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Robotic approach is already a new technological system in surgery and its potential advantages such as ergonomics, reduced tremor, 3D view and improved instruments movements have been well described (1,2). Concerning the current literature, the studies addressing the robotic benefits on left pancreatectomies are few. However, it has been showed that robotic distal pancreatectomy is both feasible and safe as well as the laparoscopic and the standard open approach. Although, there is a lack of high-level economic studies comparing these techniques (3-6).

AIM The aim of this meta-analysis is to compare perioperative outcomes and costs of robotic and laparoscopic distal pancreatectomy (RDP and LDP). MATERIAL AND METHODS In accordance with the PRISMA guidelines, we searched Medline, EMBASE, Cochrane and Web of Science for reports published before December 2020. RESULTS The literature search identified 11 papers (1 187 patients). RDP showed a lower conversion rate (odds ratio: 2.56, 95% confidence intervals [CI]: 1.31 to 5.00) with no significant differences in bleeding and operative time, complications ≥ Clavien-Dindo grade III, pancreatic fistulas and length of stay. Despite RDP presenting higher costs in all included studies, none of these differences were significant. However, RDP showed higher total costs than LDP (standardized mean differences [SMD]: -1.18, 95% CI: -1.97 to -0.39). A subgroup analysis according to the continent of origin showed that studies coming from Asian research groups kept showing significant differences (SMD: -2.62, 95% CI: -3.38 to -1.85), while Western groups did not confirm these findings. CONCLUSION Based on low-quality evidence, despite some potential technical advantages, RDP still seems to be costlier than LDP.

Aim There is no study in the literature that evaluates the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP). We performed a comparative study of RDP and LDP with the aim of evaluating clinical and cost-effective outcomes. Material and methods This is an observational, comparative prospective nonrandomized study. The primary end point was to compare the cost-effectiveness differences between both groups. A willingness to pay of €20 000 and €30 000 per quality-adjusted life year (QALY) was used as a threshold to recognize which treatment was most cost-effective. Results A total of 31 RDP and 28 LDP have been included. The overall mean total cost was similar in both groups (RDP: €9712.15 versus LDP: €9424.68; P > .5). Mean QALYs for RDP (0.652) was higher than that associated with LDP (0.59) (P > .5). Conclusion This study seems to provide data of cost-effectiveness between RDP and LDP approaches, showing some benefits for RDP.

Objective The aim of this study is to compare the clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral inguinal hernias. Summary background data A cost-effective analysis of laparoscopic versus open inguinal hernia repair is still not well addressed, especially regarding bilateral hernia. Methods This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital.Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program.The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio. Results Between March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL).The TAPP procedure had less early postoperative pain (P = 0.037), a shorter length of stay (P = 0.001), and fewer postoperative complications (P = 0.002) when compared with the OL approach. The overall cost of TAPP procedure was higher compared with the OL cost (1,683.93O vs 1192.83O, P = 0.027). The mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (P = 0.018). At a willingness-to-pay threshold of 20,000 O and 30,000 O, there was a 95.38% and 97.96% probability that TAPP was more cost-effective relative to OL. Conclusions The TAPP procedure for bilateral inguinal hernia appears to be more cost-effective compared with OL.

In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000€ and 30,000€ per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.

Objective: To carry out the Budget Impact Analysis (BIA) associated with the introduction of the Nutritional Home Care Assistance (NHCA) into the Spanish National Health System (NHS). Methods: A model was developed to assess the BIA from the Spanish NHS perspective for one year period (2015). Clinical and costs data of a retrospective cohort from HM Hospital Group were used to estimate the variable costs associated to parenteral nutrition and to estimate the population that could be treated with NHCA. Scientific literature and Related Diagnostics Group (RDG) published by the Spanish NHS were used to estimate clinical and costs of Spanish NHS. A Markov model was elaborated and processed through 15,000 Monte Carlo simulations for the whole Spanish population. A sensitivity analysis was performed for the set of variables associated with a significant uncertainty. Results: The number of patients treated at the private hospital cohort was estimated to 120 patients. In this population the net savings was € 36,572.91 for one year period. According to the model, the patient population susceptible to treatment for the Spanish NHS with NHCA was from 822 to 921 patients. The use of NHCA results in annual budgetary net savings from € 1,83 to € 2,05 millions for the Spanish NHS. Conclusions: The NHCA could generate net savings for the Spanish NHS for a period of one year.