Single Institution Robotic vs Laparoscopic Nissen Fundoplication Surgical
Time and Total Operating Time Comparison as a Measure of Cost Analysis
1
BS ,
1
MD ,
1
MD ,
Colin McGuire,
Jorge Uribe,
Lawrence Greenawald,
Francisco Couto,
1
1,
2,3
1
D. Scott Lind, MD , Patricia A. Shewokis, PhD
, Andres Castellanos, MD
1
MD ,
1. Department of Surgery, Drexel University College of Medicine. Philadelphia, PA
2. Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA
3. School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
RESULTS
INTRODUCTION
The current surgical therapy for correcting
gastroesophageal
reflux
disease
is
laparoscopic Nissen fundoplication (LNF).
This surgical method has been standard in the
United States since 1992 (Rothenberg, 2013).
The utilization of robotic Nissen fundoplication
(RNF) has been increasing. However, its role
in the management of gastroesophageal
reflux disease remains unclear. The reason for
this distinction is due to RNF having similar
outcomes as LNF but with a higher cost.
RESULTS
RNF has a lower surgical time compared to
LNF (83 vs 155; p < 0.005), a lower total
operative time (122 vs 219; p < 0.001), lower
surgical cost (1441 vs 2779; p < 0.005), and
lower total operative cost (1723 vs 3671; p <
0.001). The lower operative times are
associated with a surgeon who has passed
the learning curve.
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CONCLUSION
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We hypothesize that refinement of surgical
technique with resultant lower total operative
time for RNF will reduce cost low enough that
RNF will be priced similar to LNF.
DESIGN
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0
0
Robotic (n = 46)
Laparoscopic (n = 9)
Laparoscopic (n = 9)
Figure 1A,B: Comparison of A. median surgical time (min) and B. median total operative time (min)
between robotic and laparoscopic Nissen fundoplication. p < 0.005 for surgical time; p < 0.001 for total
operative time
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A single institution retrospective review of
patients undergoing anti-reflux surgery from
May 2013 to September 2014 was conducted.
Patients were divided into two groups based
on whether they received an RNF (n=46) or
LNF (n=9). RNF cases were conducted by
one surgeon while LNF cases were performed
by two different surgeons. The total surgical
operating time (from incision to closure) and
total operating time (from the moment the
patient enters the operating room to when the
patient leaves the operating room) were
calculated in minutes. Time and costs were
compared between RNF and LNF using a
Mann-Whitney U test for non-parametric
distributions.
Robotic (n = 46)
Ongoing efforts include replicating the study
at other institutions to gain more laparoscopic
and robotic cases. Furthermore, elucidating
the learning curve for RNF and LNF may lend
further insight into the time/cost tradeoff.
Finally, cost must be standardized across
institutions for accurate comparisons.
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We demonstrate that a surgeon’s experience
with RNF can have a large impact on the time
and the cost associated with the surgery. The
greater the surgeon’s experience the shorter
the operative time and the lower the operative
cost.
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REFERENCES
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1000
500
0
0
Robotic (n = 46)
Laparoscopic (n = 9)
Robotic (n = 46)
Laparoscopic (n = 9)
Figure 2A,B: Comparison of A. median surgical cost (USD) and B. median total operative cost (USD)
between robotic and laparoscopic Nissen fundoplication. p < 0.005 for surgical time; p < 0.001 for total
operative time
1. Rothenberg S.S. (2013). Two decades of
experience with laparoscopic Nissen
fundoplication in infants and children: A
critical evaluation of indications, technique
and results. J Laparoendosc Adv Surg Tech
A. 23(9):791-4. Doi: 10.1089/lap.2013.0299