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Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis

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Abstract

Background

Benefits and cost-effectiveness of robotic approach for distal pancreatectomy (DP) remain debated. In this prospective study, we aim to compare the short-term results and real costs of robotic (RDP) and laparoscopic distal pancreatectomy (LDP).

Methods

From 2011 until 2016, all consecutive patients underwent minimally invasive DP were included and data were prospectively collected. Patients were assigned in two groups, RDP and LDP, according to the availability of the Da Vinci® Surgical System for our Surgical Unit.

Results

A minimally invasive DP was performed in 38 patients with a median age of 61 years old (44–83 years old) and a BMI of 26 kg/m2 (20–31 kg/m2). RDP group (n = 15) and LDP group (n = 23) were comparable concerning demographic data, BMI, ASA score, comorbidities, malignant lesions, lesion size, and indication of spleen preservation. Median operative time was longer in RDP (207 min) compared to LDP (187 min) (p = 0.047). Conversion rate, spleen preservation failure, and perioperative transfusion rates were nil in both groups. Pancreatic fistula was diagnosed in 40 and 43% (p = 0.832) of patients and was grade A in 83 and 80% (p = 1.000) in RDP and LDP groups, respectively. Median postoperative hospital stay was similar in both groups (RDP: 8 days vs. LDP: 9 days, p = 0.310). Major complication occurred in 7% in RDP group and 13% in LDP group (p = 1.000). Ninety-days mortality was nil in both groups. No difference was found concerning R0 resection rate and median number of retrieved lymph nodes. Total cost of RDP was higher than LDP (13611 vs. 12509 €, p < 0.001). The difference between mean hospital incomes and costs was negative in RDP group contrary to LDP group (− 1269 vs. 1395 €, p = 0.040).

Conclusion

Short-term results of RDP seem to be similar to LDP but the high cost of RDP makes this approach not cost-effective actually.

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Authors and Affiliations

  1. Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France

    Regis Souche, Astrid Herrero, John Chauvat, Isabelle Pirlet, Françoise Guillon, David Nocca & Jean-Michel Fabre

  2. Digestive Surgery Department, Carémeau Hospital, University of Montpellier, Place du Professeur Debré, 30900, Nîmes, France

    Frederic Borie

  3. Medical Information Department, La Colombière Hospital, University of Montpellier, 39 Avenue Charles Flahault, 34295, Montpellier, France

    Guillaume Bourel & Gregoire Mercier

Authors
  1. Regis Souche
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  2. Astrid Herrero
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  3. Guillaume Bourel
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  4. John Chauvat
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  5. Isabelle Pirlet
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  6. Françoise Guillon
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  7. David Nocca
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  8. Frederic Borie
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  9. Gregoire Mercier
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  10. Jean-Michel Fabre
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Correspondence to Regis Souche.

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Disclosures

Drs. Regis Souche, Astrid Herrero, Guillaume Bourel, John Chauvat, Isabelle Pirlet, Françoise Guillon, David Nocca, Frederic Borie, Gregoire Mercier, and Jean-Michel Fabre have no conflicts of interest or financial ties to disclose.

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Souche, R., Herrero, A., Bourel, G. et al. Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis. Surg Endosc 32, 3562–3569 (2018). https://doi.org/10.1007/s00464-018-6080-9

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  • DOI: https://doi.org/10.1007/s00464-018-6080-9

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