Cost-effectiveness and clinical impact of robotic-assisted hepatectomy

Abstract

Robotic-assisted hepatectomy has gained traction in hepatobiliary surgery, but its cost-effectiveness compared to traditional surgical approaches remains unclear. This study investigates clinical outcomes and financial implications of robotic-assisted liver surgery in a high-volume center, comparing it with open and laparoscopic methods. A retrospective cohort study was conducted on patients undergoing hepatectomy at Lille University Hospital in 2018 and 2021, performed by the institution's first experienced robotic hepatobiliary surgeon. Data on patient demographics, intraoperative details, postoperative outcomes, and costs were analyzed. Costs included hospital stays, surgical materials, and complications, derived from national cost studies. A total of 111 patients were included, with a rise in minimally invasive procedures from 47.5% in 2018 to 75% in 2021. Robotic-assisted hepatectomy was associated with reduced hospital stays, lower complication rates, and fewer severe morbidities compared to laparotomy. The average cost per procedure (all surgical approaches combined) decreased from €12,169 in 2018 to €8,513 in 2021, with robotic surgery offering a significant financial advantage. The total savings for the 71 patients in the 2021 cohort was €259,576, driven primarily by reduced hospitalization times and fewer complications. Robotic-assisted hepatectomy is clinically safe and cost-effective, offering substantial financial savings over traditional surgery. The reduction in postoperative complications and hospital stay durations, particularly for complex cases, highlights the advantages of robotic surgery in hepatobiliary procedures. As surgical expertise increases, robotic surgery represents a sustainable and efficient alternative in liver resection.