COMMENTARY

Robotic Surgery: Is It Worth the Additional Expenses?

Albert B. Lowenfels, MD

Disclosures

October 12, 2018

Earlier this year, I reviewed the cost, use, and trends of robotic surgery and summarized a paper that was presented at the 2017 American College of Surgeons meeting.[1] As the use of the robotic platform for surgical procedures continues to grow, the clinical benefit and costs of robotic-assisted versus conventional laparoscopic surgery comes into question.

The aim of a recent study published in JAMA was to provide an estimate of the additional costs incurred by robotic surgery.[2] The authors gathered publically available financial data from Intuitive Surgical Inc., the company that supplies nearly all of the robotic surgical equipment to the United States and other countries.

For the year 2017, the estimate cost for each robotic procedure performed in the United States was $3568, which included $1866 for the cost of disposable instruments—considerably more than instrument costs for other procedures, such as laparoscopic surgery.

Additional Expenses of Robotic Surgery

This report provides information on the minimum costs for each robotic surgical procedure; it does not include expenses such as extra time required for these procedures or additional expenses for staff training.

From 2010 to 2017, use of robotic surgery increased dramatically in the United States, from about 225,000 annual procedures to over 600,000 procedures. The authors remind us that the justification for robotic surgery will depend upon carefully designed randomized studies to demonstrate both the immediate and the eventual long-term benefit of this approach.

For any carefully designed study, there will be problems with recruitment, follow-up, and avoiding bias from company sponsorship. Another recent study, published in Annals of Surgery, reported that comparative studies are often supported by the manufacturer, and that size of payment to the investigator has a significant relationship to the outcome.[3]

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