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Nishimura et al. Mini-invasive Surg 2020;4:11 I http://dx.doi.org/10.20517/2574-1225.2019.48 Page 9 of 10

performed. There appears to be an overall underappreciation in the surgical literature of the differences
among cost, charges, and recovery of services, which rendered comparison incredibly difficult. Additionally,
there is little appreciation for the running costs that go into caring for these patients and are often assumed
into operational overhead. This review was also based on observational studies, with all but one study
utilizing retrospective analysis. In addition, the majority of studies reported using the Si, which is an older
generation. Only two of 16 studies reviewed noted using the Xi, which was Food and Drug Administration
approved and introduced to the USA in 2014. Another limitation is the limited number of studies regarding
quality of life available for review. More studies on patient reported outcomes for those undergoing robotic
lobectomies are needed to better understand its impact on quality of life. Finally, while we evaluated
financial costs to the hospital and quality of life of patients undergoing robotic lobectomy, we did not
comprehensively assess the value of the robotic platform. There are more important factors to consider
beyond index hospitalization costs and PRO.

CONCLUSION
Developing a robotic lobectomy program may be associated with relatively higher index hospital costs
when compared to VATS approach. With increased experience and volume of robotic cases, this difference
may no longer be of significance, but additional defining of costs versus charges is needed as a surgical
society. As an overall review, the cost of robotic lobectomy is comparable if not less costly than open
lobectomy based on single institution studies and may be profitable for the hospital, if we can better
understand the operational costs needed to care for these patients. Quality of life appears to be acceptable
in the early experience of robotic lobectomy.

DECLARATIONS
Authors’ contributions
Manuscript preparation: Nishimura JM
Editorial of manuscript: Nishimura JM, Goodwin M, Kneuertz P, Moffatt-Bruce S, Merritt RE, D’Souza DM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Dr. Desmond D’Souza is a proctor for Intuitive Surgical Inc. Dr. Robert Merritt is a speaker for Intuitive
Surgical Inc. All other authors declare no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Subramanian MP, Liu J, Chapman Jr WC, Olsen MA, Yan Y, et al. Utilization trends, outcomes, and cost in minimally invasive
lobectomy. Ann Thorac Surg 2019;108:1648-55.