perioperative and long-term costs including re-operations due to the primary procedure until February 2017 were compared across both cohorts.
Results
99 patients who underwent robotic single-site cholecystectomy were matched to 99 patients with multiport cholecystectomy. A higher rate of outpatient procedures in the robotic cohort (31.3 vs. 17.2%, p = 0.0305) was found, and demographic parameters and perioperative clinical outcomes were similar. Perioperative costs were significantly higher for the robotic single-site patients (6158.0 vs. 4288.0 USD, p < 0.0001). With similar follow-up times of 59.0 and 58.9 months, respectively (p = 0.9552), significantly more patients of the robotic Single-Site cohort underwent follow-up surgery (7.1 vs. 0.0%, p = 0.0140), and follow-up costs were significantly higher for the robotic cohort (694.7 vs. 0.0 USD, p = 0.0145).
Conclusion
With similar early postoperative clinical results and a higher rate of re-operations, perioperative and long-term costs are significantly higher with robotic Single-Site cholecystectomy compared with multiport cholecystectomy. Considering the unclear clinical value of robotic single-site cholecystectomy and the significant short- and long-term costs, a call for further research and a debate as to who should bear the costs beyond the ones of the gold-standard treatment appear reasonable.
Similar content being viewed by others
References
Antoniou SA, Pointner R, Granderath FA (2010) Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 25(2):367–377
Hagen ME, Wagner OJ, Thompson K, Jacobsen G, Spivack A, Wong B, Talamini M, Horgan S (2010) Supra-pubic single incision cholecystectomy. J Gastrointest Surg 14:404–407
Hagen ME, Wagner OJ, Inan I, Morel P, Fasel J, Jacobsen G, Spivack A, Thompson K, Wong B, Fischer L, Talamini M, Horgan S (2010) Robotic single-incision transabdominal and transvaginal surgery: initial experience with intersecting robotic arms. Int J Med Robot 6:251–255
Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192
Dunker MS, Stiggelbout AM, Van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12:1334–1340
White WM, Goel RK, Kaouk JH (2009) Single-port laparoscopic retroperitoneal surgery: initial operative experience and comparative outcomes. Urology 73:1279–1282
Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A (2016) Cosmesis, patient satisfaction, and quality of life after da Vinci single-site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc 31(8):3242–3250
Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J, Chalikonda S (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci single-site platform. Surg Endosc 25:3566–3573
Morel P, Hagen ME, Bucher P, Buchs NC, Pugin F (2011) Robotic single-port cholecystectomy using a new platform: initial clinical experience. J Gastrointest Surg 15:2182–2186
Balachandran B, Hufford TA, Mustafa T, Kochar K, Sulo S, Khorsand J (2017) A comparative study of outcomes between single-site robotic and multi-port laparoscopic cholecystectomy: an experience from a tertiary care center. World J Surg 41(5):1246–1253
Morel P, Buchs NC, Iranmanesh P, Pugin F, Buehler L, Azagury DE, Jung M, Volonte F, Hagen ME (2014) Robotic single-site cholecystectomy. J Hepatobiliary Pancreat Sci 21:18–25
Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, Grosso F, Quarati R (2012) Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26:1648–1655
van der Linden YT, Brenkman HJ, van der Horst S, van Grevenstein WM, van Hillegersberg R, Ruurda JP (2016) Robotic single-port laparoscopic cholecystectomy is safe but faces technical challenges. J Laparoendosc Adv Surg Tech A 26:857–861
Hagen ME, Pugin F, Chassot G, Huber O, Buchs N, Iranmanesh P, Morel P (2012) Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass. Obes Surg 22:52–61
Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, Kim CG, Choi IJ, Lee JS, Kook MC, Rhee JY, Park SR, Kim YW (2012) Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol 38:57–63
Villamere J, Gebhart A, Vu S, Nguyen NT (2014) Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc 29(7):1729–1736
Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146
Niklas C, Saar M, Berg B, Steiner K, Janssen M, Siemer S, Stockle M, Ohlmann CH (2015) da Vinci and open radical prostatectomy: comparison of clinical outcomes and analysis of insurance costs. Urol Int 96(3):287–294
Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H, Rosen RC, Tewari AK, Wilson TG, Zattoni F, Montorsi F (2012) Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 62:418–430
Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, Werner J, Buchler MW, Diener MK (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101:51–54
Acknowledgements
The authors thank Francoise Bernardi (University Hospital Geneva) for facilitating data collection.
Funding
No funding was received for this project.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Monika E. Hagen received personal fees and nonfinancial support from Intuitive Surgical Inc. and personal fees from Ethicon Inc. outside this project. Minoa K. Jung received nonfinancial support from Intuitive Surgical Inc. outside this project. Alexandre Balaphas, Michele Podetta, Peter Rohner, Nicolas C. Buchs, Leo Buehler, Jona Mendoza, and Philippe Morel have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Hagen, M.E., Balaphas, A., Podetta, M. et al. Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs. Surg Endosc 32, 1550–1555 (2018). https://doi.org/10.1007/s00464-017-5843-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5843-z