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Robotics In Surgery

Is It Worth The Investment?

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Robots in Surgery

• Definition

• Surgical assisting

devices

• Surgeon-computer-

instrument interface

• Minimally invasive

surgery

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Da Vinci surgical system

• NASA Amesresearch centre -space surgery

• DARPA – battlefieldsurgery

• 1994 – first robotic

operation – intestinalanastomosis

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Da Vinci surgical system

• 1994 - Intuitive Surgical

• 1997 – First robotic procedure:

cholecystectomy• 2000 – 200 patient trial

• 2005 - 350 units sold

• 2006 – 70,000 operations done

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Methods

• Comparison against traditional open

surgery and standard minimally invasive

surgery

• Hospital stay, operation time, cost of 

equipment

• Pubmed and Google Scholar 

• Nissen fundoplication and Radical

retropubic prostatectomy

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Results: Initial Costs

• Initialpurchase

cost -

 €1,031,810

•  €737 per 

procedure

Item Cost (Euro)

da Vinci™ system including• Surgeon console• Surgical cart housing robotic arms• 3-D digital camera• Installation and testing

956,550

Endoscopes• 0° endoscope• 30° endoscope

16,50016,500

Sony 20’ monitor 3,800

Starter set of multispecialty traininginstruments

11,815

Starter set of accessories and disposables 16,645

Delivery cost 10,000

TOTAL 1,031,810

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Results: Maintenance costs

• Maintenance costs

•  €110,000 per year 

•  €550 per procedure

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Theatre, hospital, and

convalescence costs

• Theatre cost,

 €100.90 per hour 

• Hospital stay

cost, €432 per day

• Time away from

work, €83 per 

day

Item Cost per hour (Euro)

Surgeons’ fees*• Primary surgeon (1st year 

specialist registrar)• First assistant (1st year senior 

house officer)

27.7017.70

Anaesthetist’ fees* (1st year specialistregistrar)

27.70

 Nurses’ fees• Scrub nurse• Circulating nurse

13.9013.90

TOTAL 100.90

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Nissen FundoplicationItem (average values) Open method Standard minimally-invasive

surgery

Robotic surgery

Operative time 0.8 hours (50 minutes) 1.0 hours (60 minutes) 1.8 hours (107 minutes)

Hospital stay time 6.1 days 2.2 days 2.2 days

Convalescence time 35 days 12 days 12 days

Disposable equipment costs Not Applicable* €1006 €1558

1 Costi, R., Himpens, J., Bruyns, J., Cadiere, G. B.: Robotic Fundoplication: From Theoretic Advantages to Real Problems. J Am Coll Surg. Vol. 197

No.3 Pg. 500-507 Sept 2003

2 Richards, K. F., Fisher K. S., Flores J. H., Christensen B. J.: Laparoscopic Nissen fundoplication: cost, morbidity and outcome compared with open

surgery. Surg Laparosc Endosc. Vol. 6 No 2 Pg. 140-143 Apr 1996

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Nissen Fundoplication

• Versus open surgery

• Shorter hospital stay, shorter time to

return to work

• Longer operating time, cost of disposable

equipment, cost of maintenance, cost of 

initial purchase

• Cost savings of €647.90 per procedure

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Nissen Fundoplication

• Versus standard minimally invasive

surgery

• No cost benefit

• Longer operating time, cost of disposable

equipment, cost of maintenance, cost of 

initial purchase

• Increased cost of €1919.70 per procedure

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Radical retropubic prostatectomyItem (average values) Open method Standard minimally-invasive

surgeryRobotic surgery

Operative time 2.7 hours (163 minutes) 4.1 hours (246 minutes) 2.5 hours (148 minutes)

Hospital stay time 3.5 days 1.3 days 1.2 days

Convalescence time 47 days 47 days 30 days

Disposable equipment costs €75 €533 €1705

1 Lotan, Y., Cadeddu, J. A., Gettman, M. T.: The New Economics of Radical Prostatectomy: Cost Comparison of Open, Laparoscopic

and Robot Assisted Techniques. J Urol. Vol. 172 Pg. 1431-1435 Oct 2004

2 Menon, M., Shrivastava, A., Tewari, A.: Laparoscopic Radical Prostatectomy: Conventional and Robotic. J Urol. Vol 66 Pg 101-104.2005

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Radical retropubic prostatectomy

• Versus open surgery

• Shorter operating time, shorter hospital

stay, shorter time to return to work

• Cost of disposable equipment, cost of 

maintenance, cost of initial purchase

• Cost savings of €492.20 per procedure

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Radical retropubic prostatectomy

• Versus standard minimally invasive

surgery

• Shorter operating time, shorter hospital

stay, shorter time to return to work

• Cost of disposable equipment, cost of 

maintenance, cost of initial purchase

• Increased cost of €843.40 per procedure

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Discussion

• Cost effective

compared to open

surgery

• Expensive new

technology

• Potential for major 

improvements

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Conclusions

• Should the CUHbuy a da Vincisurgical robot?

• Probably notadvisable

• Current prices areprohibitive but thetechnology hastremendouspotential