Surg Endosc
DOI 10.1007/s00464-016-4954-2
Cost analysis of robotic versus laparoscopic general surgery
procedures
Rana M. Higgins1 • Matthew J. Frelich1 • Matthew E. Bosler1 • Jon C. Gould1
Received: 15 March 2016 / Accepted: 18 April 2016
Ó Springer Science+Business Media New York 2016
Abstract
Background Robotic surgical systems have been used at a
rapidly increasing rate in general surgery. Many of these
procedures have been performed laparoscopically for
years. In a surgical encounter, a significant portion of the
total costs is associated with consumable supplies. Our
hospital system has invested in a software program that can
track the costs of consumable surgical supplies. We sought
to determine the differences in cost of consumables with
elective laparoscopic and robotic procedures for our health
care organization.
Methods De-identified procedural cost and equipment
utilization data were collected from the Surgical
Profitability Compass Procedure Cost Manager System
(The Advisory Board Company, Washington, DC) for our
health care system for laparoscopic and robotic cholecys-
tectomy, fundoplication, and inguinal hernia between the
years 2013 and 2015. Outcomes were length of stay, case
duration, and supply cost. Statistical analysis was per-
formed using a t-test for continuous variables, and statis-
tical significance was defined as p \ 0.05.
Results The total cost of consumable surgical supplies was
significantly greater for all robotic procedures. Length of
stay did not differ for fundoplication or cholecystectomy.
Length of stay was greater for robotic inguinal hernia
repair. Case duration was similar for cholecystectomy
Presented at the SAGES 2016 Annual Meeting, March 16–19, 2016,
Boston, Massachusetts.
& Jon C. Gould
jgould@mcw.edu
1 cost of robotic surgery when compared to well-established
Division of General Surgery, Department of Surgery,
Medical College of Wisconsin, 9200 West Wisconsin
Avenue, Milwaukee, WI 53226, USA
and Other Interventional Techniques
(84.3 robotic and 75.5 min laparoscopic, p = 0.08), but
significantly longer for robotic fundoplication (197.2
robotic and 162.1 min laparoscopic, p = 0.01) and ingu-
inal hernia repair (124.0 robotic and 84.4 min laparoscopic,
p = 0.01).
Conclusions We found a significantly increased cost of
general surgery procedures for our health care system when
cases commonly performed laparoscopically are instead
performed robotically. Our analysis is limited by the fact
that we only included costs associated with consumable
surgical supplies. The initial acquisition cost (over $1
million for robotic surgical system), depreciation, and
service contract for the robotic and laparoscopic systems
were not included in this analysis.
Keywords Robotic cost analysis
Robotics and general
surgery
Robotic versus laparoscopic procedure cost
The da Vinci [1] robotic surgical system was introduced in
1999, with five versions released since that time, most
recently in 2014. According to the ECRI Institute, in
2014, one in four hospitals in the United States had at
least one da Vinci robot. An estimated 570,000 da Vinci
robotic procedures were performed worldwide, which is a
178 % increase compared to 2009 [2]. In 2014, the
majority of robotic procedures were gynecologic, and only
24 % of major robotic procedures performed were within
general surgery [2]. However, there has been growth in
the use of robotics in general surgery over the past 3 years
[1–3].
A limitation to the wide spread adoption of robotics
within general surgery has been the potentially increased
traditional laparoscopic procedures. Barbash and Glied
examined the cost studies of robot-assisted procedures and
123

found that, on average, across a full range of 20 types of
surgical procedures that the additional variable cost of
using a robot was about $1600. When the amortized cost of
the robot itself was included, the additional cost of using a
robot in a procedure rose to about $3200 [4]. In an era of
increased attention to health care expenditures, increased
costs associated with an intervention compared to a readily
available and comparable alternative must be offset by
clinical or other benefit. There is still debate about the
clinical benefit of robotic procedures such as cholecystec-
tomy, inguinal hernia, and fundoplication when compared
to the laparoscopic approach.
In a surgical encounter, a significant portion of the total
costs is associated with consumable supplies. There are
also capital costs and service contracts to be considered for
both robotic surgical systems and laparoscopic equipment.
The cost of purchasing a new da Vinci Xi system can be in
excess of $2.3 million, and the service contract is generally
an additional 10 % of the system cost per year [2]. Our
hospital system includes three total hospitals, two of which
have a total of three robotic surgical systems. We have
invested in a software program that can track the costs of
consumable surgical supplies by procedure. The aim of this
study was to determine the differences in cost of con-
sumable surgical supplies used in elective laparoscopic and
robotic general surgery procedures for specific procedure
types in our health care organization.
Materials and methods
This study was exempt from institutional review board
approval due to the de-identifiable and administrative
nature of the data. All data were obtained from the Surgical
Profitability Compass Procedure Cost Manager System
(The Advisory Board Company, Washington, DC) for our
health care system. Procedures selected were elective
outpatient laparoscopic and robotic cholecystectomy, fun-
doplication, and inguinal hernia repairs that took place
between the years 2013–2015. Any case categorized as
emergent was excluded from analysis. Any general surgeon
with privileges to perform cholecystectomy, inguinal her-
nia or fundoplication who was also credentialed in robotic
surgery could have elected to perform these cases roboti-
cally if he/she chose to do so. Outcomes measured were
length of hospital stay, case duration, and total supply cost.
A sub-analysis of total supply cost was conducted to
account for the cost of mesh for applicable procedures.
Additionally, for robotic cases, the total number and cost of
robotic instruments were determined. Robotic instruments
with single case costs that exceeded $1000 for one
instrument were considered outliers. Robotic instrument
cost comparisons were conducted with and without
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Surg Endosc
outliers. Robotic instruments included graspers, forceps,
scissors and cautery (bipolar and monopolar). Cost
accounting for robotic surgical instruments is determined
by the purchase price of a particular instrument distributed
equally among all the patients in whom the instrument was
used. For example, a $2000 instrument used in 10 patients
would appear as a charge of $200 for each patient. Because
there were numerous episodes of per instrument charges
well in excess of $200, we performed an additional analysis
in which the cost of one robotic instrument was fixed at
$200 for an individual patient. This is a best case scenario
and likely a lower cost per instrument than is observed in
the most optimal circumstances. A recently published cost
breakdown of robot-assisted prostatectomy revealed that
the EndoWrist instruments utilized are priced at between
$1800 and $4600 each [1]. If each instrument were used 10
times, this would represent a cost of $180–$460 per case
for each instrument.
Statistical analysis of our data was conducted using
VassarStats (Vassar College, Poughkeepsie, NY). A two-
tailed t-test was used for continuous variables. A p-
value \ 0.05 was considered statistically significant.
Results
Results for robotic versus laparoscopic fundoplication are
listed in Table 1. There were 22 robotic and 115 laparo-
scopic cases in this cohort over the study interval. For
robotic compared to laparoscopic fundoplication proce-
dures, we observed that the length of hospital stay was
similar. Additionally, when mesh was used, the cost of the
mesh did not differ, whether it was a robotic or laparo-
scopic procedure. However, the percentage of patients with
mesh was significantly greater in the robotic versus
laparoscopic group. Of the 22 robotic fundoplications
performed, 5 (22.7 %) cases used hiatal mesh, and among
the 115 laparoscopic fundoplications, mesh was used in 6
(5.2 %) cases (p = 0.02). Robotic cases were associated
with a statistically significant increase in operative time
and overall supply cost, both including and excluding mesh
(Table 1). The mean and median number of robotic
instruments used for fundoplication was 4.9 and 4.0,
respectively. The mean total cost of robotic instruments,
excluding outliers, was $1320.7, and $2925.2 including
outliers. Among the 22 robotic fundoplications performed,
13 outlier instruments were used (individual case cost of
[$1000). These instruments included primarily bowel
graspers and cautery spatulas. To account for the amortized
upfront cost of the robotic instruments, we performed an
additional analysis of standardizing the cost of each robotic
instrument as $200 per case. From this, we determined that
there was no difference in total supply cost between robotic
Surg Endosc

