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RESULTS: No differences were found in overall mean operative time between Xi-Rob (243 minutes) and Si-Rob group (246.4 minutes) vs Trad-Lap group 277.5 minutes (p ¼ 0.052 and p ¼ 0.163). Overall costs associated with Trad-Lap procedures were significantly lower than with Xi-Rob and Si-Rob groups also when adjusting for covariates (p < 0.001); excluding fixed costs, the difference between Trad-Lap and robotic groups resulted no longer statistically significant (p ¼ 0.602 and p ¼ 0.169 for Si-Rob and Xi-Rob, respectively). CONCLUSIONS: Robotic distal pancreatectomy is more expensive than direct manual laparoscopy for distal pancreatectomy because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs suggests a possible optimization of the cost-effectives of robotic distal pancreatectomy in this setting.