Roboterassistierte Thoraxchirurgie: Ökonomie und Lernkurve an einem High-Volume-Zentrum

Zusammenfassung

Die roboterassistierte Thoraxchirurgie (RATS) gewinnt in Europa zunehmend an Bedeutung. Ziel der Studie war es, die Lernkurve und Sicherheit während der Etablierung eines RATS-Programms an einem High-Volume-Zentrum zu analysieren und die Kosten des Operationsverfahrens darzustellen. In einem Zeitraum von 33 Monaten wurden 255 Patienten prospektiv in die Studie eingeschlossen und alle perioperativen Prozesszeiten sowie Komplikationen erfasst. In 46% erfolgten Mediastinaleingriffe, in 38% anatomische Lungenresektionen, in 7% Keilresektionen und 6% Zwerchfellraffungen. Die mittlere OP-Zeit betrug 130 min, die Gesamtverweildauer 7 Tage. Die Konversionsrate lag bei 3,2%, die 30-Tage-Mortalität bei 1,2%. Die durchschnittlichen OP-Materialkosten pro Eingriff betrugen 2039 €, der mittlere DRG-Erlös 9568 €. Zusammengefasst kann ein RATS-Programm sehr sicher bei geringer Komplikationsrate und akzeptablen Materialkosten etabliert werden.

Abstract

Robot-assisted thoracic surgery (RATS) is a rapidly evolving surgical technique in Europe. The aim of the study was to analyse the learning curve and safety during the establishment of a RATS-program at a high-volume thoracic surgery centre and to quantify the costs of the surgical procedure in Germany. Within a period of 33 months, 255 patients were prospectively enrolled in the study and all perioperative process times and complications were recorded. Mediastinal procedures were performed in 46%, anatomical lung resections in 38%, wedge resections in 7% and diaphragm plications in 6% of patients. The mean operating time was 130 min and the total length of stay was 7 days. The conversion rate was 3.2% and 30-day mortality 1.2%. Mean costs for surgical consumables per intervention amounted to 2,039 €; the average reimbursement was 9,568 €. In summary, RATS can be safely established, performed and trained with low complication rates and acceptable costs for consumables.

Schlüsselwörter

RATS - Ökonomie - Lernkurve - Kosten - roboterassistierte Thoraxchirurgie

Keywords

RATS - costs - learning curve - daVinci - robot-assisted thoracic surgery

• Literatur

• 1 Möller T, Egberts JH, Eichhorn M. et al. Current status and evolution of robotic-assisted thoracic surgery in Germany-results from a nationwide survey. J Thorac Dis 2019; 11: 4807-4815
• 2 Terra RM, Leite PHC, Dela Vega AJM. Global status of the robotic thoracic surgery. J Thorac Dis 2021; 13: 6123-6128
• 3 Paul S, Jalbert J, Isaacs AJ. et al. Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy. Chest 2014; 146: 1505-1512
• 4 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
• 5 Cheufou DH, Mardanzai K, Ploenes T. et al. Effectiveness of Robotic Lobectomy-Outcome and Learning Curve in a High Volume Center. Thorac Cardiovasc Surg 2019; 67: 573-577
• 6 O’Sullivan KE, Kreaden US, Hebert AE. et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 2019; 8: 174-193
• 7 Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 2011; 141: 673-677
• 8 Cichos KH, Linsky PL, Wei B. et al. Cost Savings of Standardization of Thoracic Surgical Instruments: The Process of Lean. Ann Thorac Surg 2017; 104: 1889-1895
• 9 Gondé H, Laurent M, Gillibert A. et al. The affordability of minimally invasive procedures in major lung resection: a prospective study. Interact Cardiovasc Thorac Surg 2017; 25: 469-475
• 10 Le Gac C, Gondé H, Gillibert A. et al. Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve?. Interact Cardiovasc Thorac Surg 2020; 30: 255-262