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    Robotic radical nephrectomy sees steady increase in use

    Procedure associated with longer OR time, higher hospital costs vs. laparoscopic surgery


    One of the potentially significant confounding factors for the cost analysis is the issue of the study period and learning curve. It is encouraging to note that there were no differences in complications between the two procedures. One might speculate that due to the learning curve, a slow or cautious approach may have resulted in prolonged surgical time and increased cost. The study period for this report (2003-2015) includes essentially the entire learning curve for the robot-assisted technique, whereas the laparoscopic technique had been well established by that time. A more meaningful comparison would be to analyze the data at the beginning of the study (eg, 2003-2005) and at the end of the study period (eg, 2013-2015) to determine whether the differences in outcomes, resources utilization, and cost still exist.

    Read - Robotic vs. open RP: Better EF recovery seen with robot

    In general, there is no increased payment by third-party payers to the hospitals and surgeons for performing robot-assisted radical nephrectomy, and the difference in cost is typically absorbed by the hospital. At least for now, we cannot automatically assume that increased cost of robotic nephrectomy results in increased cost for the insurers and/or the patients, or a net loss for the hospital. The issues surrounding hospital charges, payments, costs, and perceived value are not linear and often quite opaque.

    Clearly, robotic surgery, as with other technological advances, is associated with increased cost. Practicing cost-effective medicine is a collective responsibility. A team approach to reducing resource utilization and cost can be implemented to include the surgeon, anesthesiologist, OR staff, and postoperative early recovery pathways. Sharing the resource utilization and cost data with the robotic surgical team will create awareness of the problem and facilitate, with or without additional incentives, reduction in the total cost the procedure. In the end, it is up to the surgeons who wish to continue to perform these robotic procedure to demonstrate their cost-effectiveness.

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