Robotic Versus Video-assisted Thoracoscopic Surgery(vats) Pulmonary Segmentectomy: A Cost Analysis
Kelsey A. Musgrove, Alexander Leung, Jeremiah A. Hayanga, Ghulam Abbas.
West Virginia University, Morgantown, WV, USA.
BACKGROUND: Robotic anatomical pulmonary segmentectomy is perceived to be more expensive than segmentectomy performed via standard Video Assisted Thoracic Surgery (VATS) approach. Use of the robot allows for more precise and meticulous dissection during segmentectomy leading to decrease air leak and shorter length of stay. This study compares the cost associated with pulmonary segmentectomy using the three approaches: VATS segmentectomy vs robotic segmentectomy using manual staplers vs robotic segmentectomy using robotic staplers. METHODS: Retrospective analysis of a single surgeon’s experience comparing VATS segmentectomy to early experience with robotic pulmonary segmentectomy was performed. A total of 50 segmentectomies were done over the 30-month study period. Twenty-eight of these procedures were robotic-assisted and 22 via VATS. The cost analysis included cost of robotic instruments, staplers, and average per day stay in hospital. The OR time and other instruments were similar thus not included in the analysis. The initial capital investment for the purchase of the robot was not included in the analysis. RESULTS: The mean age of this sample was 70 ± 10 years (range 43-91 years). There were 12 male patients in the robotic group and 8 in VATS group (P = 0.642). Mean age was 71 years in the VATS group and 69 in the robotic group (P = 0.367). Median [IQR] total LOS was 2 days [2-4] in the robotic group (range 1-9 days) and 4 [2-5] in the VATS group (range 1-20 days; P = 0.089). The average cost associated with robotic segmentectomy with use of manual stapler was less than the average cost of robotic segmentectomy with use of robotic staplers, which in turn was less than VATS segmentectomy (Table 1). CONCLUSIONS: In this small retrospective series, robotic segmentectomy was associated with shorter length of stay than VATS segmentectomy thus more cost effective. Larger series are needed to validate these results. 
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