Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

Abstract

The authors declare that no funding support was received for this study. Background Robotic-assisted surgery by the da Vinci Si appears to benefit rectal cancer surgery in selected patients, but still has some limitations, one of which is its high costs. Preliminary studies have indicated that the use of the new da Vinci Xi provides some added advantages, but their impact on cost is unknown. The aim of the present study is to compare surgical outcomes and costs of rectal cancer resection by the two platforms, in a single surgeon's experience. Methods From April 2010 to April 2017, 90 robotic rectal resections were performed, with either the da Vinci Si (Si-RobTME) or the da Vinci Xi (Xi-RobTME). Based on CUSUM analysis, two comparable groups of 40 consecutive Si-RobTME and 40 consecutive Xi-RobTME were obtained from the prospectively collected database and used for the present retrospective comparative study. Data costs were analysed based on the level of experience on the proficiency-gain curve (p-g-curve) by the surgeon with each platform. Results In both groups, two homogeneous phases of the p-g-curve were identified: Si1 and Xi1: cases 1-19, Si2 and Xi2: cases 20-40. A significantly higher number of full RAS operations was achieved in the Xi-RobTME group (p<0.001). A statistically significant reduction in operating time (OT) during Si2 and Xi2 phase was observed (p<0.001), accompanied by reduced overall variable costs (OVC), personnel costs (PC) and consumable costs (CC) (p<0.001). All costs were lower in the Xi2 phase compared to Si2 phase: OT 265 vs. 290 min (p=0.052); OVC 7983 vs. 10231.9 (p=0.009); PC 1151.6 vs. 1260.2 (p=0.052), CC 3464.4 vs. 3869.7 (p<0.001). Conclusions Our experience confirms a significant reduction of costs with increasing surgeon's experience with both platforms. However, the economic gain was higher with the Xi with shorter OT, reduced PC and CC, in addition to a significantly larger number of cases performed by the fully robotic approach.

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

“…A single‐institute study from Korea found that total hospital charges were significantly higher for the robotic group (US$14 647 (€13 590; exchange rate 24 March 2020) versus US$9978 (€9260) respectively; P = 0·001), whereas the hospital profit was significantly lower (US$689 (€640) versus US$1671 (€1550); P < 0·001). Another group confirmed a significant reduction in costs with increasing surgeon experience and a fully robotic approach, especially with the da Vinci® Xi system compared with the da Vinci® Si™ robot.…”

From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot

“…Also, the enhancements made in the Xi of simpler docking, laser guided port placement and boom-mounted robotic arms could have played a role in the faster times of draping and docking we found. Comparison to other studies is hard and unreliable due to unclearly described definitions of reported time frames [3,[12][13][14][15][16], different way of docking (three arms or single-port) [6,17,18], method of data collection and/or to retrospective study designs [3,[17][18][19]. Robot-assisted surgery, especially the phase before the surgeon starts behind the console, is a team effort.…”

“…Although robotassisted surgery has several advantages over conventional endoscopic surgery, its costs and prolonged operative times remain a subject of debate. High costs are not only ascribed to high purchase and maintenance costs of the robot, but to longer operating times as well [1][2][3].…”

A meta‐analysis of DaVinci Si versus Xi in colorectal surgery

“…The primary endpoint was operating time in two studies, 14 , 15 console time in one study 17 and was not reported in three studies 13 ,. 16 , 18 Exclusion criteria were T4 tumours in one study 16 and a history of other malignancies, signs of acute intestinal obstruction or perforation, familial adenomatous polyposis coli, hereditary nonpolyposis colorectal cancer and active inflammatory bowel disease in another study 15 . Four studies did not specify exclusion criteria, although they reported a consecutive cohort to be included 13 ,.…”