Comparative study of operative expenses: robotic vs. laparoscopic vs. open liver resections at a university hospital in the UK

Robotic liver resections (RLR) are increasingly being performed and has previously been considered more costly. The aim is to explore the cost of RLR compared with laparoscopic and open liver resection in a single National Health Service (NHS) hospital. A retrospective review of patients who underwent RLR, LLR, and OLR from April 2014 to December 2022 was conducted. The primary outcomes were the cost of consumables and median income, and the secondary outcomes were the overall length of stay and mortality at 90 days. Overall, 332 patients underwent liver resections. There were 204 males (61.4%) and 128 females (38.6%), with a median age of 62 years (IQR: 51-77 years). Of these, 60 patients (18.1%) underwent RLR, 21 patients (6.3%) underwent LLR, and 251 patients (75.6%) underwent OLR. Median consumables cost per case was 3863 pound (IQR: 3458- pound 5061) pound for RLR, 4326 pound (IQR: 4273- pound 4473) pound for LLR, and 4,084 pound (IQR: 3799- pound 5549) pound for the OLR cohort (p = 0.140). Median income per case was 7999 pound (IQR: 4509- pound 10,777) pound for RLR, 7497 pound (IQR: 2407- pound 14,576) pound for LLR, and 7493 pound (IQR: 2542- pound 14,121) pound for OLR. The median length of stay (LOS) for RLR was 3 days (IQR: 2-4.7 days) compared to 5 days for LLR (IQR: 4.5-7 days) and 6 days for OLR (IQR: 5-8 days, p < 0.001). Within the NHS, RLR has consumable costs comparable to OLR and LLR. It is also linked with a shorter LOS and generates similar income for patients undergoing OLR and LLR.