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

This study evaluates the impact of transitioning from video-assisted thoracoscopic surgery (VATS) to robot-assisted thoracoscopic surgery (RATS) on patient outcomes and costs, based on the experience of a single surgeon at a quaternary center.

We reviewed patients who underwent anatomic lung resections by a single surgeon between 2015 and 2022, excluding nonanatomic resections and those involving robotic bronchoscopy followed by resection. We compared baseline characteristics, short-term outcomes, and costs between the VATS (2015 to 2018) and robotic (2018 to 2022) groups. Charges were adjusted to 2023 dollars for comparison across different time periods.

A total of 210 patients (140 robotic, 70 VATS) were analyzed, with no significant differences in baseline characteristics. Robotic surgery had a longer median procedure time (161 vs 145 min, P < 0.002). Length of stay was similar (5.3 ± 6.3 days for robotic vs 6.54 ± 7.5 days for VATS, P = 0.23), as were 30-day readmission rates (5% for robotic vs 5.7% for VATS, P = 0.83). Major complications occurred in 5 robotic and 5 VATS cases (P = 0.528). Adjusted direct charges were $40,250.40 (95% confidence interval [CI]: $34,739.0 to $45,761.8) for robotic and $44,124.00 (95% CI: $35,036.0 to $53,211.9) for VATS (P = 0.47). Total hospital charges were $74,199.00 (95% CI: $64,398.9 to $83,999.2) for robotic and $80,549.00 (95% CI: $63,028.9 to $98,069.3) for VATS (P = 0.498).

Transitioning from VATS to RATS can be done safely without increasing costs or morbidity. In addition, the robotic approach demonstrated numerically lower charges, even during the surgeon's early learning curve. Hospital cost savings would be expected to increase as operative efficiency improves.