The Untold Economic Advantages of Robotic

SurgeryRobert Poston, MD

Chairman, Cardiothoracic SurgerySt Francis Medical Center, Trenton, NJ

Conventional Wisdom: Robotic surgery is more expensive than open or laparoscopic surgery

LIMITATIONS OF LITERATURE: ACCOUNTING FOR DYNAMIC COSTS

• Standard accounting practice for determining ROI• Spread out fixed costs of capital over the

timeframe in which revenue is generated• Hospitals allocate fixed costs to the

responsible department

Decision to Purchase a Robot Decision to Use a Robot

• Not standard practice for calculating costs/profitability of specific procedures

Allocate fixed robot costs

only to robotic cases

Costs/case increased

for robotics

More cases done open/ laparoscopc

Decreased volume of

robotic cases

Sunk cost fallacy

LIMITATIONS OF LITERATURE: AMORTIZATION OF CAPITAL EQUIPMENT

AVAILABLE SAFEGUARDS

Totally endoscopic (TECAB)

Minithoracotomy

safety frontier

Unsafe

Safe

Robotic Heart Surgery Tradeoffs

LESS

INVA

SIVE

NES

S

Sternotomy• Standardized, automated• Prerequisites understood• Easy access to safety net (CPB)

LESS

INVA

SIVE

NES

S

AVAILABLE SAFEGUARDS

Safe

Totally endoscopic (TECAB)

Minithoracotomy

safety frontier

Unsafe

Safe

Robotic Heart Surgery Tradeoffs

Sternotomy• Standardized, automated• Prerequisites understood• Easy access to safety net (CPB)

safety frontier Unsafe

Safe

Culture of safety- “no blame” approach- psychological safety- collaboration

LESS

INVA

SIVE

NES

S

AVAILABLE SAFEGUARDS

Expectations

Time

Performance

Low

High

Low

High

Rapid Improvements

1st case …Nth case

Expectations-reality gap

Robotic programintroduced

Trial and error

Status quo

Life Cycle of Robotic Surgery

Conclusions

1. Control for costs that are dynamic or sunk2. Focus on the opportunity costs3. Tie value into the “big picture”

Rational economic analysis of robotics: