Robotic Surgery and Cost

Over the last few years there has been a significant increase in the number of hospitals starting up "robotic surgery" programs. In fact, robotic assisted surgery for prostate removal has become the "standard of care" for prostatectomy. Robotic surgery in gynecology has become more controversial. I think all providers would agree that the benefits of laparoscopic approach to surgery are much greater than by traditional laparotomy or open surgery. In my view, robotic assisted surgery is merely a laparoscopic surgery that is helped by robotic or computer assistance. Robotic systems have allowed many gynecologists the opportunity to offer a less invasive approach to surgery that would otherwise have been done by a large incision. These are gynecologists who were not trained to perform advanced laparoscopic procedures. With the "buzz" around robotic surgery, hospitals have had a difficult time understanding the appropriate use of the robotic system. From which procedures to allow to appropriate training of the surgeons, hospital systems are wading through new waters to provide a better service while assuring that patient safety and economic sensibility is maintained. Many published studies have shown that robotic hysterectomy is more expensive to the healthcare system than laparoscopic or open, abdominal, hysterectomy. These studies include the purchase price or depreciation of the robotic system for each surgery performed. In most cases, the additional amount applied to surgical cost is around $2500 per surgery. The major flaw with this approach to calculating cost of robotic surgery is that any hospital that commits to a robotic prostate program has to purchase the system. The cost of the system and the annual maintenance are fixed costs that are required if only one type of procedure is done. Allowing hysterectomy to be performed robotically, does not increase the cost that hospitals have already committed to a robotics program. In fact, at one of the hospitals I practice, we did an internal cost analysis of robotic hysterectomy compared to regular laparoscopic and abdominal hysterectomy. We were surprised to find out that the robotic approach was actually the least expensive for total hospital cost of the surgery. The cost of robotic hysterectomy is close to that of laparoscopic and is significantly less than that of abdominal or open. As each day passes patients are becoming more aware that regular "open" surgery really is a thing of the past. Most abdominal surgeries can be done and should be done in a less invasive way. New surgeons are constantly being trained as they see their patients seek out providers who can offer a less invasive treatment. Patients should understand that they have a right to find the least invasive option for treating their medical conditions. This may include robotic or laparoscopic surgery or, often, treatment with medicine that doesn't require surgery. If surgery is chosen, surgeon experience and outcomes are the two most important aspects to a safe surgery with expected outcomes. There is a large myth that robotic surgery is too costly and dangerous to use for more routine surgeries. The overall cost to the healthcare system is not increased, at least in my practice. The safety of robotic surgery depends on those aspects that the safety of any surgery depends on: surgeon experience, proven techniques, experienced operative team, appropriate decision-making and educated patients.

Robotic Surgery

There has been much talk in Utah recently about the new DaVinci Robot for performing laparoscopic or minimally invasive surgery. It offers many advantages including a minimally invasive approach to surgery, less blood loss, fewer infections, better surgical visualization, and increased dexterity of performing complex laparoscopic procedures, not to mention a more ergonomic and comfortable operating experience for the surgeon.

There are a few hospitals in Salt Lake City which have these laparoscopic robots. They are allowing physicians in the Salt Lake area the ability to offer their patients advanced laparoscopic procedures instead of surgery performed through larger, traditional incisions.

I have trialed one of these robots at a conference, and it is truly a neat device. It allows a simplicity in performing advanced dissection techniques, and laparoscopic suturing. Access to a laparoscopic robot would provide many more surgeons the opportunity to learn advanced procedures without the time and effort of a fellowship or extended training.

Although there is an increase in cost to performing robot assisted surgery, the overall cost is still lower than a traditional "open" surgery.

To surgeons who are already trained and skilled in advanced laparoscopic surgery, the robot does not at this time offer too many advantages except in difficult cases. Gynecologic surgeries performed by laparoscopy include surgery for: hysterectomy, extensive endometriosis, uterine fibroids, adhesion, pelvic prolapse and bladder drop surgery.

Robot assisted laparoscopy is an upcoming addition to women's surgery. There are thousands of "robotic" surgeries performed each year. For years, traditional laparoscopic surgeons have been struggling to find a route to decreasing the number of open surgeries performed. Robotic surgery will dramatically increase the number of physicians able to perform minimally invasive surgery. Hopefully we will finally see a change in the type of surgery done for the majority of women that will allow them to get back home, go back to work, and get back to life quicker with less pain.