Robotic lobectomy costs and quality of life

Abstract

The surgical approach for lobectomy has changed over time with recent data demonstrating that the majority are performed using a minimally invasive approach. While the use of the robotic platform for pulmonary resection has been shown to have acceptable clinical outcomes, cost and quality of life need to be considered when starting a robotic lobectomy program. In this review, we evaluate the literature on cost of robotic lobectomy and quality of life. The results suggest that early experience in a robotic lobectomy program may be associated with relatively higher index hospital costs when compared to video-assisted thoracoscopic surgery; however, with increased experience and volume, the difference may no longer be of significance. When compared with thoracotomy, the cost is comparable if not less costly and may even be profitable for the hospital. Quality of life appears to be acceptable in the early experience of robotic lobectomy.

Keywords

Robotic / thoracic surgery / lobectomy / cost / quality of life / patient reported outcomes

References

[1] Subramanian MP,Chapman Jr WC,Yan Y.Utilization trends, outcomes, and cost in minimally invasive lobectomy..Ann Thorac Surg2019;108:1648-55 PMCID:PMC6878158

[2] Oh DS,Gorrepati ML,Reed MF.Robotic-assisted, video-assisted thoracoscopic and open lobectomy: propensity-matched analysis of recent premier data..Ann Thorac Surg2017;104:1733-40

[3] Veronesi G,Maisonneuve P,Schmid RA.Four-arm robotic lobectomy for the treatment of early-stage lung cancer..J Thorac Cardiovasc Surg2010;140:19-25

[4] Park BJ,Rusch VW.Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results..J Thorac Cardiovasc Surg2006;131:54-9

[5] Dylewski MR,Pereira JF.Pulmonary resection using a total endoscopic robotic video-assisted approach..Semin Thorac Cardiovasc Surg2011;23:36-42

[6] Singer E,D’Souza DM,Merritt RE.Understanding the financial cost of robotic lobectomy: calculating the value of innovation?.Ann Cardiothorac Surg2019;8:194-201 PMCID:PMC6462550

[7] Gondé H,Gillibert A,Varin R.The affordability of minimally invasive procedures in major lung resection: a prospective study..Interact Cardiovasc Thorac Surg2017;25:469-75

[8] Glenn ZF,Hussain L.Comparison of pulmonary lobectomies using robotic and video-assisted thoracoscopic approaches: results from 2010-2013 national inpatient sample..J Cardiovasc Surg (Torino)2019;60:526-31

[9] Swanson SJ,Gunnarsson CL,Howington JA.Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis..Ann Thorac Surg2012;93:1027-32

[10] Paul S,Isaacs AJ,Isom OW.Comparative effectiveness of robotic-assisted vs. thoracoscopic lobectomy..Chest2014;146:1505-12

[11] Kaur MN,Shiwcharan A,Shargall Y.Robotic versus video-assisted thoracoscopic lung resection during early program development..Ann Thorac Surg2018;105:1050-7

[12] Park BJ.Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy..Thorac Surg Clin2008;18:297-300

[13] Nasir BS,Minnich DJ,Cerfolio RJ.Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes..Ann Thorac Surg2014;98:203-8

[14] Novellis P,Voulaz E,Testori A.Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute..J Thorac Dis2018;10:790-8 PMCID:PMC5864633

[15] Deen SA,Wilshire CL,Farivar AS.Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches..Ann Thorac Surg2014;97:1000-7

[16] Nelson DB,Mitchell KG,Correa AM.Robotic-assisted lobectomy for non-small cell lung cancer: a comprehensive institutional experience..Ann Thorac Surg2019;108:370-6

[17] Kneuertz PJ,D’Souza DM,Moffatt-Bruce SD.Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison..J Thorac Cardiovasc Surg2019;157:2018-26.e2

[18] Bao F,Yang Y,Wang L.Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis..J Thorac Dis2016;8:1798-803 PMCID:PMC4958846

[19] Li JT,Huang J,Lin H.Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: retrospective study of 1,075 consecutive p-stage I non-small cell lung cancer cases..J Thorac Dis2019;11:882-91 PMCID:PMC6462703

[20] Spillane J.Developing a robotic program in thoracic surgery at Cape Cod Hospital..J Robot Surg2014;8:213-20

[21] Worrell SG,Gilbert C,Chang AC.The cost and quality of life outcomes in developing a robotic lobectomy program..J Robot Surg2019;13:239-43

[22] Lacroix V,Kahn D,Poncelet A.Pain, quality of life, and clinical outcomes after robotic lobectomy..Thorac Cardiovasc Surg2017;65:344-50

[23] Cerfolio RJ,Skylizard L.Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms..J Thorac Cardiovasc Surg2011;142:740-6

[24] Kneuertz PJ,D’Souza DM,Merritt RE.Postoperative complications decrease the cost-effectiveness of robotic-assisted lobectomy..Surgery2019;165:455-60