Cost comparison of laparoscopic versus robot-assisted radical cystectomy

Abstract Purpose Minimally invasive techniques have had an increasing implementation trend in recent years but they are associated with significantly higher costs. Objective To assess the costs of radical cystectomy procedure performed using a laparoscopic (LRC) and robot-assisted (RARC) technique and to determine the postoperative complications resulting from surgical treatment and estimate the impact of complications on the formation of total costs. Materials and Methods A retrospective costs analysis was conducted between February 2016 and March 2018 in 89 patients who underwent radical cystectomy with ureterocutaneostomy or ileal urinary diversion. Primary outcomes included patients’ characteristics and variables which had an influence on the overall cost of the surgery. Secondary outcomes included selected direct medical costs: hospitalization, operating room, blood products, parenteral nutrition, diagnostic procedures and costs of surgical instruments. Results Perioperative data were similar in the compared groups. The Clavien-Dindo complications rate ≤30 days was lower for RARC. LRC had a higher mean length of hospital stay than RARC but a shorter operating time by an average of 66 min. The shorter operating time had an impact on the operating room costs (LRC: €769; RARC: €1015; p p Conclusions In the Polish healthcare system RARC had a higher total cost but a shorter length of stay, a lower volume of blood transfusions and a lower percentage complications rates than LRC. The cost analysis presented in this paper showed the superiority of LRC over RARC.