Table 1 Results for robotic versus laparoscopic fundoplication

Robotic (n = 22) Laparoscopic (n = 115) p value

Mean length of stay (days) 2.2 (1.0) 2.3 (1.7) 0.80

Mean case duration (mins) 197.2 (64.4) 162.1 (59.6) 0.01
Total supply cost (mean) $4101.2 (1660.4) $1918.2 (957.0) 0.01
Total supply cost (median) $3677.0 (1797–7073) $1613.0 (216–6488) 0.01
Mesh supply cost (mean) $751.0 (543.3) $761.1 (503.4) 0.98
Mesh supply cost (median) $466.0 (420–1703) $478.3 (466–1703) 0.98
Total supply cost excluding cost of mesh (mean) $3930.5 (1730.0) $1878.5 (910.4) 0.01
Total supply cost (Mean, $200 per robotic instrument, excludes mesh) $2071.6 (695.0) $1878.5 (910.4) 0.35
Total supply cost (Mean, $200 per robotic instrument, includes mesh) $2150.4 (738.7) $1918.2 (957.0) 0.28
Total # of robotic instruments (mean) 4.9 (2.8) N/A N/A
Total # of robotic instruments (median) 4.0 (2–14) N/A N/A
Total cost for robotic instruments (Mean, $200 per instrument) $981.8 (565.4) N/A N/A
Total cost for robotic instruments (Median, $200 per instrument) $800.0 (400–2800) N/A N/A
Total cost for robotic instruments/case [Mean (excluding outliers)] $1320.7 (792.7) N/A N/A
Total cost for robotic instruments [Median (excluding outliers)] $1095.0 (260–3405) N/A N/A
Total cost for robotic instruments [Mean (including outliers)] $2925.2 (1750.7) N/A N/A
Total cost for robotic instruments [Median (including outliers)] $2302.5 (470–6125) N/A N/A
Represented as Mean (SD), Median (Range), N/A (data not applicable)

and laparoscopic fundoplications, both including and
excluding mesh.
Results for robotic versus laparoscopic inguinal hernia
repair are listed in Table 2. There were 12 robotic and 274
laparoscopic cases in this cohort. For robotic compared to
laparoscopic inguinal hernia repair, we observed that the
length of hospital stay, cost associated with the use of
mesh, operative type, and overall supply cost were all
associated with a statistically significant increase. The
mean and median number of robotic instruments used for
inguinal hernia repair were 2.7 and 2.5, respectively. The
mean and median total cost of robotic instruments,
excluding outliers, were $628.3 and $595.0, respectively.
No supplies with outlier costs were used for robotic ingu-
inal hernia repairs. From our additional analysis of stan-
dardizing the cost of each robotic instrument as $200 per
case, there was still a difference in total supply cost
between robotic and laparoscopic inguinal hernia repairs.

