VATS Versus Robotic Anatomic Pulmonary Resection in a High-Volume Institution: Cost and Outcomes Analysis

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Video-assisted thoracoscopic surgery (VATS) is a standard minimally invasive approach for lung resections.
• The adoption of robot-assisted thoracoscopic surgery (RATS) offers potential advantages in visualization and dexterity.
• Evaluating the transition from VATS to RATS is crucial for understanding its impact on surgical practice.

Purpose of the Study:

• To compare patient outcomes and costs between VATS and RATS for anatomic lung resections.
• To assess the safety and efficacy of RATS during a single surgeon's learning curve.
• To determine the economic implications of adopting RATS in a quaternary center.

Main Methods:

• Retrospective analysis of 210 patients undergoing anatomic lung resections by a single surgeon (2015-2022).
• Comparison of baseline characteristics, short-term outcomes (length of stay, readmissions, complications), and adjusted costs between VATS and RATS groups.
• Statistical analysis to identify significant differences between the two surgical approaches.

Main Results:

• No significant differences in baseline characteristics, major complications (5 vs 5), or 30-day readmission rates (5% vs 5.7%) between RATS and VATS.
• Robotic surgery had a longer median procedure time (161 vs 145 min, P < 0.002).
• Adjusted direct charges ($40,250 vs $44,124) and total hospital charges ($74,199 vs $80,549) were numerically lower for RATS, though not statistically significant (P > 0.47).

Conclusions:

• Transitioning from VATS to RATS is safe, with comparable patient outcomes and costs.
• RATS demonstrated numerically lower charges, even during the initial learning phase.
• Increased operative efficiency with RATS is expected to lead to greater hospital cost savings over time.