Page 27 - Read Online

Ziogas et al. Mini-invasive Surg 2020;4:69 I http://dx.doi.org/10.20517/2574-1225.2020.63 Page 7 of 11

ECONOMIC COST
Mejia et al. reported that the adjusted room and board charges were significantly lower in the LMH vs.
[46]
the RMH group, with no other difference between the two groups regarding economic cost. Of note, when
comparing the cost of LMH vs. RMH, the fixed capital cost ($1,000,000-$2,600,000 for a robotic system
[120]
with a 10-year longevity period) [117-120] and annual maintenance cost ($90,000-$175,000) for a hospital to
purchase and maintain a surgical robot, should also be taken into consideration. The addition of this cost
can be burdensome, particularly for low-volume liver surgery centers, and this remains a significant driving
factor for the slow spread of RMH and robotic liver surgery in general. It should also be noted that access
to the robot in the operating room can be a challenge due to competition with other surgical service lines.

CONCLUSION
The introduction of laparoscopy and robotic surgical systems in liver surgery has significantly changed the
current state of practice. Although both approaches have been more widely tested for minor liver resections,
the number of LMHs and RMHs performed worldwide has significantly increased over recent years, and
is still on the rise. Although there is a considerable deviation in outcomes after RMH, especially during
early experience, when RMH is performed by experienced surgeons in high-volume liver centers, it can be
associated with equivalent operating time, EBL, LOS, morbidity and mortality, and comparable oncologic
outcomes in terms of achieving a margin-negative resection and long-term overall survival. The fixed capital
and annual maintenance costs for the robotic surgical system may pose a significant obstacle in the broader
adoption of RMH, particularly in low-volume centers.

DECLARATIONS
Authors’ contributions
Study concept, data acquisition, data analysis and interpretation, drafting, critical revision, final approval of
the manuscript: Ziogas IA, Tohme S, Geller DA

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg 2009;250:831-41.
2. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative short-term benefits of laparoscopic liver resection: 9000 cases
and climbing. Ann Surg 2016;263:761-77.
3. Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol 1991;78:956-8.