Costs and Benefits of Robotic Surgery
Medscape: One of the major issues in the use of the robotics is the price. The machine itself costs between $1.5 and $2.2 million dollars. In addition, the service contracts run from $160,000 to $170,000 per year. Then disposable instruments range from $600 to $1000, and each procedure can use 3-8 instruments. Given that, do you think these machines will ever become as cost effective as the use of laparoscopy?
Dr. Colella: This is a very general question, and it boils down to using the robot for the appropriate indications. Let's take the example of a hysterectomy: It's a major advance when you can take a patient from an open to a minimally invasive procedure using the robot. It has an impact on that patient's overall life in a very substantial, beneficial way. The cost is ultimately realized in terms of savings—from length of stay in the hospital to lower complication and readmission rates. All of these are much improved with the robot vs an open procedure for a hysterectomy.
Also consider that in bariatric robotic surgery the bleed rate approaches zero, the major complication rate is less than 0.3%, and there have been no reported deaths in robotic bariatric surgery. Then factor in the substantial reduction in stricture rates, which cause postoperative readmissions and procedures, and the use of fewer staples than in laparoscopy. You can begin to realize the cost savings with robotic surgery and that it does not take very many cases to realize those savings.
Medscape: I know that you specialize in bariatric surgery, but are there robotic procedures that you think will eventually be most or least advantageous?
Dr. Colella: Well, as a potential patient, stop for a moment and put on the common sense hat. Your surgeon tells you that he can see 100% better in 3 dimensions, that he can sew better, and probably within 1-2 years he will be able to do every procedure through 1 incision. You can imagine that the sky is the limit in employing robotic surgery. It's an enabling technology. I firmly believe that we are finding new and beneficial applications almost on a monthly basis.
For instance, nobody ever thought that you would be able to resect tumors of the larynx without taking half of the face apart to get to them. With the robot in the right hands, you can do those operations in an hour, and the patient goes home the next day.
Another example that will be a tremendous game changer is when you can do robotic gastric bypass with a single 15-mm incision in a 600-lb patient, who goes home the next day with the same safety profile that I just talked about. Robotics have enormously minimized the trauma that these patients face from the surgery and have lessened the need for pain medication, which allows much quicker gastrointestinal recovery, which, in turn, reduces the incidences of pneumonia and aspirations. This technology is making impacts in ways that aren't even obvious to some of the people who employ it.
Medscape: What about the visual field? I know with laparoscopy that was one of the disadvantages compared with open procedures. Is that an issue with robotics?
Dr. Colella: The robotic visual field is somewhat smaller than the laparoscopic visual field. However, you quickly adapt and know the limits of your vision or the lack of them. The slight reduction in visual field is insignificant for me, and one might argue that a bariatric operation is one of the most complex procedures done either robotically or laparoscopically. I don't perceive visual limitation to be anything of a disadvantage. As a matter of fact, with 3-dimensional vision, with the ability to see better in any spot than I ever could with laparoscopy, it changes the game in a very positive way. I don't see that a slight reduction in the visual field has any impact on my ability to perform a procedure, given the other benefits from using robotic instrumentation.
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Cite this: Is Robotic Surgery Worth Its Price? An Interview With Dr. Joseph Colella - Medscape - Jun 20, 2013.