Introduction of robotic surgery for endometrial cancer is associated with lower bill sizes: The experience of a tertiary oncological centre in Singapore

Objective: In this exploratory study, we aim to present the effects of a shift in the standard of care from open to robotic surgery in endometrial cancer in the single largest series in Singapore, on total hospital bill size. Methods: We retrospectively collected de-identified data from January 2008 to December 2017, consisting of all open and robotic surgeries performed for endometrial cancer in a tertiary oncology centre in Singapore. The data collected consisted of the number of open and robotic cases done per annum, and the average bill size incurred by patients for both routes of surgery. We analyzed the trend of the data over 10 years. Results: There was a steady increase in the number of robotic hysterectomies performed over 10 years, from six robotic cases in 2008 (13.6%), to 41 cases in 2017 (60.2%). The number of open cases performed for endometrial cancers decreased from 38 cases (86.4%) to 27 cases in 2017 (39.7%). The total bill size decreased, from an average of SGD 15809.05 in 2012 to SGD 12891.00 in 2017. Conversely, the total bill size of open surgery rose from an average of SGD 13804.36 in 2012 to SGD 16243.43 in 2017. Conclusion: This pilot data suggests that with the increase in uptake of robotic surgery for endometrial cancer, there was significant decrease in total bill size for patients who underwent robotic surgery.