Economic Cost and Value in Robotic Liver Surgery

There has been a global increase in the uptake of minimally invasive techniques in the field of liver surgery in recent decades, and many studies have demonstrated that both laparoscopic and robotic approaches are safe, feasible and associated with short-term advantages compared to open liver resection (OLR) [1–5]. The potential advantages of robotic over laparoscopic surgery are currently under investigation and the topic of several retrospective studies [6–10], although there is currently a lack of prospective data. There is emerging data to indicate that robotic liver resection (RLR) may increase the feasibility of a minimally invasive approach for technically difficult resections in comparison with laparoscopic liver resection (LLR), potentially by shortening the learning curve and reducing the rate of conversion to open surgery [10–12]. Implementation and widespread adoption of RLR programmes have been hindered by high capital and procedural costs of surgical robots, particularly in low-middle income countries, combined with a lack of robust evidence of a benefit over LLR. Estimation of the economic cost of a new surgical procedure, such as RLR, is highly complex and influenced by various factors including capital expenditure, cost of disposable instruments, operating room and hospital resources and postoperative patient outcomes. At the time of writing, several companies have launched novel surgical robots, and market forces are likely to significantly improve the cost-effectiveness of robotic procedures in the near future. In this chapter we provide a comprehensive overview of the current literature focusing on the economic costs and value of robotic liver resection compared to open and laparoscopic approaches.