A Comparative Analysis of Outcomes and Costs in Robotic Versus Laparoscopic Anterior Resection: A Retrospective...

Our study aimed to compare the peri-operative and economic outcomes of an anterior resection undertaken using robotic and laparoscopic techniques. By evaluating key factors such as surgical complications, recovery times, hospital stays and overall procedural expenses. This research aims to enhance understanding of the potential benefits of robotic surgery, including its financial implications.

This is a retrospective study conducted on patients undergoing elective anterior resections via laparoscopy or the robotic platform (Da Vinci Xi) between January 2018 and August 2023. A single surgeon across public and private hospitals in New South Wales and Queensland, Australia, performed the surgeries.

There were 107 patients in total: 58 underwent robotic resection, and 49 underwent laparoscopic resection. The majority of patients were male; otherwise, demographics were similar between groups, with a mean age of 65. Most patients in both groups underwent resections for benign conditions. Among the group undergoing robotic procedures, there was a reduced incidence of ileus, along with a faster recovery of bowel function and a notably shorter length of hospitalisation (4.3 days vs. 5.8 days, p = 0.0038). The average operative time was shorter for the robotic cohort (96 min) compared to the laparoscopic group (136 min, p < 0.0001). Within those patients who underwent a robotic resection, they achieved a higher average lymph node harvest (21 vs. 18). While the laparoscopic cohort had more Clavien-Dindo Grades 1 and 2 complications and statistically high rates of wound infections (p = 0.046), there was no significant disparity in 30-day mortality rates. Regarding costs, when considering differences in length of stay and total operative time, there was a saving in cost of care totalling AUS$3528.61 in favour of robotic resections. Robotic instrument expenses totalled AUS$4176.97, compared to AUS$3829.58 for laparoscopic instruments. The cost of a hospital bed stay was AUS$1464.00/day.

Our findings suggest that robotic anterior resections result in shorter hospital stays, a quicker recovery and return of bowel function and a greater yield of lymph nodes. Additionally, fewer complications were observed with the robotic platform. When performed by an experienced team, robotic surgeries may also have shorter operative times than laparoscopic procedures. Robotic resection proves to be safe, efficient and cost-effective.