General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy.
Multidisciplinary Center of Robotic Surgery, University Hospital of Pisa, Pisa, Italy.
Surg Endosc. 2022 Jun;36(6):4417-4428. doi: 10.1007/s00464-021-08793-4. Epub 2021 Oct 27.
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.
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.
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).
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.
机器人辅助胰十二指肠切除术（RPD）相较于开腹胰十二指肠切除术（OPD）具有一定优势，但鲜有研究对两种技术进行成本分析。本研究通过对达芬奇 Xi 机器人系统辅助手术与传统开腹手术进行成本分析，考虑与干预和短期术后过程相关的医疗直接成本，比较了这两种方法。
对 2011 年 1 月至 2020 年 12 月由同一位术者在我们的机器人辅助手术和胰腺外科高容量多学科中心进行的 20 例 RPD 和 194 例 OPD 进行回顾性分析。通过将 RPD 组与 OPD 组按 1:2 比例匹配，获得了两组 20 例患者（Xi-RPD 组）和 40 例患者（OPD 组）。比较了两组患者的围手术期数据和总费用，包括总变动成本（OVC）和固定成本。
两组患者的平均手术时间无差异：Xi-RPD 组为 428 分钟，OPD 组为 404 分钟，p=0.212。Xi-RPD 组的中位总住院时间明显低于 OPD 组：10 天 vs 16 天，p=0.001。Xi-RPD 组耗材成本显著较高（€6149.2 比 €1267.4，p<0.001），而住院费用显著较低：€5231.6 比 €8180（p=0.001）。两组 OVC 无显著差异：Xi-RPD 组为 €13483.4，OPD 组为 €11879.8（p=0.076）。
机器人辅助手术的成本更高，因为其购置和维护成本更高。然而，尽管 RPD 与较高的材料成本相关，但机器人系统的优势与较低的住院费用相关，且由于与 OPD 相比手术时间相似，人员成本无差异，使得两种技术的 OVC 不再有差异。因此，先进技术的高成本可以部分通过临床优势得到补偿，尤其是在机器人辅助和胰腺外科高容量多学科中心。这些初步数据需要进一步研究来证实。
