246 Robotic Assisted Minimally Invasive Oesophagectomy (RAMIO) versus Minimally Invasive Oesophagectomy (MIO) a cost and outcome comparative observational study.

Abstract Aim This study aimed to compare demographics, outcomes and costs of 50 consecutive unselected RAMIO and MIO cases at a single centre. Method Retrospective data was collected on cases performed by the same surgeons, using the same anastomotic technique and equipment (to reduce operator variability) between 2021 and 2025 and analysed using SPSS. MIO and RAMIO were carried out on alternate weeks due to limited access to robotics. Results There was no significant difference in age, smoking status or BMI between RAMIO and MIO groups. There was a difference in ASA (84% RAMIO ASA 3 versus 26.5% MIO p<.001), however, cardiovascular/respiratory co-morbidities were similar (p.15). Median operating time was 381 minutes RAMIO (IQR 353-409), MIO 282 (IQR 250-351) p.002, length of stay 11 days RAMIO (IQR 9-13), 9 MIO (IQR 8-12) p.046. There was no significant difference in rate of anastomotic leaks (RAMIO 2% n=1 requiring stent, MIO 6%,p.617) or re-operation (RAMIO 2%, MIO 6%,p.61). RAMIO had a higher rate of clear circumferential margins (83.7% versus MIO 76%), similar median lymph node yields (IQR 22-36, MIO IQR 23-33.75). Less RAMIO patients were referred for adjuvant radiotherapy (16%, MIO 24%). Cost of consumables and post operative hospital stay were similar (p.81). Conclusions This study comparing demographically similar RAMIO and MIO cases found RAMIO had a longer operating time with no difference in post operative complication rates. The cost per procedure was comparable, allowing the for the initial cost of the robotic platform. There was a trend towards improved oncological outcomes.