[机器人与腹腔镜右半结肠切除术--成本分析]。

Chirurgie (Heidelberg, Germany) Pub Date : 2024-08-01 Epub Date: 2024-05-16 DOI:10.1007/s00104-024-02077-y
M Wittmann, M Vladimirov, M Renz, L Thumfart, L Giulini, A Dubecz
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摘要

使用机器人手术方法进行右侧半结肠切除术一直存在一定争议,主要是出于对成本的担忧。本研究的目的是记录我院最初开展的机器人右半结肠切除术,并将其与腹腔镜参照组进行比较。本研究的一个重点是详细分析这两种技术在德国医疗系统中的相关成本。我们比较了纽伦堡医院进行的机器人和腹腔镜右侧半结肠切除术各 34 例的手术和成本相关数据。这项比较是通过回顾性单中心病例匹配分析进行的。患者群的平均年龄为70岁,男性患者比例为57.4%。对围手术期参数的分析表明,两种手术技术的结果相似。在Clavien-Dindo III-V期并发症的发生率方面(8.8% vs. 17.6%; p = 0.48),机器人手术呈现出积极的趋势。成本分析显示,两组选定病例的总成本几乎相同(平均 13,423 欧元对 13,424 欧元;p = 1.00),其中手术(操作)成本差异最大(5,779 欧元对 3,521 欧元;p = 1.00)。
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[Robotic vs. laparoscopic right hemicolectomy-An analysis of costs].

The use of robotic surgical methods for performing right-sided hemicolectomy has been somewhat controversial, primarily due to concerns related to costs. The purpose of this study is to document the initial robotic right hemicolectomies conducted at our institution and to compare them with a laparoscopic reference group. A significant focus of this study is the detailed analysis of the costs associated with both techniques within the German healthcare system.Surgical and cost-related data for 34 cases each for robotic and laparoscopic right-sided hemicolectomy performed at Nürnberg Hospital were compared. This comparison was conducted through a retrospective single-center case-matched analysis. Cost analysis was carried out following the current guidelines provided by the Institute for the Hospital Remuneration System (InEK) of Germany.The average age of the patient cohort was 70 years, with a male patient proportion of 57.4%. Analysis of perioperative parameters indicated similar outcomes for both surgical techniques. Regarding the incidence of complications of Clavien-Dindo stages III-V (8.8% vs. 17.6%; p = 0.48), a positive trend towards robotic surgery was observed. The cost analysis showed nearly identical total costs for the selected cases in both groups (mean €13,423 vs. €13,424; p = 1.00), with the most significant cost difference noted in surgical (operative) costs (€5,779 vs. €3,521; p < 0.01). The lower costs for laparoscopic cases were primarily due to the reduced material costs (mean €2,657 vs. €702; p < 0.05).In conclusion, both surgical approaches are clinically equivalent, with only minor differences in the total case costs.

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