Table 2 Results for robotic versus laparoscopic inguinal hernia repair

Robotic (n = 12) Laparoscopic (n = 274) p value

Mean length of stay (days) 1.1 (0.3) 1.0 (0.1) \0.01

Mean case duration (minutes) 124.0 (49.0) 84.4 (33.0) 0.01
Total supply cost (mean) $1954.6 (596.9) $1471.5 (433.3) 0.01
Total supply cost (median) $1868.5 (1321–3573) $1470.5 (274–3354) 0.01
Mesh supply cost (mean) $637.2 (602.1) $475.8 (1437.2) \0.01
Mesh supply cost (median) $392.4 (198–2354.3) $308.4 (61.8–937.7) \0.01
Total supply cost (Mean, $200 per instrument, includes mesh) $1859 (542.8) $1471.5 (433.3) \0.01
Total # of robotic instruments/case (mean) 2.7 (1.0) N/A N/A
Total # of robotic instruments/case (median) 2.5 (1–4) N/A N/A
Total cost for robotic instruments (Mean, $200 per instrument) $533.3 (196.9) N/A N/A
Total cost for robotic instruments (Median, $200 per instrument) $500 (200–800) N/A N/A
Total cost for robotic instruments (Mean, no outliers) $628.3 (264.4) N/A N/A
Total cost for robotic instruments (Median, no outliers) $595.0 (200–990) N/A N/A
Represented as Mean (SD), Median (Range), N/A (data not applicable)

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 Surg Endosc

Results for robotic versus laparoscopic cholecystec-
tomy are listed in Table 3. There were 38 robotic and
343 laparoscopic cases in this cohort. Differences
between the mean hospital length of stay and operative
time were not statistically significant. However, overall
supply cost was significantly greater for robotic com-
pared to laparoscopic cholecystectomy. The mean and
median number of robotic instruments used for chole-
cystectomy was 4.3 and 5.0, respectively. The mean total
cost of robotic instruments, excluding outliers, was
$665.9 and $992.6 including outliers. The median total
cost of robotic instruments, excluding outliers, was
$657.5 and $657.5 including outliers. Among the 38
robotic cholecystectomies performed, 5 outlier instru-
ments were used, including clip appliers and hook cau-
tery. From our additional analysis of standardizing the
cost of each robotic instrument as $200 per case, there
was still a difference in total supply cost between robotic
and laparoscopic cholecystectomies.
Discussion
We found a significantly increased cost of general surgery
procedures for our health care system when cases com-
monly performed laparoscopically are instead performed
robotically. The costs considered in this analysis were
limited to consumable surgical supplies and did not con-
sider the initial acquisition cost (well over $1 million for a
robotic surgical system), depreciation, and service contract
of either the robotic or laparoscopic equipment. Length of
stay and case duration were also evaluated and did
demonstrate a greater length of stay for robotic versus
laparoscopic inguinal hernia, and a longer case duration for
robotic fundoplication and inguinal hernia repair.
The advent of laparoscopy in the 1990s has led to
improvements in patient clinical outcomes compared to
open surgery including decreased length of stay, postop-
erative pain, wound complications (infection and hernia),
and a more rapid return to work and normal activity [5–7].
Robotic surgery has demonstrated similar clinical out-
comes as laparoscopic surgery when compared to open
procedures, but has not been found to be superior to
laparoscopy [8]. Clinical advantages of robotic surgery
compared to open have been demonstrated in both the
urologic and general surgery literature. Anderson et al. [9]
published a retrospective analysis of a national database of
368,239 patients comparing open, laparoscopic, and
robotic general surgery procedures. They determined that
robotic surgery procedures were associated with a
decreased length of stay and mortality when compared to
both open and laparoscopic surgery. However, outcomes
were most improved when comparing robotic to open
surgery. This included all robotic procedures performed
within different specialties, including general, cardiac, and
urologic surgery.
The SAGES Technology and Value Assessment Com-
mittee (TAVAC) published a safety and efficacy analysis
of the daVinci surgical system [8]. The authors of this
analysis concluded that although gastrointestinal surgery
with the da Vinci Surgical System is safe and the outcomes
of robotic procedures are comparable to laparoscopic sur-
gery, they are not superior. The European Association of
Endoscopic Surgeons (EAES) released a consensus state-
ment in 2015 addressing the relevance of robotics within
general surgery [10]. They examined the robotic surgical

