Cost Minimization and Cost Comparison of the Use of Conventional Double Lumen Tube versus Single-Use VivaSight-Double Lumen Tube in Thoracic Surgery: The Pascale Institute Experience

Purpose: One lung ventilation (OLV) is essential in thoracic surgery to isolate and ventilate a single lung, ensuring optimal surgical exposure and patient safety. Precise placement of a double lumen tube (DLT) is critical and conventionally confirmed via reusable bronchoscopy. Patients and Methods: We evaluated the economic and organisational impact of introducing VivaSightDLT-an endobronchial tube with an integrated camera-at Fondazione G. Pascale (Naples). Data from 50 patients were reviewed to compare device efficacy and positioning accuracy. Cost data from the Institute's management control informed a cost minimization analysis (CMA) and cost comparison analysis (CCA), projecting financial outcomes over 1, 3, and 5 years, based on an annual thoracic surgery volume of 400 cases (328 eligible for VivaSightDLT). Results: Although the per unit cost of VivaSightDLT exceeds that of the conventional DLT, mean savings per procedure were €86.36. When additional intraoperative bronchoscopic checks were required, savings increased to €193.89 per case. Net savings of €16,728.54 at 1 year, €50,185.62 at 3 years, and €83,642.70 at 5 years (15% reduction in direct variable costs) were projected. Full replacement of conventional DLTs would yield a 41% reduction in direct variable costs (€33,457.08, €100,371.25, and €167,285.41 over 1, 3, and 5 years, respectively). VivaSightDLT also reduced operative times by 14-25 minutes (19.5 min IC95%: 14-25), enhancing operating room turnover. Conclusion: The integration of VivaSight DLT at the Istituto Nazionale Tumori, Fondazione G. Pascale, demonstrates superior cost-effectiveness and procedural organisational efficiency compared to conventional DLTs. By eliminating routine reusable bronchoscopy and reducing procedure duration, VivaSight DLT represents an optimal strategy for OLV in thoracic surgery.