Laparoscopic vs. robotic-assisted antireflux surgery: a matched cohort analysis of procedure costs and outcomes

Abstract Background The use of robotic surgery has expanded rapidly; however, its cost-effectiveness in foregut surgery remains unclear. We aimed to compare early postoperative outcomes and procedure-related costs between robotic (R-) and laparoscopic (L-) antireflux surgery (ARS). Methods This retrospective cohort and cost-effectiveness study was conducted using a prospectively maintained database of adults who underwent minimally invasive ARS by a single experienced esophageal surgeon. All primary elective R-ARS cases (September 2016–December 2024) were identified, and perioperative outcomes and procedure costs (US) were compared to a 1: 1 propensity-score matched L-ARS cohort. Moreover, incremental cost-effectiveness ratios (ICERs) were calculated for predefined outcomes. Results In total, 138 patients (69 R-ARS, 69 L-ARS) were included. R-ARS was associated with a longer median operating room utilization time (169 vs 128 min. , p 0. 999), and 90-day readmissions (R-ARS, 6. 1% vs. L-ARS, 3. 3%, p = 0. 749) were similar between the groups. The median all-inclusive cost was higher with R-ARS (15, 676. 1 vs. 7694. 9, p < 0. 001). Although the incidence of patient-reported postoperative dysphagia was similar after R-ARS or L-ARS (26. 1 vs. 30. 4%, p = 0. 705), resulting endoscopic interventions were more frequent after R-ARS (16/18 88. 9% vs. 9/21 42. 9%, p = 0. 008). The ICERs for intraoperative complications and 90-day readmissions were –181, 390. 9 (favoring L-ARS) and 285, 042. 9 (favoring R-ARS), respectively. Conclusion Overall, R-ARS may not offer superior short-term safety compared to L-ARS, utilizes greater resources, and appears to be less cost-effective.