Table 3 Results for robotic versus laparoscopic cholecystectomy

Robotic (n = 38) Laparoscopic (n = 343) p value

Mean length of stay (days) 1.0 (0.0) 1.1 (0.3) 0.14

Mean case duration (minutes) 84.3 (25.2) 75.5 (30.1) 0.08
Total supply cost (mean) $1699.0 (844.1) $631.1 (281.1) 0.01
Total supply cost (median) $1401 (692–4617) $548 (235–2003) 0.01
Total supply cost (Mean, $200 per instrument) $1559.1 (355.5) $631.1 (281.1) 0.01
Total # of robotic instruments/case (mean) 4.3 (1.3) N/A N/A
Total # of robotic instruments/case (median) 5 (1–6) N/A N/A
Total cost for robotic instruments (Mean, $200 per instrument) $852.6 (265.8) N/A N/A
Total cost for robotic instruments (Median, $200 per instrument) $1000.0 (200–1200) N/A N/A
Total cost for robotic instruments [Mean (excluding outliers)] $665.9 (393.5) N/A N/A
Total cost for robotic instruments [Median (excluding outliers)] $657.5 (142.5–2355) N/A N/A
Total cost for robotic instruments [Mean (including outliers)] $992.6 (935.31) N/A N/A
Total cost for robotic instruments [Median (including outliers)] $657.5 (142.5–4387.5) N/A N/A
Represented as Mean (SD), Median (Range), N/A (data not applicable)

