Resource implications of robotic thoracic surgery: what are the wider issues?

Abstract

The benefits of minimally invasive thoracic surgery are well documented when compared to the use of standard thoracotomy. Much controversy exists, however, regarding the resource implications when using robot-assisted thoracic surgery (RATS), especially when compared to video-assisted thoracoscopic surgery (VATS). Much of the costs attributed to a particular approach center around the frequency and severity of the complications that may arise. Little exists in the literature to appropriately compare and contrast the complication rate following either of the minimally invasive approaches. There is a suggestion that many conventional open surgeons are more readily persuaded to adopt a minimally invasive approach through the use of the robotic platform, therefore reducing the complication-related costs of standard thoracotomy by an increase in minimally invasive resection rates. Further gains may be made in the ability to perform more complex minimally invasive procedures via a RATS approach without recourse to open conversion when compared to VATS. As opportunities and competition increase in the commercial market place, it is reasonable to assume costs will fall and further savings will be made.

Robotic-Assisted Thoracic Surgery Approach to Thoracic Endometriosis Syndrome with Unilateral Diaphragmatic Palsy

“…This has also been addressed by Stamenkovic and Slight who concluded that the resource implication benefits of RATS concerning the shorter length of hospital stay, fewer complications, enhanced recovery, and increased uptake of adjuvant treatments contribute towards decreased costs. Currently, there is a commercial expansion of the robot platform market, which may result in a competitive reduction of costs [ 18 ]. This has been further studied in Shanahan et al's comprehensive micro-cost analysis of RATS procedures [ 19 ].…”

Value proposition of robotic thoracic surgery in high volume centers

“…Although some of the variability was likely due to different cost definitions, it became clear that most of the studies on cost to that date (prior to 2018) were derived from the early experience with robotic lobectomy. In a thoughtful discussion of the wider issues of resource implication of robotics, the guest editor Dr. Stamenkovic points to the close relationship between cost of the robotic technology (i.e., disposables, drapes and staplers), as well as other hospital resources that drive cost, such as operating room time and length of stay (2). Recently, we have critically reviewed our experience with robotic lobectomy to better understand the value of robotics at a high-volume center.…”