The Cost of Learning Robotic-Assisted Prostatectomy

ObjectiveRobotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients’ outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications.MethodsBetween 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method.ResultsBased on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was €1456 per intervention. The robot-specific costs amounted to €2213 per intervention, and the cost of the robot-specific surgical supplies was €957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to €1432, which is significantly higher than that of the robotic supplies (P < 0.001). Hospital costs were lower in the case of the robotic strategy (€2380 vs €2841, P < 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (€1490 vs €1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours).ConclusionsThe main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.

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Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1713895 ◽

2020 ◽

Cited By ~ 3

Author(s):

Eric J. Cotter ◽

Jesse Wang ◽

Richard L. Illgen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Patient Characteristics ◽

Robotic Assisted ◽

Episode Of Care ◽

Total Knee ◽

Implant System ◽

The Cost

AbstractExcellent durability with traditional jig-based manual total knee arthroplasty (mTKA) has been noted, but substantial rates of dissatisfaction remain. Robotic-assisted TKA (raTKA) was introduced to improve clinical outcomes, but associated costs have not been well studied. The purpose of our study is to compare 90-day episode-of-care (EOC) costs for mTKA and raTKA. A retrospective review of an institutional database from 4/2015 to 9/2017 identified consecutive mTKAs and raTKAs using a single implant system performed by one surgeon. The raTKA platform became available at our institution in October 2016. Prior to this date, all TKAs were performed with mTKA technique. After this date, all TKAs were performed using robotic-assistance without exception. Sequential cases were included for both mTKA and raTKA with no patients excluded. Clinical and financial data were obtained from medical and billing records. Ninety-day EOC costs were compared. Statistical analysis was performed by departmental statistician. One hundred and thirty nine mTKAs and 147 raTKAs were identified. No significant differences in patient characteristics were noted. Total intraoperative costs were higher ($10,295.17 vs. 9,998.78, respectively, p < 0.001) and inpatient costs were lower ($3,893.90 vs. 5,587.40, respectively, p < 0.001) comparing raTKA and mTKA. Length of stay (LOS) was reduced 25% (1.2 vs. 1.6 days, respectively, p < 0.0001) and prescribed opioids were reduced 57% (984.2 versus 2240.4 morphine milligram equivalents, respectively, p < 0.0001) comparing raTKA with mTKA. Ninety-day EOC costs were $2,090.70 lower for raTKA compared with mTKA ($15,629.94 vs. 17,720.64, respectively; p < 0.001). The higher intraoperative costs associated with raTKA were offset by greater savings in postoperative costs for the 90-day EOC compared with mTKA. Higher intraoperative costs were driven by the cost of the robot, maintenance fees, and robot-specific disposables. Cost savings with raTKA were primarily driven by reduced instrument pan reprocessing fees, shorter LOS, and reduced prescribed opioids compared with mTKA technique. raTKA demonstrated improved value compared with mTKA based on significantly lower average 90-day EOC costs and superior quality exemplified by reduced LOS, less postoperative opioid requirements, and reduced postdischarge resource utilization.

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Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

Indian Journal of Surgery ◽

10.1007/s12262-021-02864-5 ◽

2021 ◽

Author(s):

Vivek Sharma ◽

Thusitha Hettiarachchi ◽

Dhiraj Sharma ◽

Irshad Shaikh

Keyword(s):

Laparoscopic Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Anterior Resection ◽

Cost Effective ◽

Robotic Assisted ◽

Novel Method ◽

Standard Laparoscopic Surgery ◽

The Cost ◽

Disposable Equipment

AbstractIn the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

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Evaluation of Operative Waste in a Military Medical Center: Analysis of Operating Room Cost and Waste during Surgical Cases

The American Surgeon ◽

10.1177/000313481908500729 ◽

2019 ◽

Vol 85 (7) ◽

pp. 717-720 ◽

Cited By ~ 1

Author(s):

Elizabeth D. Rose ◽

David M. Modlin ◽

Maeghan L. Ciampa ◽

Christopher W. Mangieri ◽

Byron J. Faler ◽

...

