As surgeons have just started to report their experiences as proficient robotic surgeons compared to all of the ‘initial Y 27632 experience with robot’ papers, the operative times numbers are going to be dramatically different and of course that is going to affect the cost. Based on insurance reimbursement, costs cannot be correlated to charges. Certainly, it would be more effective if ultimate costs were analyzed; however, it is extremely difficult to analyze direct and indirect costs. For this reason, one could argue that a cost-effectiveness model, including a specific cut-off point at which volume justifies investment and docking speed leads

to equivalent costs with laparoscopy, could offer more information in the hospital systems across the world. From our literature search, robotic procedures cost more than laparoscopic and open procedures; however, it seems that when the initial cost for robotic acquisition is ignored, then robotic procedures are the Olaparib in vitro most cost-effective approach. It has already been shown that the cost-effectiveness could be explained by three different models: the societal perspective model,

the hospital perspective plus robot costs and the model with exclusion of robotic acquisition cost.[41] In general, we conclude that the cost of robotic procedures could be lowered by counting the lost wages and the caregiver costs, as well as by decreasing the cost of disposable equipment, operating room supplies, docking time, theatre time and recovery time. However, due to the heterogeneity of the studies and the lack of all the above information in several studies, safe conclusions could 6-phosphogluconolactonase not be reported in our opinion by cost-effectiveness models that include studies from the initial phase of robotic use in gynecology, as well as newer studies, including operations

performed by most well-trained surgical teams. Furthermore, there are not yet studies that present long-term outcomes in order to have a real cost-effective analysis, including quality-adjusted life-years gained. In addition, in the retrieved studies, there is no clarification between the clinical outcomes among experienced surgeons and trainees. Costs of readmission are difficult to assess and insert into our analysis. Last but not least, the cost is different in diverse types of operations as well as the cost of surgical time, while in order to maintain uniformity in the charges due to different currencies, all costs were converted into Euros. As far as our search strategy, which was previously defined, it could be considered limited due to the exclusion of abstracts, reviews, short surveys, commentaries and editorials. The application of robotics in the field of gynecologic surgery is an innovation that has had an important impact on the surgical treatment of several pathologies.