Endo-cost: efficient economic model of adopting robotic versus laparoscopic gynecological surgery for endometrial cancer

Abstract

This retrospective cost-analysis study evaluated and compared the economic and clinical outcomes of laparoscopic versus robotic surgery in the treatment of endometrial cancer at the University and Polytechnic La Fe Hospital in Valencia, Spain. The analysis included 153 patients who underwent surgery between January 2022 and December 2024. Robotic surgery resulted in a shorter average hospital stay (1.12 vs. 1.7 days; p < 0.05) compared to laparoscopy, but was associated with significantly higher costs in both consumables (€1985 vs. €1197; p < 0.001) and fixed amortization (€2000 vs. €140; p < 0.001) and total cost per procedure (€4698 vs. €7052 ± 816; p < 0.001). No significant differences were observed in surgical time or postoperative complications. A theoretical cost model based on the high procedural volume (three robotic surgeries per day, 7920 total over ten years) still showed laparoscopy to be more cost-effective overall (€4596 vs. €5431 per procedure; p < 0.001). However, robotic surgery could become economically competitive with a 15% reduction in equipment costs and a 30% decrease in consumable expenses, provided at least two procedures are performed daily. Ultimately, although laparoscopy remains more cost-efficient under typical conditions, robotic surgery offers potential economic viability under optimized circumstances, supporting its consideration as a sustainable option in high-volume centers managing endometrial cancer.