Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 10.
doi: 10.1097/SLA.0000000000006665. Online ahead of print.

Cost-analysis of Implementing robot-assisted Versus Open Pancreatoduodenectomy

Julia E Menso  1   2 , Michiel F G Francken  1   2 , Nine de Graaf  1   2 , Alessandro M Bonomi  1   2   3   4 , Riccardo Guastella  1   2   5 , Dylan Balaban  1 , Mahsoem Ali  2   6 , H Jaap Bonjer  1   2   6 , Susan van Dieren  1   2 , Marcel G W Dijkgraaf  7 , Jony van Hilst  1   2   8 , Gabriela Pilz da Cunha  2   6 , Joris Erdmann  2   6 , Geert Kazemier  2   6 , Rutger-Jan Swijnenburg  2   6 , Barbara M Zonderhuis  2   6 , Freek Daams  2   6 , Sebastiaan Festen  1   8 , Olivier R Busch  1   2 , Marc G Besselink  1   2 ; for HPB-Amsterdam
Affiliations

Cost-analysis of Implementing robot-assisted Versus Open Pancreatoduodenectomy

Julia E Menso et al. Ann Surg. .

Abstract

Objective: To perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.

Background: Many high-volume centers are implementing RPD as alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.

Methods: Post-hoc cost-analysis of consecutive RPD versus OPD in a singly high-volume center (Jan 2015-May 2024). The eligibility criteria for RPD (i.e. no vascular contact, no chronic and necrotizing pancreatitis, and BMI<35 kg/m2) were used to select patients undergoing OPD, to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.

Results: Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPD, 374 OPD). Total hospital stay was shorter after RPD (10 [6-17] vs. 12 [8-21] days, P=0.001). Mean total hospital costs were €4,804 higher for RPD (€27,307 vs. €22,503, P=0.010). Outcomes improved in the second half of the RPD experience (n=107): total hospital stay (12 [7-23] to 9 [6-15] days, P<0.001), pancreatic fistula (48.6% to 31.8%, P=0.012), delayed gastric emptying (33.6% to 15.0%, P=0.001), and operative time (373 [341-411] to 310 [272-352] minutes, P<0.001). Consequently, costs per RPD procedure decreased with €11,058 (€32,836 to €21,778, P=0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P=0.210). Hence, total costs for RPD and OPD became comparable in the second half (€21,778 vs. €21,013, P=0.644).

Conclusion: Implementing RPD is associated with considerable additional costs compared to OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large scale randomized trials will have to confirm these findings.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: JEM and MGB received a grant from KWF (Dutch Cancer Society) and Intuitive Surgical for the investigator-initiated DIPLOMA-2 and DIPLOMA-2×2 randomized trials which include robot-assisted pancreatoduodenectomy. MGB, SF and FD are clinical proctors for Intuitive Surgical.

LinkOut - more resources