Robotic vs. bedside staplers in robotic lung resection: a real-world cohort study

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Comparative data on stapler strategies in robotic lung resections, especially for sublobar procedures, is limited.
• Contemporary stapler devices are increasingly used in robotic-assisted thoracic surgery.

Purpose of the Study:

• To evaluate clinical and economic outcomes of robotic versus bedside staplers in robotic lung resections.
• To compare complication rates, operative efficiency, and costs between the two stapler types.

Main Methods:

• Retrospective cohort study using the Premier Healthcare Database (2019-2023) of adult robotic lobectomy or sublobar resections.
• Overlap weighting (OW) was used to balance baseline characteristics between robotic stapler and bedside stapler groups.
• Primary outcome was postoperative air leak; secondary outcomes included complications, conversion rates, operative time, length of stay, and costs.

Main Results:

• Robotic staplers were associated with significantly lower rates of air leak (10.9% vs. 15.2%), pneumothorax (8.5% vs. 11.4%), pneumonia (1.1% vs. 2.8%), and conversion to thoracotomy (0.4% vs. 4.7%).
• Patients using robotic staplers experienced shorter operative times (209 vs. 225 min) and length of stay (3.8 vs. 5.4 days).
• Index hospitalization costs were lower with robotic staplers (USD 25,887 vs. 27,432), with similar 30-day perioperative cost trends.

Conclusions:

• Robotic staplers demonstrate superior clinical outcomes and economic benefits in robotic lung resections compared to bedside staplers.
• Findings suggest robotic staplers may improve patient recovery and reduce healthcare resource utilization.
• Results were consistent in sensitivity analyses, though residual confounding warrants cautious interpretation.