Comparative analysis of operative cost in lung resection: preoperative robotic navigational bronchoscopy (Nav) vs. intraoperative wedge biopsy

Abstract Evaluate differences in operative cost in pulmonary resection between patients who had preoperative biopsy via robotic navigational bronchoscopy versus an intraoperative diagnostic wedge. We performed a retrospective cohort study of patients who underwent standard lobectomy at our institution between January 2024 and July 2025. We identified patients who had a preoperative robotic navigational bronchoscopy (Nav) prior to lung resection and those who had no preoperative biopsy (NPB) and had intraoperative diagnostic wedge. We then examined operative time, stapler load quantity, stapler cost, robotic cost, and overall operative cost. 128 patients were identified, 53 in the NPB cohort and 75 in the Nav cohort. The mean age of the cohort was 68. The average surgical cost of the non-preoperative biopsy (NPB) cohort was $10,258.68 and $9,249.36 in the Nav cohort ( P = 0.007). The average stapler loads used, total stapler cost, total robotic I&A costs, and surgical supply costs were higher in the NPB cohort ( P < 0.001). The average technical cost of performing a frozen specimen was $65.35. There was no statistically significant difference in operative time between cohorts, however the NPB cohort had a longer operative time on average (187.83 min vs. 174.63 min, P = 0.161). We found that on average, surgical cost, operative time, robotic cost, and OR charges were higher in patients who had undergone intraoperative frozen section (NPB) compared to those with preoperative biopsy (Nav). This data suggest that the use of preoperative robotic bronchoscopy is associated with decreased cost of robotic lung resection.