Cost Analysis of Pediatric Robot-Assisted and Laparoscopic Pyeloplasty

Purpose: An increasing percentage of pediatric pyeloplasties are being performed with assistance of the da Vinci (R) Surgical System. A review of the recent literature shows decreased operative times and length of hospital stays when robotic procedures are performed, although there are few published data comparing the cost of pediatric robotic and pure laparoscopic pyeloplasty. We reviewed a representative sample of pyeloplasties performed at our institution and performed a cost analysis. Materials and Methods: We retrospectively identified 23 robot-assisted and 23 laparoscopic pyeloplasties performed at our institution between August 2008 and April 2012. Total cost was calculated from direct and indirect costs provided by our billing department. Results: Robotic procedures were shorter than pure laparoscopic procedures (200 vs 265 minutes, p < 0.001) but there was no significant difference in the total cost of the 2 procedures ($15,337 vs $16,067, p < 0.46). When compared to laparoscopic cases, subgroup analysis demonstrated decreased operative times (140 vs 265 minutes, p < 0.00001) and total cost ($11,949 vs $16,067, p < 0.0001) in robotic cases where stents were placed in an antegrade fashion. Conclusions: With widespread use the cost of robotic instrumentation may decrease, and experience may further shorten operative times. However, it currently remains to be seen whether robotic technology will become a cost-effective replacement for pure laparoscopy in the management of pediatric ureteropelvic junction obstruction.