Comparison Between Robotic and Thoracoscopic Surgical Stapling Devices During Robotic Pulmonary Resection: Analysis of Surgical and Economic Outcomes

D. Galetta¹, M. Gagliasso^2
1San Giovanni Bosco Hospital, Turin, Italy, Turin, Piemonte ²European Institute of Oncologgy, Milan, Lombardia

Purpose: To date there exists no published study examining the safety and efficacy of the EndoWrist (Intuitive Surgical, Inc.) 30 and 45 robotic stapler. We compare the use of robotic staplers with standard thoracoscopic endostaplers (30 and 45 reloads) during pulmonary anatomic resection.

Methods: We analyze a prospective collected cohort of 488 patients who underwent robotic lobectomy or segmentectomy utilizing robotic staplers or endostaplers for vascular, bronchial or parenchimal resection between May 2017 and December 2023 in two different hospitals. Pulmonary anatomic resection was performed by Da Vinci Xi and Da Vinci Si, respectively. Endostapler (EndoGIATM) was introduced in the thorax by the assistant surgeon who fired them through one of the robotic-port. Robotic stapler was instead completely controlled from the console by the surgeon. Preoperative demographic, intraoperative data and postoperative outcomes were examined. Student’s t-test and Fischer’s exact used were appropriate.

Results: Robotic stapler was used in 245 cases, while endostapler in 243 cases. There was no difference in age (p=.54), gender (p=.72), side (p=.52), body mass index (p=.83), comorbidity (p=.65) between groups. There was no difference in docking time between Da Vinci Si and Xi (p=.77), estimated blood loss (p=.65), intraoperative complication rate (p=.64), and postoperative complication rate (p=,79). Operative time and length of stay was shorter for robotic stapler group versus endoscopic group (p=.04, and p=.05, respectively). There were more endoscopic stapler fires (mean, 6.4) per patient than robotic stapler fires (mean, 4.7) (p=.01). The stapler cost per patient for the endoscopic group was $1502.27 versus $1195.82 for the robotic group (p = .01).

Conclusion: This is the first study evaluating robotic stapler in thoracic minimally invasive surgery. Advantages of robotic stapler include a larger range of motion and articulation which may provide a benefit when use it in difficult areas. Robotic staplers simplify suture and resection of vascular, bronchial structures and parenchyma rendering robotic resections safer, simpler and rapid. The robotic stapler has a comparable level of safety as an endoscopic stapler and is more cost effective.

Identify the source of the funding for this research project: none