The cost and quality of life outcomes in developing a robotic lobectomy program

Abstract

The use of the robotic platform is increasingly being utilized for lung resections. Our aim was to compare outcomes of thoracoscopic (VATS) versus robotic-assisted thoracoscopic (RATS) lobectomy early in a program's adoption of robotic surgery, including perioperative outcomes, cost, and long-term quality of life. A prospective database was retrospectively reviewed for all patients undergoing minimally invasive lobectomy by either VATS or RATS techniques from 2010 to 2012. Patients' operative, post-operative complications, cost (operating room and hospital) and quality of life were compared between the two resection techniques. Long-term follow-up including assessment using the European Organization for Research and Treatment of Cancer quality of life questionnaire was documented. During the first 25 RATS lobectomies, there were 73 VATS lobectomies performed, for a total of 98 cases. There was no significant difference in cancer stage, operative time, estimated blood loss, lymph node count, or hospital length of stay. The RATS resections had significantly higher operative and total hospital cost (p < 0.0001 and p < 0.05). At a median of 65-month follow-up, 29 patients (9 robotic; 20 VATS) completed the EORTC questionnaire. The global health status and symptom scale median scores were similar to the general population and did not significantly differ between groups. While transitioning from thoracoscopic to robotic lobectomy incurs increased operative and total hospital cost, equivalent operative outcomes, length of hospitalization, and long-term quality of life can be maintained during this transition. With increasing patient and surgeon interest in robotic resection, it appears both safe and feasible to adopt this approach while maintaining outcomes.

Robotic lobectomy costs and quality of life

“…The literature search for costs associated with robotic lobectomy and review of its references resulted in 16 relevant articles [ Table 1] from five different countries (Canada, 1; China, 2; France, 1; Italy, 1; and USA, 11) [1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . These articles were published from 2008 to 2019 with the study period ranging from 2008 to 2017.…”

“…Only two studies noted the use of the Xi [16,17] . Both four-arm [11,13,14,17,18,20] and three-arm [7,12,15,19,21] techniques were reported. There were three relevant articles identified that studied quality of life in patients undergoing robotic lobectomy [21][22][23] .…”

“…The hospital cost of robotic lobectomy during initiation of a robotic lobectomy program and/or early experiences at an institution has consistently been shown to be higher when compared to VATS lobectomy [11,18,20,21] . There were many factors observed to affect total hospital cost, one of which was intraoperative cost.…”

“…There were many factors observed to affect total hospital cost, one of which was intraoperative cost. Studies that disclosed OR time during early experiences reported a significantly longer time for robotic lobectomies when compared to VATS [ Table 3] [11,18,20,21] . Two of these studies observed a decrease in operating time with more experience, which translated into a difference in intraoperative cost [11,20] .…”

“…In the study by Worrell et al [21] , costs and quality of life outcomes were evaluated during the initiation of their robotic lobectomy program. They compared their first 25 robotic assisted lobectomies with 73 VATS lobectomies, which were performed from 2010 to 2012.…”