Department of Surgery, Indiana University, Indianapolis, IN 46202, USA.
Surgery. 2010 Oct;148(4):814-23. doi: 10.1016/j.surg.2010.07.027. Epub 2010 Aug 24.
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.
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.
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.
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.
微创技术甚至机器人技术在胰胆管手术中应用越来越多。成本效益是与外科创新引入相关的实际负担。本研究比较了开腹、腹腔镜和机器人胰体尾切除术的成本和结果。我们假设机器人胰体尾切除术具有成本效益。
2008 年 8 月至 2009 年 8 月，在一家学术医疗中心进行了 77 例胰体尾切除术。对前瞻性收集的人口统计学、短期结果和直接成本数据进行了回顾性分析。
32 例开腹胰体尾切除术、28 例腹腔镜胰体尾切除术和 17 例机器人胰体尾切除术。年龄、美国麻醉医师协会术前风险评分和标本长度相似。腹腔镜胰体尾切除术和机器人胰体尾切除术的适应证包括更多的囊性肿瘤（49%）和较少的恶性肿瘤（29%），而开腹胰体尾切除术为 16%和 47%。机器人胰体尾切除术保脾率为 65%，而开腹胰体尾切除术和腹腔镜胰体尾切除术分别为 12%和 29%（P<0.05）。机器人胰体尾切除术的手术时间平均为 298 分钟，而开腹胰体尾切除术和腹腔镜胰体尾切除术分别为 245 分钟和 222 分钟（P<0.05）。术中出血量和并发症发生率相似，无死亡。机器人胰体尾切除术的住院时间为 4 天，开腹胰体尾切除术和腹腔镜胰体尾切除术分别为 8 天和 6 天（P<0.05）。机器人胰体尾切除术的总费用为 10588 美元，开腹胰体尾切除术和腹腔镜胰体尾切除术分别为 16059 美元和 12986 美元。
这些数据表明，所有组别的直接医院成本相当。与开腹或腹腔镜手术相比，机器人手术的住院时间更短。最后，机器人手术可能会提高保脾和血管的成功率，但手术时间会延长。总之，机器人胰体尾切除术在选择病例中是安全且具有成本效益的。
