50 | wetenschapsdag 2023 Sessie 1d: Een Goede Fundering Voor de Chirurgische Lering x3 Auteurs G. Pilz da Cunha, V.M.H. Coupé, B.M. Zonderhuis, M.G.H. Besselink, R.J. Swijnenburg Abstract titel Robotic versus laparoscopic liver resection: An economic evaluation from a high-volume expert centre Background Minimally invasive liver surgery (MILS) can be performed using a laparoscopic or robot-assisted approach. Surgeons perceive the robotic approach as favourable in terms of instrument handling and ergonomics. However, there is limited evidence supporting that this translates to improved perioperative patient outcomes. Additionally, the implementation of the robotic platform has faced scrutiny because of its high costs. The aim of this study is to assess and compare the healthcare cost expenditure for laparoscopic (LLR) and robotic liver resections (RLR). Methods This study a post-hoc economic evaluation of prospectively collected data of MILS procedures performed between 2015 and 2022 at the Amsterdam UMC. Healthcare costs per patient were calculated until 30-days postoperative and compared between the LLR (n=156) and RLR groups (n=143). Indirect costs of the robotic platform and laparoscopy tower were not considered. Costs were stratified according to resection technical complexity (minor, technically major and anatomically major ) in a subgroup analysis. Results Total per-procedure costs were € 10,302 for RLR and € 10,581 for LLR, not differing significantly. Operative costs were significantly lower for RLR (Mean difference: € -395 [95I € -726 – -56]) which could be attributed to shorter surgical and anesthesia time and lower sterilization costs. When stratified for technical complexity, intraoperative costs were only lower for RLR for technically major resections (Mean difference: € -982 [95I € -1564 – € -420]). Postoperative costs were similar for LLR (€ 4,586 [95I € 3,901 - € 5,356]) and RLR (€ 4,701 [95I € 3,531 - € 6,242]) (Mean difference: € 115 [95I € -1343 - € 1,836]). Conclusion When performed in a high-volume expert center, RLR has similar total cost expenditure as LLR. Utilization of the robotic platform for technically major resections may potentially lead to costsavings. Future research should focus on identifying indications in hepatic surgery where the value of the robot lies.
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