Two strategies to reduce costs of robotic-assisted surgery in benign gynaecological cases: a German model for intraoperative cost minimisation and counteracting the shortage of physicians.

The dissemination of robotic-assisted surgery (RAS) for benign gynaecological conditions may be delayed due to concerns about incremental system and instrument costs, without considering associated potential efficiencies and cost savings. This retrospective, single-centre study aims to analyse the feasibility, safety, and potential intraoperative financial savings of omitting the assisting physician (AP) and the fourth EndoWrist©-arm (FEWA). Consecutive patients are enrolled and stratified in terms of the omission of AP and FEWA. Console time, cut-seam time, theatre-block time, complications, and the duration of hospitalisation are used to prove feasibility and safety. The personnel and material costs are calculated and interpreted via the InEK (Institut für das Entgeltsystem im Krankenhaus) cost matrix of the Diagnosis-Related Group (DRG). The data of 55 consecutive women were analysed. No differences in terms of feasibility or safety were detected (all p values > 0.05). Omitting the AP results in a significant staff cost reduction of €0.84 (19.1%) per operating room minute (p < 0.001). These savings translate into a total amount of €79.12 per procedure (12.5% of personnel costs of €633.47 within the InEK). The omission of the FEWA saves €115.16 per procedure (23.04% of the material costs of €499.63 within the InEK). The omission of AP and FEWA in RAS for benign gynaecological conditions appears feasible without an immediately detectable signal of harm in this small cohort, justifying a larger prospective evaluation. The potential savings in terms of personnel and material costs represent a relevant portion of the provided amount within the InEK and should thereby facilitate the further dissemination of RAS in this field of gynaecology.