News Feed Discussions Interesting article comparing the costs of open, lap or robotic repair

  • Interesting article comparing the costs of open, lap or robotic repair

    Posted by Good intentions on February 1, 2023 at 12:33 pm

    This was published in General Surgery News in June of 2022. I might have already made a Topic about it.

    It’s a little bit dense but it makes a person wonder if all of the new technology being introduced in to the field of hernia repair is really being advanced for the benefit of the patient. I think that hernia repair, due to its high volume, might be considered as the training ground for learning basic surgery techniques. A great place to teach/learn new technologies.

    “Value was defined as quality divided by cost, in which quality (based on recurrence rate) was assumed to be equivalent for each repair, and cost was calculated as both fixed (basic OR equipment [e.g., surgical instruments, laparoscopic systems and robotic systems use and maintenance]) and variable (“materials,” which included supplies used perioperatively; “providers,” which included surgeon and anesthesiologist time; and “overhead,” which included cost per minute of OR time and factors in support staff labor). Cost data were compared among approaches using linear modeling normalized to the open approach. The study involved 100 consecutive patients undergoing each type of operation.

    Taking all costs and considering the revenues associated with each approach, the authors found the laparoscopic inguinal hernia repair had a gross margin 4% higher than the open approach, while the robotic repair’s margin was only 4% of the open repair margin. This led to a final calculation of the value of each minimally invasive repair compared with the open approach as follows: Laparoscopic repairs reduce value by 3%, whereas robotic repairs reduce value by 69%.”

    Good intentions replied 1 year, 2 months ago 3 Members · 3 Replies
  • 3 Replies
  • Good intentions

    February 1, 2023 at 5:23 pm

    Dr. Towfigh, the paper does not say that lap is better than open. It actually ends suggesting that open is the best. But, it’s about economics.

    I was actually thinking of this recently. Where are the lawsuits for Lichtenstein repairs? There don’t seem to be any.

    One person who might have an objective opinion about open mesh versus laparoscopic mesh would be David Chen of the UCLA Lichtenstein Amid Hernia Clinic.

    Here is a recent presentation of his that is very educational in many different ways. He sounds very confident, as we were all taught to be when giving presentations. But if you look at the numbers there is still much work to do. And he does not offer a path to reach the goals he describes. He does offer things to avoid though, like plugs. You can also derive from his presentation that if you decide to get an open repair with mesh you should probably find a well-trained Lichtenstein method surgeon. Not a 10 minutes and done plug surgeon.

    Overall, he is suggesting that open mesh, lap, and robotic are all about the same. He does not promote that lap mesh as better than open. The presentation is worth watching, just for general knowledge.

    It is from 2017 but not much has changed, except for more robotics.

  • William Bryant

    February 1, 2023 at 1:59 pm

    It’s pretty blunt sounding, very cold reducing it to the sort of article box shifters and money makers may write.

    It does sound as though the major benefit is cost reduction not patient comfort and improved outcome.

  • drtowfigh

    February 1, 2023 at 1:59 pm

    Yup. A lot of ways to analyze the pros/cons of robotic inguinal hernia repair.

    It’s certainly never been show to be cost effective purely from the surgery/Hospital utilization standpoint. But it the technology has made it so that more surgeons are offering minimally invasive inguinal hernia repairs, which is a good thing, as the alternative would be an open repair with mesh.

Log in to reply.