Reducing Costs for Robotic Radical Prostatectomy: Three-instrument Technique


      To describe our technique for performing robotic-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection using only 3 robotic instruments to reduce disposable costs associated with the robotic surgical platform.


      The financial impact of robotic surgery is real. Whereas the initial capital investment of the robotic platform (including the cost of the device itself and the maintenance contract) is largely fixed, the cost of disposable instrumentation can vary depending on utilization. Herein we describe our technique for 3-instrument robotic radical prostatectomy that may decrease costs by limiting the use of disposable instruments.


      Exclusion of the high-cost energy instruments may reduce operative costs by up to 40%. In addition, using 1 robotic needle driver vs 2 may decrease overall costs by another 12%. At our institution, we have adopted these techniques in cost-efficiency and have gone further by only using 3 instruments during robotic radical prostatectomy. The only 3 instruments necessary to perform a successful RALP are a robotic needle driver, Prograsp forceps, and monopolar scissors.


      To improve the value of care while utilizing robotic technology, we must be cognizant of keeping operative costs to a minimum while maintaining positive patient outcomes. We demonstrate here a method to decrease disposable operating room costs while preserving the ability to successfully perform a RALP.
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        • Barbash G.I.
        • Glied S.A.
        New technology and health care costs—the case of robot-assisted surgery.
        N Engl J Med. 2010; 363: 701-704
        • Jacobs E.F.
        • Boris R.
        • Masterson T.A.
        Advances in robotic-assisted radical prostatectomy over time.
        Prostate Cancer. 2013; 2013: 902686
        • Cozzi G.
        • Lorenzis E.D.
        • Palumbo C.
        • et al.
        Robotic prostatectomy: an update on functional and oncologic out comes.
        Ecancermedicalscience. 2013; 7: 355
        • De Lorenzis E.
        • Palumbo C.
        • Cozzi G.
        • et al.
        Robotics in uro-oncologic surgery.
        Ecancermedicalscience. 2013; 7: 354
        • Ahmed K.
        • Ibrahim A.
        • Wang T.T.
        • et al.
        Assessing the cost effectiveness of robotics in urologic surgery—a systematic review.
        BJU Int. 2012; 110: 1544-1556
        • Ramsay C.
        • Pickard R.
        • Robertson C.
        • et al.
        Systemic review and economic modeling of the relative clinical benefit an cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localized prostate cancer.
        Health Technol Assess. 2012; 16: 1-313
        • Lowrance W.T.
        • Tarin T.V.
        • Shariat S.F.
        Evidence-based comparison of robotic and open radical prostatectomy.
        ScientificWorldJournal. 2010; 10: 2228-2237
        • Mirkin J.N.
        • Lowrance W.T.
        • Feifer A.H.
        • Mulhall J.P.
        • Eastham J.E.
        • Elkin E.B.
        Direct-to-consumer internet promotion of robotic prostatectomy exhibits varying quality of information.
        Health Aff (Millwood). 2012; 31: 760-769
        • Becker C.
        Nowhere to run, or hide. Current economic downturn may exacerbate hospitals' weakness with buildings, technology, costs, reimbursements.
        Mod Healthc. 2008; 38 (16; Available at:): 6-7
        • Ramirez D.
        • Lotan Y.
        Cost-Effectiveness Is Minimally Invasive Urologic Surgery. Minimally Invasive Urology.
        Springer, 2015
        • Tabib C.H.
        • Bahler C.D.
        • Hardacker T.J.
        • Ball K.M.
        • Sundaram C.P.
        Reducing operating room costs through real-time cost information feedback: a pilot study.
        J Endourol. 2015; 29: 963-968
        • Delto J.C.
        • Wayne G.
        • Yanes R.
        • Nieder A.M.
        • Bhandari A.
        Reducing robotic prostatectomy cost by minimizing instrumentation.
        J Endourol. 2014; 29: 556-560
        • Shuster M.
        • Standl T.
        • Wagner J.A.
        • Berger J.
        • Reimann H.
        • Esch J.S.
        Effect of different cost drivers on cost per anesthesia minute in different anesthesia subspecialties.
        Anesthesia. 2004; 101: 1435-1443