Keyword(s):

Quality Improvement ◽

Inguinal Hernia ◽

Observational Study ◽

Medical Center ◽

Hospital Costs ◽

Improvement Project ◽

Robotic Assisted ◽

Surgical Devices ◽

The Cost ◽

Complex Cases

Operating rooms (ORs) contribute to at least 40 per cent of hospital costs. There is an existing cost waste in ORs for surgical devices that are opened without being used. There is a paucity of data evaluating the hospital cost of opened but unused OR supplies. The goal of this observational study is to examine the cost of opened but unused OR supplies for general surgery cases. We performed a quality improvement project of OR cost waste by observing 30 cases. Surgical cases of a senior surgeon who had been at the institution for more than five years were evaluated for items opened appropriately and whether the items are used. The cases evaluated ranged from open hernia repairs to robotic-assisted hernia repairs. We found that the cost of instruments opened but not used was $4528.18. Of the cases evaluated, we found that a range of 0 per cent to 27 per cent of total items were wasted, an average of 8.3 per cent. We found that for the open inguinal hernia case, there was minimal waste. The highest waste was among complex cases such as the robotic-assisted inguinal hernia with an average waste and cost of 15.8 per cent and $379. We found that on average for less complex cases such as open inguinal hernia repairs, $1.44 was potentially wasted per case, whereas for more complex cases up to $379 was wasted per case. We identified the outdated preference cards, lack of instrument knowledge, circulating nurse, and surgical technician distractions as reasons for contributing to waste.

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P105 Robosurgeons vs. robosceptics’: can we afford robotic technology or can we afford not to?

BJS Open ◽

10.1093/bjsopen/zrab032.104 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Jasmesh Sandhu ◽

Jasmesh Sandhu

Keyword(s):

Cost Effectiveness ◽

Radical Prostatectomy ◽

High Volume ◽

Robotic Prostatectomy ◽

Robotic Technology ◽

Robotic Training ◽

Robotic Assisted ◽

Open Radical Prostatectomy ◽

Robotic Assisted Radical Prostatectomy ◽

The Cost

Abstract Aim To investigate the cost-effectiveness of robotic technology in robotic-assisted radical prostatectomy in comparison with laparoscopic radical prostatectomy and open radical prostatectomy. Methods The British Association of Urology Surgeons database (2014–2016) and Cancer Research UK (2012–2014) were accessed in conjunction with media; keywords included: ‘Da Vinci’, ‘first robotic prostatectomy’, ‘hospital’ to estimate the cost-effectiveness of robotic-assisted radical prostatectomy in the National Health Service. Results Approximately 12/43 (27.9%) centres achieved 150 robotic-assisted radical prostatectomies per year while 26/43 (60.4%) centres have managed to meet 100 robotic-assisted radical prostatectomies per year in 2014–2016. A national mean of 120–130 robotic-assisted radical prostatectomies per year for 2014–2016 was estimated. Conclusion The cost of robotic-assisted radical prostatectomy is adequately justified if a high volume of surgeries (>150) are performed in high volume centres by high volume experienced surgeons per year. This can be achieved by subsidising the cost of robotic technology, centralisation and establishing robotic training centres.

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Postoperative complications decrease the cost-effectiveness of robotic-assisted lobectomy

Surgery ◽

10.1016/j.surg.2018.08.024 ◽

2019 ◽

Vol 165 (2) ◽

pp. 455-460 ◽

Cited By ~ 3

Author(s):

Peter J Kneuertz ◽

Emily Singer ◽

Desmond M D'Souza ◽

Susan D Moffatt-Bruce ◽

Robert E Merritt

Keyword(s):

Cost Effectiveness ◽

Postoperative Complications ◽

Robotic Assisted ◽

The Cost

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Robotic Surgery for the Thoracic and Vascular Surgeon

10.5772/intechopen.97598 ◽

2021 ◽

Author(s):

Lawek Berzenji ◽

Krishan Yogeswaran ◽

Patrick Lauwers ◽

Paul Van Schil ◽

Jeroen M.H. Hendriks

Keyword(s):

Robotic Surgery ◽

Great Majority ◽

Minimal Invasive ◽

Vascular Surgeon ◽

Robotic Assisted ◽

Hand Eye Coordination ◽

Arcuate Ligament ◽

Mediastinal Tumours ◽

The Cost ◽

Proven Benefit

In the last two decades, robotic-assisted approaches have gained popularity as alternatives to conventional open and minimal-invasive surgery (MIS). The robotic approach combines the concepts of the traditional MIS with the latest technological advancements, enabling the surgeon to control the instrumentation using a robotic device connected to a remote console. With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception and hand-eye coordination. Since its introduction, numerous robotic-assisted procedures have been developed and tested across nearly all surgical fields. Data from previous studies have shown that a great majority of these techniques are feasible and have favourable treatment outcomes. In the field of thoracic and vascular surgery, two disciplines often combined in Belgium, robotic approaches have been implemented in the treatment of a wide array of disorders including lung cancer, mediastinal tumours, thoracic outlet syndrome, diaphragmatic paralysis, sympathectomy, aortobifemoral bypass surgery and division of the arcuate ligament for median arcuate ligament syndrome (MALS). Despite this increasing popularity, there are still a number of controversies regarding robotic surgery. There are only limited data on the cost-effectiveness of robotic surgery and its objective proven benefit over conventional MIS. In this review, we summarise the latest data on robotic approaches for the most relevant thoracic and vascular disorders.

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