Robotic-assisted thoracic surgery: a helpful tool or just another expensive gadget?

Optimizing the Financial Burden of the Approach to Robot-Assisted Radical Prostatectomy

Objectives: The robot-assisted approach to radical prostatectomy (RARP) has been adopted worldwide as an acceptable alternative to open prostatectomy owing to improved visualization and dexterity for surgeons, with improved recovery and convalescence for patients. However, the associated cost of installation of robot as well as running costs may hamper its utilization. We sought to investigate and identify the drivers of cost at our institution and implement changes that could reduce costs. Methods: We retrospectively reviewed the annual cost data of all RARPs performed by a single surgeon between April 1, 2017 and March 31, 2018. A cost analysis was performed investigating the variable costs associated with RARP: anesthesia related, operative time, and medical supplies. We then prospectively implemented a cost reduction plan that included reducing the number of robotic instruments used per surgery, surgical supplies, and changing the type of trocars. We also investigated whether these changes impacted cost as well as operative outcomes. Results: Forty retrospective procedures were compared with 32 prospective procedures after implementation of cost reduction plan. There were no differences in clinical characteristics. Cost savings per case were $705 for variable costs (95% CI $662, $748, p < 0.01): $36 for anesthesia related (95% CI $5, $67, p = 0.03), $198 for operative time (95% CI $145, $251, p < 0.01), and $471 for medical supplies (95% CI $438, $504, p < 0.01). There was no statistically significant difference in operative time or estimated blood loss between the two groups. Conclusion: Cost reduction plan can reduce total cost associated with RARP without compromising patient safety or operating room efficiency.