OBJECTIVES: This study aimed to determine the benefits of minimally invasive robotic-assisted surgery (RAS) over conventional laparoscopic surgery (CLS) in two outpatient procedures (cholecystectomy, inguinal hernia repair) and three inpatient (colectomy, gastrectomy, total hysterectomy) procedures.

METHODS: Adult patients undergoing any of these procedures at a U.S. hospital, with an index discharge date between January 1, 2018 and June 30, 2022, were identified using the PINC AI™ Healthcare Database, which represents over one billion patient encounters. Generalized linear model regressions were used to model operating room (OR) procedure time and cost and total cost at index visit, and to calculate adjusted mean predicted index visit clinical and cost outcomes. Mean predicted values were adjusted for gender (except for hysterectomy), age, race, ethnicity, payor, patient comorbidities, number of hospital beds, rural vs. urban setting, U.S. geographic region, and hospital teaching status and 95% CIs were calculated.

RESULTS: 1,343,018 adult patients (13.3% RAS, 86.7% CLS) were included. All outpatient procedures for CLS versus RAS exhibited lower mean predicted index visit total cost, OR cost, and OR time by $1,596 ($1,558-$1,633), $1,082 ($1,059-$1,105), and 17.6 minutes (16.3-18.9), respectively (all p values <.0001). Similarly, all inpatient procedures for CLS versus RAS demonstrated lower mean predicted index visit total cost, OR cost, and OR time, with reductions of $3,664 ($3,593-$3,735), $2,653 ($2,617-$2,689), and 42.7 minutes (40.1-45.2), respectively (all p values <.0001). Of the three inpatient procedures, a modest proportion of CLS colectomy patients experienced postprocedural infections compared to their RAS counterparts.

CONCLUSIONS: The RAS benefits of fewer infections during colectomy may not justify its substantially higher cost across the other four procedures. Despite the growing appeal of RAS, financially constrained hospitals will benefit from investing in or switching to CLS given the higher costs and reduced OR efficiency of RAS, particularly for ambulatory procedures.