07 September 2010

Invasive surgery cheaper than robot

According to a new study, minimally invasive surgery for endometrial cancer is more cost effective than using a surgical robot.

Minimally invasive surgery for endometrial cancer is cheaper on a society-wide and hospital level than surgery done with a robotic system or a more invasive hysterectomy, according to a new study.

The robot still has other benefits that aren't reflected in the dollars-and-cents calculation, the authors say, such as greater ease and comfort for the surgeon.

Billions are spent on treating endometrial cancer each year, but it's unclear how that number will change if more of the surgeries are done robotically.

Robots worth, calculated

"I think one of the main arguments people have about robotic surgery is the potential cost associated with it - whether it's worth it or not," said Dr Jason Barnett of the San Antonio Military Medical Centre, the study's lead author.

To better answer that question, Barnett and his colleagues used models to calculate the hospital's costs for performing endometrial cancer surgery by the three different methods, all of which have been shown to have a similar rate of success in curing the disease, they say.

They did the same calculation to determine the total costs to society, which factor in lost wages when a woman must take time off from work post-surgery as well as the cost of providing her a caregiver while she heals.

Using the researchers' cost figures - which they estimated from discussions with hospital accounting departments and from Medicare reimbursement information - the minimally invasive surgery done without the robot was cheapest in both instances.

The costs

The researchers found other studies showing that hysterectomies are the quickest of the three surgeries (taking an average of 2 hours, 27 minutes), followed by robotic (3 hours, 12 minutes) and minimally invasive procedures (3 hours, 33 minutes).

After the procedures, minimally invasive and robotic surgery patients stayed in the hospital for an average of one day, compared to four days after a hysterectomy. It also took women longer to return to their normal activity levels after a hysterectomy (52 days) than after minimally invasive surgery (32 days) or surgery using the robot (24 days).

Replacing robot parts

Robotic surgery could become a better option financially if hospitals are able to limit the amount they spend on the robot's disposable parts for each surgery, the researchers write in their article, which is published in Obstetrics & Gynaecology.

Specialised robotic instruments, which the authors estimated would need to be replaced after every 10 surgeries, added thousands to the cost of the robotic procedures.

Surgery using the robot, which mimics a surgeon's movements on electronic instruments, has picked up since the first device was approved by the US Food and Drug Administration in 2000.

The robot itself costs about R11,8 million, the authors estimate, and can be used for a range of procedures, including surgery for prostate cancer and gastric bypass surgery.

Obvious benefits

One of the arguments in favour of the robot is that it makes surgery easier on the surgeon, the authors say. It can also help turn what would need to be an invasive procedure in advanced cases of disease into a surgery with smaller incisions and a shorter recovery time. That's still one of the "obvious benefits" of robotic surgery, Barnett said.

But in situations that would only call for a minimally invasive procedure to begin with, the robot might not offer much advantage - to patients' health or to patients' and hospitals' pocketbooks, as this study shows.

"The model ... used in the article is enlightening," said Dr Tommaso Falcone, the chair of Obstetrics and Gynaecology at Cleveland Clinic.

"But at the end of the day it will depend on the health plan objectives - do we offer treatment (such as minimally invasive surgery) that has been validated by randomised clinical trials or do we accept all technology?" he said.

More cost effective over time

Over time, robotic surgery may become more cost effective if there is more competition between companies making the robots, or doctors start to be more aware of how to limit the cost of disposable equipment, Barnett said.

"I only see robotic surgery rates increasing," he said. "The study supports the use of minimally invasive approaches," he continued, "and as we optimise the cost associated with robotic surgery, I think that it will slowly grow into probably a very common way of doing the surgery." (Reuters Health, Genevra Pittman, September 2010)

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