The Surgeon, the Robot, and the Stapler: Comparison of Stapling Strategies During Robotic Lobectomy

There are 2 methods for surgical stapling during robotic lobectomy (RL): handheld assistant-driven (HH) and robotic (RS) staplers. This study aims to compare the clinical and financial outcomes between these HH and RS approaches used in RL for lung cancer.

Between January 1, 2021, and December 31, 2022, patients who underwent elective RL for lung cancer were identified and extracted from the PINC AI™ Healthcare Database. To compare RS and HH outcomes, 1:1 nearest-neighbor propensity score matching (PSM) was conducted using patient and provider characteristics. Chi-square, Fisher's exact, and t tests were used to examine outcomes after PSM. Multivariable generalized linear models (GLMs) with respective gamma or binomial distribution and log-link function were also performed to examine outcome variations.

A total of 2,511 inpatient admissions following RL were included (14.4% HH and 85.6% RS), and 361 matched pairs were generated by PSM. Adjusted outcomes showed no significant differences in air leak, postoperative pneumothorax, or length of stay between matched pairs. There was a 12.5% versus 5.5% rate of bleeding associated with RS versus HH (odds ratio = 2.4, 95% confidence interval [CI]: 1.4, 4.2, P = 0.001); however, GLMs minimized the discrepancy. Using RS had higher inpatient costs than HH (mean difference [MD] = $7,024 USD, 95% CI: $4,495, $9,554, P < 0.001). Operating room (OR) time was longer for RS than HH (MD = 25 min, 95% CI: 12, 38, P = 0.002).

Assistant-driven HH used in RL for lung cancer appears at least as safe and effective as RS but may provide increased OR efficiency and cost savings. In this era of fiscal austerity, these findings cannot be overlooked.