Cost analysis of robot NICE procedure versus open, laparoscopic, and robotic colorectal surgery: is there an economic benefit to natural orifice resection?

Background: The robotic NICE procedure (Natural Orifice IntraCorporeal Anastomosis with Transrectal Extraction) has emerged as an innovative approach for left-sided colorectal resections. In this procedure, specimen extraction and completion of anastomosis are performed without abdominal wall incision, improving patient outcomes and potentially reducing healthcare costs.

Objective: This study aims to evaluate the cost-effectiveness of the robotic NICE procedure compared to open, laparoscopic, and robotic surgical approaches for left-sided colorectal resections.

Methods: This retrospective cohort study analyzed 351 patients who underwent elective, non-emergent left-sided colorectal resections between January 2018 and August 2021. Patients were grouped by surgical approach: open, laparoscopic, robotic, and robotic NICE. Generalized linear models were used to assess factors influencing direct and total costs.

Results: Among 351 patients, the robotic NICE procedure was associated with the lowest costs. The median direct cost for NICE was $9,946, which was significantly lower than laparoscopic ($16,389), robotic ($14,473), and open surgery ($10,427). The median total cost was also the lowest, at $22,263, compared to laparoscopic ($29,324), robotic ($32,908), and open surgery ($22,915). In adjusted analysis, compared to laparoscopic surgery, the NICE approach resulted in $5,736 in reduced direct costs and $6,393 in total costs, representing the largest cost savings across all comparisons. Patients with complications incurred an additional $4,519 in direct costs and $10,851 in total costs. Higher ASA grade increased direct costs by $1,976 and total costs by $4,242.

Conclusion: The robotic NICE procedure shows potential cost benefits by reducing direct expenses and improving patient outcomes. However, these findings should be interpreted cautiously, as institutional efficiencies and surgical expertise may influence cost differences.