Robotic distal pancreatectomy: Cost effective?

Waters, Joshua A.; Canal, David F.; Wiebke, Eric A.; Dumas, Ryan P.; Beane, Joal D.; Aguilar-Saavedra, Juan R.; Ball, Chad G.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila; Pitt, Henry A.; Lillemoe, Keith D.; Schmidt, C. Max

doi:10.1016/j.surg.2010.07.027

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Volume 148, Issue 4 , Pages 814-823, October 2010

Robotic distal pancreatectomy: Cost effective?

Joshua A. Waters, MD
- Department of Surgery, Indiana University, Indianapolis, IN
David F. Canal, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Eric A. Wiebke, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Ryan P. Dumas, BS
- School of Medicine, Indiana University, Indianapolis, IN
Joal D. Beane, BA
- School of Medicine, Indiana University, Indianapolis, IN
Juan R. Aguilar-Saavedra, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Chad G. Ball, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Michael G. House, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Nicholas J. Zyromski, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Attila Nakeeb, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Henry A. Pitt, MD
- Department of Surgery, Indiana University, Indianapolis, IN
Keith D. Lillemoe, MD
- Department of Surgery, Indiana University, Indianapolis, IN
C. Max Schmidt, MD, PhD, MBA
- Department of Surgery, Indiana University, Indianapolis, IN
- Reprint requests: C. Max Schmidt, MD, PhD, MBA, Department of Surgery, Indiana University, 980 W Walnut Street C522, Indianapolis, IN 46202.

Accepted 15 July 2010. published online 27 August 2010.

Background

Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective.

Methods

Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed.

Results

Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies.

Conclusion

These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases.