Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

Giuseppe Turchetti (Lead / Corresponding author), Francesca Pierotti, Ilaria Palla, Stefania Manetti, Cinzia Freschi, Vincenzo Ferrari, Alfred Cuschieri

    Research output: Contribution to journalArticlepeer-review

    17 Citations (Scopus)
    258 Downloads (Pure)


    Background: Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA).

    Methods: The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches.

    Results: The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge.

    Conclusions: The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

    Original languageEnglish
    Pages (from-to)543-551
    Number of pages9
    JournalSurgical Endoscopy
    Issue number2
    Early online date17 Jun 2016
    Publication statusPublished - Feb 2017


    • Health technology assessment
    • Robotic surgery
    • da Vinci
    • Economic evaluation in health care
    • Economics of innovation


    Dive into the research topics of 'Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study'. Together they form a unique fingerprint.

    Cite this