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Introduction: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres., Methods: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP., Results: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively., Conclusions: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Leiomyomatosis peritonealis disseminata is an uncommon condition characterized by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells. This entity generally appears in premenopausal women and hormonal influences may play a role in its pathogenesis. The macroscopic appearance mimics peritoneal carcinomatosis. The characteristic clinical course is asymptomatic and diagnosis is only feasible after microscopic examination. To date, less than 100 cases have been reported in the literature. We report the case of a 40-year-old woman who underwent surgery in our department.

Surgery in hemophilic patients is a challenge for the general surgeon. Hemophilic pseudotumor is a rare complication occurring in 1-2% of hemophiliacs and affecting mainly patients with severe disease or those who have developed antibodies to factor VIII or IX. A number of alternatives are available for the management of these tumors, including conservative treatment, surgical removal, percutaneous drainage, embolization, and external radiation. The only definitive treatment is surgical excision. We report a case of hemophilic pseudotumor of the pelvic bone. Treatment consisted of surgical resection after arterial embolization using factor replacement to achieve hemostasis.

Esophageal lipomas are uncommon benign tumors. The main symptom of this type of tumor is dysphagia due to esophageal obstruction. The diagnostic studies of choice are endoscopy, radiological investigation with contrast administration, computed tomography, and echoendoscopy. We present an unusual case of giant pediculated esophageal lipoma which manifested clinically with dysphagia. Management was surgical.