Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Pulmonary segmentectomy using robotic assistance is often perceived as being more expensive than segmentectomy using video-assisted thoracic surgery. The robotic technique allows for meticulous dissection during segmentectomy, potentially leading to fewer parenchymal injuries, fewer air leaks, and shorter length of stay. This study compared pulmonary segmentectomy costs using video-assisted thoracic surgery versus robotic with manual staplers versus robotic with robotic staplers. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Retrospective analyses were performed evaluating our early experience with robotic pulmonary segmentectomy for 30 months compared with the video-assisted thoracic surgery approach. All 50 anatomical segmentectomies performed since introduction of robotic technique in the practice were included. Twenty-eight procedures were robotic-assisted and 22 were video-assisted thoracic surgery. Procedure-specific evaluation of direct costs was performed, including cost of robotic instruments, staplers, and average length of stay in the hospital. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The mean ± SD age was 70 ± 10 years (range = 43–91 years). There were 12 males in the robotic group and eight in the video-assisted thoracic surgery group ( P = 0.642). The mean age was 69 years in the robotic group and 71 years in the video-assisted thoracic surgery group ( P = 0.367). The median length of stay was 2 (2–4) days in the robotic group (range = 1–9) and 4 (2–5) days in the video-assisted thoracic surgery group (range = 1–20, P = 0.089). The cost of robotic segmentectomy with manual staplers was less than that with robotic staplers. Both robotic techniques cost less than video-assisted thoracic surgery. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In this small series, cost and outcomes in our early experience with robotic-assisted segmentectomy were comparable with our video-assisted thoracic surgery approach with trends toward shorter length of stay and fewer complications. Larger series are needed to validate these results. </jats:p></jats:sec>

Overview of the outcomes of robotic segmentectomy and lobectomy

“…In a nation in which reimbursements are provided by a national healthcare system and based on Disease Related Group (DRG), the higher costs of robotic approach still allowed a profit margin of 18% (56). A retrospective analysis of 50 segmentectomies even found out a reduction in overall costs for this procedure (3650$ for RATS versus 4850$ for VATS) thank to a shorter LOS and the use of manual stapler instead of the more expensive robotic one (57).…”

Robotic segmentectomy S7 + S8 with the use of indocyanine green (ICG): technical details

“…RATS is superior to VATS in terms of 3D visualization, ergonomics for the operator, maneuverability of instruments, tremor filtering and learning curve (15) (16). On the other side, initial cost of the Da Vinci surgical system is the main limitation to the widespreading of the robotic-aided segmentectomy, even if the cost-per-patient is inferior mainly due to a shorter inhospital stay (5,17). In the next years, this limitation will be probably overcome by the introduction in the market of robotic surgical system manufactured by other companies.…”

“…Robot-assisted thoracic surgery (RATS) can overcome these limitations thank to 3-dimensional (3D) visualization, shorter learning curve and better dexterity with same outcome and complications rate as compared to VATS (4). Moreover, RATS allow a shorter length of stay with even a cost-saving balance for the Institute (5). Intraoperative administration of ICG can also improve the visualization of intersegmental plane, reducing the inter-operator variability and increasing the safe margin (6).…”

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

“…41 Despite the success of robotic thoracic surgery, costs remain higher than for VATS, except in the study of Musgrove et al where robotic and VATS segmentectomy had similar costs, with a trend to shorter length of stay and fewer complications in VATS cases. [42][43][44] In more than 1600 propensity-matched cases, conversions and postoperative complications were fewer in robotic than VATS cases after excluding learning-curve robotic cases. 45 Conversion from minimally invasive to open surgery may not increase postoperative morbidity or mortality risk.…”