Robotic cholecystectomy: A cost comparison with historically novel laparoscopic cholecystectomy

Abstract

Introduction Robotic cholecystectomy (RC) is an emerging modality in minimally invasive surgery. Critics of this technology however cite unsubstantiated costs in a fiscally tight health care budget as a major limitation to widespread use. Laparoscopic cholecystectomy (LC) was also once an “emerging” technology which shared similar critiques yet is now considered standard of care for gallbladder disease. In order to assess the merit of cost critiques, we performed a retrospective analysis for historically “novel” LC and compared with the modern equivalent, RC. Materials and methods Using a PubMed database search, an operating room cost differential was calculated for LC vs. open cholecystectomy (OC). Similarly a modern operating cost-differential was calculated for RC vs. LC. Both values were inflation adjusted to the current US dollar value using the Consumer Price Index (CPI) for Medical Care Specific Inflation, (fiscal year 2012). Results After standardizing cost, the modern added cost of each “emerging” technology was +$904 for LC, compared with +$1164 for RC. Discussion As an emerging technology, LC was once regarded as experimental and costly but is now recognized as the gold standard for benign gallbladder disease. Robotic surgery is an example of a modern emerging technology equivalent that has shown merit for several minimally invasive procedures. If we use history as a guide, the additional cost associated with robotic surgery as a developing technology will diminish over time as market competition and utilization increases. Conclusion As robotic surgery is further developed and utilized there is a potential for the attenuation of cost similar to laparoscopic cholecystectomy. This potential is particularly true as patents expire and the market is opened to competition.