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Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

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Abstract

Background

Robot-assisted pancreatoduodenectomy (RPD) has shown some advantages over open pancreatoduodenectomy (OPD) but few studies have reported a cost analysis between the two techniques. We conducted a structured cost-analysis comparing pancreatoduodenectomy performed with the use of the da Vinci Xi, and the traditional open approach, and considering healthcare direct costs associated with the intervention and the short-term post-operative course.

Materials and methods

Twenty RPD and 194 OPD performed between January 2011 and December 2020 by the same operator at our high-volume multidisciplinary center for robot-assisted surgery and for pancreatic surgery, were retrospectively analyzed. Two comparable groups of 20 patients (Xi-RPD-group) and 40 patients (OPD-group) were obtained matching 1:2 the RPD-group with the OPD-group. Perioperative data and overall costs, including overall variable costs (OVCs) and fixed costs, were compared.

Results

No difference was reported in mean operative time: 428 min for Xi-RPD-group versus 404 min for OPD, p = 0.212. The median overall length of hospital stay was significantly lower in the Xi-RPD-group: 10 days versus 16 days, p = 0.001. In the Xi-RPD-group, consumable costs were significantly higher (€6149.2 versus €1267.4, p < 0.001), while hospital stay costs were significantly lower: €5231.6 versus €8180 (p = 0.001). No significant differences were found in terms of OVCs: €13,483.4 in Xi-RPD-group versus €11,879.8 in OPD-group (p = 0.076).

Conclusions

Robot-assisted surgery is more expensive because of higher acquisition and maintenance costs. However, although RPD is associated to higher material costs, the advantages of the robotic system associated to lower hospital stay costs and the absence of difference in terms of personnel costs thanks to the similar operative time with respect to OPD, make the OVCs of the two techniques no longer different. Hence, the higher costs of advanced technology can be partially compensated by clinical advantages, particularly within a high-volume multidisciplinary center for both robot-assisted and pancreatic surgery. These preliminary data need confirmation by further studies.

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Acknowledgements

The authors thank Arpa and Tizzi Foundations for the support. The authors also thank Sharon Bernadette King for the language editing.

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Authors and Affiliations

  1. General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy

    Gregorio Di Franco, Matteo Palmeri, Niccolò Furbetta, Simone Guadagni, Desirée Gianardi, Matteo Bianchini, Giulio Di Candio & Luca Morelli

  2. Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy

    Valentina Lorenzoni & Giuseppe Turchetti

  3. Second Division of Surgical Pathology, University Hospital of Pisa, Pisa, Italy

    Luca Emanuele Pollina

  4. Multidisciplinary Center of Robotic Surgery, University Hospital of Pisa, Pisa, Italy

    Gregorio Di Franco, Matteo Palmeri, Niccolò Furbetta, Simone Guadagni, Desirée Gianardi, Matteo Bianchini, Franca Melfi, Giulio Di Candio & Luca Morelli

  5. Pharmaceutical Unit: Medical Device Management, University Hospital of Pisa, Pisa, Italy

    Domenica Mamone

  6. Board of Directors, University Hospital of Pisa, Pisa, Italy

    Carlo Milli

  7. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy

    Luca Morelli

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  1. Gregorio Di Franco
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Correspondence to Luca Morelli.

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Dr. Gregorio Di Franco, Dr. Valentina Lorenzoni, Dr. Matteo Palmeri, Dr. Niccolò Furbetta, Dr. Simone Guadagni, Dr. Desirée Gianardi, Dr. Matteo Bianchini, Dr. Luca Emanuele Pollina, Prof. Franca Melfi, Dr. Domenica Mamone, Dr. Carlo Milli, Prof. Giulio Di Candio, Prof. Giuseppe Turchetti, Prof. Luca Morelli have no conflicts of interest or financial ties to disclose.

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Di Franco, G., Lorenzoni, V., Palmeri, M. et al. Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach. Surg Endosc 36, 4417–4428 (2022). https://doi.org/10.1007/s00464-021-08793-4

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