da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

2015 ◽  
Vol 96 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Christina Niklas ◽  
Matthias Saar ◽  
Britta Berg ◽  
Katrin Steiner ◽  
Martin Janssen ◽  
...  
Keyword(s):  
Health Insurance ◽  
Radical Prostatectomy ◽  
Clinical Outcomes ◽  
Open Surgery ◽  
Research Database ◽  
Robotic Assisted ◽  
Open Radical Prostatectomy ◽  
Insurance Costs ◽  
Study Results ◽  
Robotic Assisted Radical Prostatectomy

Purpose: To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. Methods: Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. Results: Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). Conclusions: The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.

Robotic-Assisted Laparoscopic Prostatectomy: Do Minimally Invasive Approaches Offer Significant Advantages?

2005 ◽  
Vol 23 (32) ◽  
pp. 8170-8175 ◽  
Author(s):  
Joseph A. Smith ◽  
S. Duke Herrell
Keyword(s):  
Radical Prostatectomy ◽  
Open Surgery ◽  
Radical Retropubic Prostatectomy ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Retropubic Prostatectomy ◽  
Experienced Surgeon ◽  
Open Radical Prostatectomy ◽  
Postoperative Continence ◽  
Invasive Surgical Approach

Radical prostatectomy has maintained a cardinal role in the treatment of localized prostate cancer. Robotic-assisted laparoscopic prostatectomy (RALP) has been introduced as a less invasive surgical approach. Available data on RALP versus open approaches were reviewed for surgical and cancer related outcomes. RALP is consistently associated with decreased blood loss and limited postoperative pain and hospital stay. Surgical margins seem similar between most reported series of RALP or open radical prostatectomy. Most intrainstitutional comparisons demonstrate better postoperative continence and potency with RALP, but there is still debate about whether results are superior to radical retropubic prostatectomy in the hands of a highly experienced surgeon. RALP provides outcomes at least comparable, and, in some measures, superior to open surgery. Refinements of instrumentation may provide even better results in the future.

scholarly journals P105 Robosurgeons vs. robosceptics’: can we afford robotic technology or can we afford not to?

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jasmesh Sandhu ◽  
Jasmesh Sandhu
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
High Volume ◽  
Robotic Prostatectomy ◽  
Robotic Technology ◽  
Robotic Training ◽  
Robotic Assisted ◽  
Open Radical Prostatectomy ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Cost

Abstract Aim To investigate the cost-effectiveness of robotic technology in robotic-assisted radical prostatectomy in comparison with laparoscopic radical prostatectomy and open radical prostatectomy. Methods The British Association of Urology Surgeons database (2014–2016) and Cancer Research UK (2012–2014) were accessed in conjunction with media; keywords included: ‘Da Vinci’, ‘first robotic prostatectomy’, ‘hospital’ to estimate the cost-effectiveness of robotic-assisted radical prostatectomy in the National Health Service. Results Approximately 12/43 (27.9%) centres achieved 150 robotic-assisted radical prostatectomies per year while 26/43 (60.4%) centres have managed to meet 100 robotic-assisted radical prostatectomies per year in 2014–2016. A national mean of 120–130 robotic-assisted radical prostatectomies per year for 2014–2016 was estimated. Conclusion The cost of robotic-assisted radical prostatectomy is adequately justified if a high volume of surgeries (&gt;150) are performed in high volume centres by high volume experienced surgeons per year. This can be achieved by subsidising the cost of robotic technology, centralisation and establishing robotic training centres.

scholarly journals Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

ISRN Urology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-22 ◽  
Author(s):  
Douglas W. Skarecky
Keyword(s):  
Radical Prostatectomy ◽  
Report Cards ◽  
Life Outcomes ◽  
New Paradigm ◽  
Short Term ◽  
Robotic Assisted ◽  
Open Radical Prostatectomy ◽  
Robotic Assisted Radical Prostatectomy

Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical “canvas” for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old “gold standard” surgery.

1082: Learning Curve for Robotic-Assisted Radical Prostatectomy: Comparison between an open and Laparoscopic Trained Surgeon

2006 ◽  
Vol 175 (4S) ◽  
pp. 348-348
Author(s):  
Edward M. Gong ◽  
Albert A. Mikhail ◽  
Alvaro Lucioni ◽  
Marcelo A. Orvieto ◽  
Arieh L. Shalhav ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Robotic Assisted ◽  
Robotic Assisted Radical Prostatectomy

145: Urinary Function Quality of Life After Laparoscopic or Robotic Assisted Radical Prostatectomy

2004 ◽  
Vol 171 (4S) ◽  
pp. 38-38
Author(s):  
Laura E. Crocitto ◽  
Timothy Wilson ◽  
Jeffrey S. Yoshida ◽  
Soroush A. Ramin ◽  
Mark H. Kawachi
Keyword(s):  
Quality Of Life ◽  
Radical Prostatectomy ◽  
Urinary Function ◽  
Robotic Assisted ◽  
Robotic Assisted Radical Prostatectomy

scholarly journals 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Nathan ◽  
N Hanna ◽  
A Rashid ◽  
S Patel ◽  
Y Phuah ◽  
...  
Keyword(s):  
Blood Test ◽  
Open Surgery ◽  
Clinical Judgement ◽  
Robotic Assisted ◽  
Blood Tests ◽  
Routine Blood ◽  
Operative Complications ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Uk ◽  
Post Operative Complications

Abstract Introduction Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines. Method 1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients. Results 16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion. Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%). Conclusions Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.

Sign in / Sign up

Export Citation Format

Share Document