Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy

- Robotic radical hysterectomy can be performed at an equal cost as by laparotomy, given a sufficient case load.
- A substantial implementation time is needed to reach cost neutrality.
- Cost effectiveness requires a restrictive use of instruments.

ObjectiveTo compare robot-assisted laparoscopy and laparotomy for radical hysterectomy and pelvic lymphadenectomy in terms of hospital costs.MethodsConsecutive women undergoing radical hysterectomy and pelvic lymphadenectomy as a sole procedure between January 2001 and February 2012 were included. We compared OR times, hospital stay, procedure specific costs, blood transfusions and cost for readmissions and re-interventions until three months after surgery for 231 women operated who received either an open (n = 51) or a robot-assisted laparoscopic radical hysterectomy (n = 180). The hospital internal charges and purchase costs were used for estimation. The specific robotic cost was based on an investment depreciation time of seven years, with 400 operations performed annually, costs for maintenance, robotic instruments, robot-specific assistant's instruments and robot draping.ResultsThe estimated mean costs for an open radical hysterectomy was $12,986, for the first 30 robotic radical hysterectomies was $18,382, and for the last 30 was $12,759, with a break even in cost after 90 robotic procedures. The specific robot costs ($3469) was, for the last robot cohort, compensated mainly by an average of 22 min shorter OR time and 4.9 days shorter hospital stay.ConclusionGiven 400 robot operations annually, and only after a substantial implementation period, it is feasible to perform robot-assisted radical hysterectomy at an equal hospital cost compared with open surgery.