Daily cost-efficiency of robotic liver resection over laparoscopic and open liver resection especially for complex liver resection procedures: An inverse probability of treatment weighting analysis

To address our hypothesis that increased surgical costs for robotic liver resection would be compensated by reduced postoperative care expenses, we compared the economic outcomes of robotic, laparoscopic, and open liver resection under the Japanese national health insurance system. Patients who underwent liver resection between 2022 and 2024 were included in this study. The perioperative and economic outcomes were compared among the patients who underwent robotic, laparoscopic, and open liver resection using inverse probability of treatment weighting. Subgroup analyses were conducted for single partial resection, mono-segmentectomy, and the resection of two contiguous sections. Of 402 patients, 302 met the inclusion criteria: robotic (n = 45), laparoscopic (n = 75), and open (n = 182). The hospital revenue per admission did not differ significantly among the three groups (P = 0.427). The overall hospital profit per day was significantly higher in the robotic group than in the laparoscopic and open groups (P < 0.001). The hospital profit per day was more favorable in patients undergoing robotic liver resection for mono-segmentectomy than in those undergoing laparoscopic and open liver resection, and for the resection of two contiguous sections than for open liver resection. Although the hospital revenue and profit per admission did not differ significantly among the groups, robotic LRR may offer economic advantages regarding hospital profit per day.