The cost of robotic assisted surgery is an obstacle to wider implementation. We aimed to evaluate the effect of our strategy to reduce the cost of robotic lobectomy (RL) for lung cancer.
This single institutional retrospective study included RL for lung cancer between October 2018 to November 2019. We initiated minimal RL (miRL) in September 2019 aiming to reduce the consumable cost, in which we intended to use only bipolar fenestrated (left), long bipolar grasper (right) and vessel sealer (3rd arm) as robotic instrument. Additional consumable cost was calculated based on Japanese catalog price (1USD = 110JPY) to perform RL (excluding robot and maintenance fee, and staplers) compared to our video assisted thoracoscopic surgery lobectomy (VATS-L) (3 ports, no energy device). We then assessed the effect of miRL on the cost and perioperative outcomes.
Twenty-one RATS-L were performed [20 c-stage I and one c-T3(PM1)N0M0]. There were no significant differences in patient characteristics between the miRL group (N = 6) [age 73(56–76); male 67%; tumor size 18(5–33) mm] and the Control group (N = 15) [age 68(50–84); male 60%; tumor size 13(8–32) mm]. In all cases with miRL, procedure was completed with only 3 arms. The mean (range) additional consumable cost to perform RL compared to VATS-L was significantly reduced in the miRL group compared to the control group [Control 2168(1808–2746) vs miRL 1424(1424–1424) USD, p༜0.01]. There was no conversion to thoracotomy or grade > 4 complications. There were no significant differences in blood loss [Control 25(0-203) vs miRL 30(0-152) g, p = 0.90], operation duration [Control 193(106–284) vs miRL 179(154–211) mins, p = 0.53] or postoperative hospital stay [Control 4(3–10) vs miRL 4(3–17) days, p = 0.87].
With miRL strategy in our cohort, consumable cost for RATS-L was significantly reduced while maintaining perioperative outcomes. Further evaluation with larger number of patients is warranted.