Performance evaluation of a two-arm robotic chemotherapy compounding system: Effects of syringe size and compounding cycles on accuracy, efficiency, and safety margins

BackgroundManual chemotherapy compounding carries occupational hazards and requires high technical accuracy. Robotic automation has emerged as an important advancement to enhance personnel safety and improve dosing precision.ObjectiveThis study evaluated the impact of syringe size and compounding cycle number on accuracy, operational efficiency, and safety margins of a prototype two-arm robotic chemotherapy compounding system during its first year of clinical implementation at Maha Vajiralongkorn Thanyaburi Hospital, Pathum Thani, Thailand.MethodsA retrospective analysis of 7,922 intravenous chemotherapy preparations was conducted. Preparation accuracy was assessed using percentage volume error determined by gravimetric verification, and efficiency was measured by total preparation time. The effects of syringe size (10, 30, and 50 ml) and compounding cycles (one to three) were analyzed. Bootstrap resampling was applied to generate 90% confidence intervals and evaluate safety margins.ResultsThe system demonstrated high precision, with an overall mean percentage error of -1.19 ± 1.32% (median -1.14 ± 1.86%) and a mean preparation time of 11.86 ± 3.47 min (median 11.29 ± 3.06 min). Smaller syringe sizes and increased compounding cycles were associated with a consistent tendency toward slight under-delivery. However, all deviations remained within the clinically acceptable ±5% threshold. Bootstrap analysis confirmed stable and reproducible safety margins across hardware configurations.ConclusionClinical implementation of the robotic compounding system demonstrated high accuracy, reproducibility, and operational safety, supporting its role in enhancing safety in high-throughput chemotherapy compounding practice.