Adoption of Robotics in a General Surgery Residency Program: At What Cost?

• Published in: The Journal of surgical research Vol. 213; pp. 269 - 273
• Main Authors: Mehaffey, J. Hunter, MD, Michaels, Alex D., MD, Mullen, Matthew G., MD, Yount, Kenan W., MD, MBA, Meneveau, Max O, Smith, Philip W., MD, Friel, Charles M., MD, Schirmer, Bruce D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Cholecystectomy - economics; Cholecystectomy - education; Cholecystectomy - methods; General Surgery - economics; General Surgery - education; Health care cost; Hernia, Abdominal - economics; Hernia, Abdominal - surgery; Herniorrhaphy - economics; Herniorrhaphy - education; Herniorrhaphy - methods; Hospital Costs - statistics & numerical data; Humans; Internship and Residency - economics; Laparoscopy - economics; Laparoscopy - education; Linear Models; Operative Time; Opportunity cost; Resident training; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - economics; Robotic Surgical Procedures - education; Surgery; Virginia; Robotic surgery; Opportunity cost; Resident training; Health care cost
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.02.052

Abstract Background Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. Methods All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. Results We identified 2,260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases, but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887) and VHR (+$1,124) as well as substantial associated fixed costs. Conclusions Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program.