ROBOTIC AND DIRECT MANUAL LAPAROSCOPIC DISTAL PANCREATECTOMY: A COST-ANALYSIS COMPARISON

Aim: The aim of the present study is to address a structured cost analysis by comparing surgical outcomes and costs of robotic distal pancreatectomy (RAS) with the da Vinci Si and Xi, and with direct manual laparoscopy (DML). Methods: Data related to 66 robotic distal pancreatectomies performed at our Institute with either the da Vinci Si (Si-Rob group) or the da Vinci Xi (Xi-Rob group) from April 2010 to July 2019 and to 26 laparoscopic distal pancreatectomies (Trad-Lap group) performed between June 2004 and June 2007 were retrospectively collected. We compared these three groups by a propensity score method using age, gender, BMI and ASA risk score as matching variables. Overall costs were compared between groups using generalized linear regression model adjusting for covariates. Results: No differences were found in overall mean operative time between Xi-Rob (243 min) and Si-Rob group (246.4 min) vs Trad-Lap group 277.5 min (p=0.052 and p=0.163). Overall costs associated with Trad-Lap procedures were significantly lower than with Xi-Rob and Si-Rob groups also when adjusting for covariates (p < 0.001); excluding fixed costs, the difference between Trad-Lap and robotic groups resulted no longer statistically significant (p=0.602 and p=0.169 for Si-Rob and Xi-Rob respectively). Conclusions: RAS is more expensive than DML for distal pancreatectomy because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs suggests a possible optimization of the cost-effectives of RAS in this setting.