Short-Term Outcomes and Cost of Robotic Versus Open Distal Pancreatectomy During the Initial Phase of a Robotic Pancreatectomy Program.

BACKGROUND

This retrospective study evaluates the safety and cost-effectiveness of robotic distal pancreatectomy (RDP) during surgeons' early experience, a period for which data remain limited. We compared outcomes and costs of RDP versus open distal pancreatectomy (ODP) during the initial phase of our robotic program.

METHODS

RDP and ODP cases from January 2018 to May 2024 were analyzed using a prospective database to obtain clinicopathologic and 90-day outcomes. Costs were expressed as ratios to ODP operative cost. 1:1 propensity-matched cohorts were compared.

RESULTS

One hundred nineteen RDP and 164 ODP cases were identified; matching yielded 101 per group. Major complications (Accordion grade ≥3: 10% vs 17%; P = 0.15), 90-day readmissions (17% vs 17%; P > 0.99), and operative time (266 vs 268 minutes; P = 0.95) were similar. RDP had higher rates of biochemical leak (34% vs 20%; P = 0.026) but similar rates of grade B postoperative pancreatic fistula (13% vs 21%; P = 0.13). RDP had higher intraoperative (1.25 vs 1.00) but lower index stay (2.48 vs 2.99) and 30-day (2.73 vs 3.41) cost ratios, all P < 0.001. RDP had lower inpatient opioid use (36 vs 111 mg; P < 0.001) and shorter hospital stay (3 vs 5 days; P < 0.001).

CONCLUSIONS

RDP was safe, with comparable 90-day outcomes and lower 30-day costs compared to ODP during RDP program implementation.