Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 28; no. 4; pp. 1205 - 1214
• Main Authors: Hinojosa-Ramirez, F., Tallon-Aguilar, L., Tinoco-Gonzalez, J., Sanchez-Arteaga, A., Aguilar-Del Castillo, F., Alarcon-Del Agua, I., Morales-Conde, S.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.08.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Costs; Economic analysis; Female; Health care; Hernia; Hernia, Inguinal - economics; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - economics; Herniorrhaphy - methods; Humans; Laparoscopy; Laparoscopy - economics; Laparoscopy - methods; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Observational learning; Operative Time; Original; Original Article; Patients; Postoperative Complications - economics; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - economics; Robotics; Cost-analysis; Inguinal hernia; Robotic approach; Laparoscopic approach; Cost-effective
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-024-03006-y

Introduction There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). Materials and methods A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. Results A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p  < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p  < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p  < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p  < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. Conclusions The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.