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.