Dingemann, J., J. F. Kuebler, et al. (2011). “Laparoscopic and computer-assisted surgery in children.” Scandinavian Journal of Surgery 100(4): 236-242.
Marhuenda, C., C. Giné, et al. (2011). “[Robotic surgery: first pediatric series in Spain].” Cirugía robótica: primera serie pediátrica en España. 24(2): 90-92.
Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to robotic laparoscopy. Retrospective review of all the pediatric laparoscopic surgery assisted by the da Vinci robot (Intuitive Surgical), in our center, between April 2009 and February 2010. 8 patients were operated (7-15 years), with an average weight of 42 Kg (18 to 83 Kg). 11 procedures were performed: bilateral salpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4), splenectomy (2), resection of pancreatic mass (1), fundoplication (1), adrenalectomy (1). All proceedings, except two, were completed with the robot. As complications, there was one intraoperative bleeding that required blood transfusion, and in the postoperative period, there was a surgical wound infection. There were no conversions to open surgery. The average time of preparation before surgery was 130 minutes. The three-dimensional vision and lack of tremor are the main advantages cited by all surgeons. The learning curve of Robotic Surgery is shorter than that of conventional laparoscopy. Trained surgeons can perform complex procedures laparoscopically from the outset. The main difficulty in children is the proper planning of trocar placement, due to the smaller size of the surgical field. The organization of surgery is complex and success depends on close collaboration of all stakeholders.
Rowe, C. K., M. W. Pierce, et al. (2012). “A Comparative Direct Cost Analysis of Pediatric Urologic Robot-Assisted Laparoscopic Surgery vs. Open Surgery: Could Robotic Surgery be Less Expensive?” Journal of Endourology.
Purpose: Cost in health care is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(R) surgical robot. As equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery. Materials and Methods: We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures. Results: Robot-assisted surgery direct costs were 11.9% (p = 0.03) lower than open surgery. This cost difference was due primarily to the difference in hospital length of stay between patients undergoing open vs. robotic surgery (3.8 vs. 1.6 days, p < 0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robotic purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates. Conclusions: Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robotic surgery costs included: a consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.