Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis

Background Following the Food and Drug Administration approval, robot-assisted colorectal surgery has gained more acceptance among surgeons. One of the open issues about robotic surgery is the economic sustainability. The aim of our study is to evaluate the economic sustainability of robotic as compared to laparoscopic right colectomy for the Italian National Health System. Methods We performed a retrospective multicentre case-matched study including 94 patients for each group from four different Italian surgical departments. An economic evaluation gathered from a real-world data was performed to assess the sustainability of the robotic approach for right colectomy in the Italian National Health System. In particular, a differential cost analysis between the two procedures was performed. Results No statistical differences were found between the two groups for postoperative outcomes. After a careful review of the literature on the cost assessment for the operative room, medical devices and hospital stay according with our data, we estimated the followings: (a) the mean operative room cost for robotic group was 2179 +/- 476 euro vs. 1376 +/- 322 euro for laparoscopic group; (b) the mean hospital stay cost for robotic group was 3143 +/- 1435 euro vs. 3292 +/- 1123 euro for laparoscopic group; and (c) the mean cost for instruments was 6280 euro for robotic group vs. 1504 euro for laparoscopic group. The total mean cost of robotic right colectomy was 11,576 +/- 1915 euro vs. 6196 +/- 1444 euro for laparoscopic right colectomy. Conclusion In conclusion, to date, robotic right colectomy with intracorporeal anastomosis does not provide any significant clinical advantages, which may justify the additional costs, as compared to its laparoscopic counterpart. Further evolution of robotic technology and experience may lead to a reduction of costs, especially if the robotic platform is used in an appropriate healthcare setting.