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platform on a technical and an outcomes basis. The authors
of the EAES study concluded that robotic surgical systems
can enhance manual dexterity, but there are no data to
support that this is needed to perform a task well. They also
concluded that the lack of haptic feedback forces the sur-
geon to rely on visual cues when handling tissue. The
EAES determined that clinical outcomes were similar for
robotic compared to laparoscopic cholecystectomy and
fundoplication, although with longer operative times and
higher costs. They felt that robotic hernia repair can be
performed safely, but there are limited data regarding long-
term efficacy of this procedure when performed roboti-
cally. Ultimately, the EAES authorship group concluded
that robotics has a higher cost than laparoscopic general
surgery, with similar clinical outcomes.
There are certain advantages to robotic surgical systems
that are difficult to objectively quantify. The robotic sur-
gical platform places the surgeon in a more ergonomic
position that may diminish fatigue and minimize surgeon
injuries [11–13]. The articulating robotic instruments pro-
vide a range of motion at the tip of the instrument not
possible with traditional rigid laparoscopic instruments.
This makes more complex maneuvers possible that may be
advantageous in certain procedures, especially in confined
spaces such as the pelvis. It can also help eliminate innate
handedness or dexterity to assist in performing more
complex tasks [14]. The three-dimensional camera pro-
vides an enhanced view of the surgical field. The advan-
tages of 3-D visualization in surgery have been
investigated, but are difficult to quantify [15–18]. There
may also be a shorter learning curve for surgeons looking
to adopt a minimally invasive approach to a particular
procedure when transitioning from an open approach for
robotic when compared to laparoscopic techniques [19–
21].
Robotic compared to laparoscopic Nissen fundoplica-
tion and hiatal hernia repair has been demonstrated to be
associated with increased costs in previously published
studies. Müller-Stich et al. [22] conducted a randomized
controlled trial comparing laparoscopic to robotic fundo-
plication. They identified a shorter operative time for
robotic fundoplication at 88 min, compared to 102 min for
laparoscopic (p = 0.033). Costs were higher for robotic
compared to laparoscopic procedures (€3244 vs. €2743,
respectively; p = 0.003). A study on robotic fundoplica-
tion costs using the United Health System Consortium
database included 12,079 patients who underwent robotic,
laparoscopic, or open fundoplication [23]. When laparo-
scopic was compared to robotic fundoplication, there was
no significant difference in morbidity, mortality, or length
of stay. Robotic fundoplication was associated with an
increased 30-day readmission rate compared to a laparo-
scopic approach (3.6 vs. 1.8 %; p \ 0.05). Costs were also
higher in robotic procedures in this study ($10,644 robotic
vs. $7968 laparoscopic; p \ 0.05). Another large database
study, this time using the Nationwide Inpatient Sample,
evaluated 297,335 patients undergoing robotic compared to
laparoscopic gastrointestinal surgery, including both fun-
doplication and gastroenterostomy without gastrectomy
[24]. In the fundoplication cohort, there was no difference
in the length of stay or complications. Costs were signifi-
cantly higher with robotic fundoplication ($37,638 vs.
$32,947; p \ 0.0001).
Robotic inguinal hernia surgery is one of the fastest
growing applications of robotic surgery at the current time.
There are almost no comparative, peer-reviewed data
evaluating the two minimally invasive approaches. Escobar
Dominguez et al. [25] published a retrospective chart re-
view of 78 patients who underwent a TAPP using the da
Vinci Surgical System. The total complication rate was
11.5 %, and the mean operative time was 104.2 min. Cost
data were not provided. There is limited literature exam-
ining the clinical advantages of robotic inguinal hernia
repair as a single procedure. The majority of literature
focuses on concurrent robotic trans-abdominal pre-peri-
toneal hernia repair at the time of robotic-assisted prosta-
tectomy [26–29]. These studies primarily address clinical
outcomes, without any cost analyses.
We observed that for cholecystectomy, the robotic
approach was associated with a longer operative time.
There were relatively few robotic compared to laparo-
scopic cases performed in the study interval, and it is likely
that many of the robotic cases were early in each surgeon’s
robotic cholecystectomy experience. Nio et al. [30] repor-
ted an operative time of 95.4 min for laparoscopic com-
pared to 123.5 min for a robotic cholecystectomy. When
identifying what components of the robotic case contribute
to a longer operative time, Kornprat et al. [31] found that
the preoperative portion, including equipment setup, was
longer, as was the intraoperative portion with cut-closure
time and camera and trocar insertion times. However, they
noted the dissection time was not different in comparison
with laparoscopic cholecystectomy. Breitenstein et al. [32]
conducted a prospective case-matched study and found no
difference in operative time or hospital stay for robotic
versus laparoscopic cholecystectomy. However, there was
a higher cost at $7985.4 for robotic compared to $6255.3
for laparoscopic cholecystectomy (p \ 0.001).
A 2015 ERCI publication [2] suggests that the incre-
mental cost per robotic procedure is $3000–$6000.
Excluding the cost of the robotic surgical system itself,
much of this incremental cost is related to the cost of the
robotic surgical instruments. The robotic surgical instru-
ments cost approximately $2000 each on average and can
only be used 10 times before the robotic surgical system
will no longer accept them and they must be discarded.
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According to the Intuitive Surgical website, ‘‘our busi-
