Cost Comparison: Robotic Thyroidectomy versus Standard Open Thyroidectomy

The use of a robotic system such as the da Vinci^® Surgical System (Intuitive Surgical, Inc.) has grown in the years since its creation. Surgical fields utilizing a robotic system include urology, gynecology, cardiac surgery, and general surgery. Recently, according to researchers, “The robotic revolution has extended to the treatment of thyroid disease.” Robotic thyroidectomy (RT) has been shown to be safe and effective in removing a range of pathologic conditions of the thyroid.

According to the researchers, the only benefit of RT seems to be the cosmetic effect of moving the incision. Noting “robotic thyroidectomy has not demonstrated superiority in any comparison with standard open thyroidectomy (ST) for length of procedure, complication rates, or oncology outcome,” researchers recently conducted a retrospective cost analysis to determine the cost differences between ST performed by 2 high-volume endocrine surgeons compared with the calculated costs using published variables from high-volume RT surgeons. Results of the analysis were reported in Archives of Surgery [2012;147(12):1102-1106].

The study was conducted in the endocrine surgery division at an academic center. The researchers identified ST at the center using Current Procedural Technology^® code 60240. The RT cost was estimated as operative time plus anesthesia fees plus consumables plus the robotic system. Institution-specific data were collected; researchers included only the costs that varied between ST and RT in the analysis.

Mean operative times for ST from skin incision to skin closure were 103 minutes for surgeon 1 and 123 minutes for surgeon 2. Mean costs for ST were $2503 for surgeon 1 (operative time, $513; anesthesia, $1378; consumables, $612) and $2832 for surgeon 2 (operative time, $630; anesthesia, $1590; consumables, $612); mean cost between the 2 surgeons was $2668.

For RT, mean operative times from skin incision to skin closure in 2 large published series were 129 minutes and 144 minutes. The same calculations and assumptions as those for ST were used to determine the cost of the operative time and the anesthesia fees. Consumables that would differ from those for ST are the robot-use harmonic scalpel, a 12-mm bladeless trocar used in the case, special drapes to cover the robotic arms, each robotic arm (defrayed over the 10 uses allowed per arm), and a special retractor described for creation and maintenance of the operative space. The cost of the robot was estimated at $1.5 million; the relative cost of the robot per case was $1703.

Mean costs for a short case were $630 for operative time, $1590 for anesthesia, $1819 for consumables, and $1703 for the robotic system (total cost, $5742). Mean costs for a long case were $630 for operative time, $1696 for anesthesia, $1819 for consumables, and $1703 for the robotic system (total cost, $5848); mean cost for both cases was $5795.

In conclusion, the researchers said, “Technologic advances are paramount in providing the best medical care for patients. This progress must be tempered by a rational, open discussion about the costs of these advancements. Only then can the proposed benefits of a new technology be weighed accurately against the overall societal costs. Surgeons need to be aware of the cost of their technologic choices and the burdens that those place on limited resources.”