MINIMALLY-INVASIVE DISTAL PANCREATECTOMY: A COST-ANALYSIS COMPARISON BETWEEN ROBOTIC AND DIRECT MANUAL LAPAROSCOPIC APPROACH

• Main Authors: Morelli L, Palmeri M, Lorenzoni V, Gianardi D, Furbetta N, Di Franco G, Guadagni S, Bianchini M, Peri A, Pugliese L, Di Candio G, Turchetti G, Pietrabissa A
• Other Authors: Morelli, L, Palmeri, M, Lorenzoni, V, Gianardi, D, Furbetta, N, Di Franco, G, Guadagni, S, Bianchini, M, Peri, A, Pugliese, L, Di Candio, G, Turchetti, G, Pietrabissa, A
• Format: Conference Object
• Language: unknown
• Published: 2020
• Subjects: DML
• Online Access: http://hdl.handle.net/11568/1069466

Aims To date few studies have reported a structured cost analysis of robotic distal pancreatectomy, and none has compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of robotic distal pancreatectomy with the da Vinci Si and Xi, and with the DML. Methods Data related to 88 robotic distal pancreatectomies performed with either da Vinci Si (Si-Rob group) (47 cases) and da Vinci Xi (Xi-Rob group) (41 cases) and to 47 laparoscopic distal pancreatectomies (Trad-Lap group) performed between April 2010 and January 2020 were retrospectively analysed and compared. Si-Rob and Xi-Rob interventions were matched to laparoscopic distal pancreatectomies by case-control matching method using age, gender, BMI and ASA risk score as matching variables. Overall costs (including costs of personnel, hospital stay, consumables and fixed costs related to robot acquisition and maintenance) were compared between groups using generalized linear regression model adjusting for covariates. Results Thirty-five patients for each group were selected. No differences were found in overall mean operative time (OT) between Xi-Rob (226 min) and Si-Rob group (247 min) vs Trad-Lap group 262 min (p=0.164). The conversion rate was significantly higher in the Trad-Lap group: 5/35 cases (14.3%) (2 cases to hand-assisted laparoscopic technique and 3 cases to traditional open technique) vs 1/35 case (2.9%) in the Si-Rob group and 0 case in the Xi-Rob group (p=0.045). Overall costs associated with Trad-Lap procedures were significantly lower than with Xi-Rob and Si-Rob groups, also when adjusted for covariates (p < 0.001). However, excluding fixed costs, the difference between Trad-Lap and robotic groups resulted no longer statistically significant with the da Vinci Xi (p=0.105 and p=0.049 for Xi-Rob and Si-Rob respectively) at multivariate analysis. Conclusions RAS is more expensive than ...