ness model is essentially a ‘razor/razor blade’ operation.
Initially, we sell and install the daVinci Surgical System
into new customer accounts. Once systems are sold into
accounts, we generate recurring revenue as our cus-
tomers use the system to perform surgery, and in the
process buy and consume our EndoWrist instruments and
accessory products. We also generate recurring revenue
from system service’’ [33]. If a robotic instrument can be
used 10 times, the cost can be distributed to 10 patients
and the cost of a single instrument can decrease to about
$200 per case. We observed numerous episodes where
the charges for an instrument to a patient were in excess
of $1000 for a single instrument. This may indicate that
the instrument in question was not used 10 times before
it either malfunctioned, expired, or was discarded. We
have obvious opportunities for increasing efficiency
when it comes to robotic surgical instruments. Although
we used a relatively high number of unique robotic
surgical instruments per case (median of 5 robotic sur-
gical instruments for a robotic cholecystectomy), we
think it is likely that this number could be decreased for
many procedures.
We chose not to include the capital and service expense
in this analysis. This is a cost that cannot be ignored when
considering the value (value = cost/quality) of robotic
surgery when compared to a well-established laparoscopic
alternative. A recently published financial model of
robotic cholecystectomy utilized the income statements
derived from Intuitive Surgical 2014 Q4 Investor pre-
sentation outlining activities in 2013 [34]. Capital
expenses amortized over 5 years and distributed per case
and annual service fees per case were included in this
model. A best and worst case scenario of the incremental
cost of robotic versus laparoscopic cholecystectomy is
presented based on high-end and low-end systems and
high- and low-volume utilization. In the worst case (high-
end system and low utilization), the incremental addi-
tional cost per case of robotic cholecystectomy was
$8675. In the best case scenario (low-end system and high
utilization), the incremental additional cost was $2908. In
this same analysis, the acquisition costs of laparoscopic
tower systems, service, and maintenance on these sys-
tems, and disposable laparoscopic instruments used in
laparoscopic cholecystectomy, were estimated to add up
to $389 per case. Without a dramatic increase in the
quality of the outcomes observed in robotic when com-
pared to laparoscopic cholecystectomy, based on these
figures, the value proposition for robotic cholecystectomy
is not favorable.
We have presented a real-world, retrospective review of
the cost of consumable surgical supplies in common
laparoscopic cases performed robotically in a single health
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care system. Surgeons were not presented with cost data in
real time or prior to conducting this retrospective analysis.
The concept of ‘‘surgical auditing’’ has been used as a
quality instrument to provide feedback to surgeons and
hospitals about their outcome measures [35]. This has been
applied to cost-saving strategies, demonstrating that when
surgeons are given information on their procedural and
equipment costs, there has been a cost savings in response
to that feedback [36, 37]. Surgeons can have a dramatic
impact on the cost of surgical care. It is likely that with
increased attention to the cost of robotic consumable sur-
gical supplies, attention to the number of instruments used,
efforts around maximizing the use of every purchased
robotic surgical instrument, and increased experience and
efficiency with robotic surgical procedures that the dis-
crepancy in cost we observed in our experience when
comparing robotic to laparoscopic surgical procedures
would diminish. Based on the published literature on this
topic to date, however, we feel robotic surgery would
remain significantly more costly than the laparoscopic
counterpart for the specific procedures we investigated in
this work.
In 2002, the Institute of Medicine published Crossing
the Quality Chasm, an influential book that has framed
recent discussions of quality health care [38]. Among the
6 specific aims of quality health care defined was effi-
ciency: Care and service should be cost effective. The
proposed measure for this aim was to assess the cost of
care by patient, provider, organization, and community.
The Center for Medicare and Medicaid Services Value-
Based Purchasing Program bases their payments to
hospitals for care provided to Medicare beneficiaries
using various domains to assess quality. In fiscal year
2016, 25 % of the quality assessment was based on
efficiency or cost per Medicare beneficiary. Private
insurers are driving patients to health care systems with
the highest quality and the lowest cost. Cost is becoming
increasingly relevant to surgeons, and we need to ensure
that the procedures we perform are of the highest pos-
sible quality and safety and as cost effective and effi-
cient as possible. For robotic surgery, we need to
demonstrate clear clinical benefit or create other cogent
arguments to make any potential increased cost
justifiable.
In summary, we have demonstrated that our health care
system’s initial experience in converting commonly per-
formed laparoscopic general surgery procedures to a
robotic approach has come at a significantly increased cost
per procedure without a tangible benefit in terms of
decreased operative time or length of hospital stay. Unless
a significant patient-centered clinical outcome advantage
can be identified for the robotic approach in these selected
general surgery procedures, we believe that the robotic
Surg Endosc
approach is not an effective use of our limited health care
dollars.
Compliance with ethical standards
Disclosures Dr. Jon C Gould is a consultant for Torax Medical. Dr.
Rana M Higgins, Matthew E Bosler, and Matthew J Frelich have no
conflict of interest or financial ties to disclose.
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