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8/14/2019 Robotics in Surgery is It Worth The
http://slidepdf.com/reader/full/robotics-in-surgery-is-it-worth-the 1/19
Robotics In Surgery
Is It Worth The Investment?
8/14/2019 Robotics in Surgery is It Worth The
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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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8/14/2019 Robotics in Surgery is It Worth The
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8/14/2019 Robotics in Surgery is It Worth The
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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