Economic sustainability of a newly established robotic thoracic surgery programme in a public healthcare system: early experience from a high-volume latin American centre.

Abstract

Robotic-assisted thoracic surgery (RATS) has emerged as an important advancement in minimally invasive thoracic surgery; however, concerns regarding its economic impact continue to limit its broad adoption. We evaluated the early clinical outcomes and economic performance of a newly established robotic thoracic surgery programme in a tertiary referral centre in Mexico. A retrospective observational study was conducted, including consecutive patients undergoing RATS between October 2023 and June 2024. Clinical outcomes of the robotic cohort were analysed descriptively. Economic comparisons with conventional thoracic surgery were performed using institutional administrative costing data. A total of 116 patients underwent RATS. Median postoperative hospital stay was 5 (2-10) days, with a 90-day mortality of 1.7%. Economic performance differed according to procedure. Mediastinal tumour resection demonstrated lower overall institutional costs than conventional surgery, representing a dominant economic strategy. Thymectomy and bronchoplasty achieved favourable cost-effectiveness profiles below the two-times gross domestic product per capita willingness-to-pay threshold, whereas bullectomy remained cost-effective only under the three-times threshold. The implementation of a robotic thoracic surgery programme within a public healthcare institution was clinically feasible and demonstrated favourable economic performance in selected thoracic procedures. The economic sustainability of robotic thoracic surgery appears to be procedure-specific and may be facilitated by innovative implementation strategies and appropriate case selection.