Financial Considerations in Robotic Surgery

  • Nikhil L. ShahEmail author
  • Rajesh G. Laungani
  • Matthew E. Kaufman


The adoption of any new technology in surgery or any other field of medicine brings new challenges. There will always be advocates on the cutting edge of innovation, while others will be slower to change. The greatest factors inhibiting the adoption of new technology are the often-higher costs associated with product acquisition and the absence of a formal pathway to best practice and surgical excellence. When robotic surgery was first clinically introduced in late 2000, only about 1000 robotic surgeries were being performed worldwide, and the cost for each procedure was largely prohibitive [1–3]. Among these costs were the cost of the system, instruments, training, and prolonged operative times. Between 2000 and 2012, the number of robotic procedures performed increased from approximately 1000–2000 per year to nearly 450,000 [4]. It is evident that robotic surgery has established itself as a standard of care for certain disease states, yet challenges still arise as the new healthcare environment balances both cost and quality [5–9].


Robotic surgery Costs Financials Operating room Training Outcomes 


  1. 1.
    Herron DM, Marohn M, SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc. 2008;22:313–25. discussion 311–2CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM, et al.; Members of the Society of Urologic Robotic Surgeons. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol. 2009;182:1126–1132.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Tandogdu Z, Vale L, Fraser C, Ramsay C. A systematic review of economic evaluations of the use of robotic assisted laparoscopy in surgery compared with open or laparoscopic surgery. Appl Health Econ Health Policy. 2015;13:457–67.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Mehr SR, Zimmerman MP. Robotic-assisted surgery: a question of value. Am J Manag Care. 2014;20:E13.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Wright JD, Tergas AI, Hou JY, Burke WM, Chen L, Hu JC, et al. Effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery. JAMA Surg. 2016;151:612–20.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Chan JK, Gardner AB, Taylor K, Blansit K, Thompson CA, Brooks R, et al. The centralization of robotic surgery in high-volume centers for endometrial cancer patients--a study of 6560 cases in the U.S. Gynecol Oncol. 2015;138:128–32.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Tabib CH, Bahler CD, Hardacker TJ, Ball KM, Sundaram CP. Reducing operating room costs through real-time cost information feedback: a pilot study. J Endourol. 2015;29(8):963.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, et al.; European Association of Endoscopic Surgeons. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc. 2015;29:253–288.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Williams SB, Prado K, Hu JC. Economics of robotic surgery: does it make sense and for whom? Urol Clin North Am. 2014;41:591–6.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Barbash GI, Friedman B, Glied SA, Steiner CA. Factors associated with adoption of robotic surgical technology in US hospitals and relationship to radical prostatectomy procedure volume. Ann Surg. 2014;259:1–6.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Salman M, Bell T, Martin J, Bhuva K, Grim R, Ahuja V. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg. 2013;79:553–60.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Geller EJ, Matthews CA. Impact of robotic operative efficiency on profitability. Am J Obstet Gynecol. 2013;209:20.e1–5. Erratum in: Am J Obstet Gynecol. 2014;211:546CrossRefGoogle Scholar
  13. 13.
    Turchetti G, Palla I, Pierotti F, Cuschieri A. Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc. 2012;26:598–606.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Kranzfelder M, Staub C, Fiolka A, Schneider A, Gillen S, Wilhelm D, et al. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc. 2013;27:1681–8.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Abboudi H, Khan MS, Aboumarzouk O, Guru KA, Challacombe B, Dasgupta P, Ahmed K. Current status of validation for robotic surgery simulators - a systematic review. BJU Int. 2013;111:194–205.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nikhil L. Shah
    • 1
    Email author
  • Rajesh G. Laungani
    • 2
  • Matthew E. Kaufman
    • 3
  1. 1.Minimal Access & Robotic SurgeryPiedmont Health CareAtlantaUSA
  2. 2.Robotic Service LinePiedmont Atlanta HospitalAtlantaUSA
  3. 3.Piedmont Atlanta HospitalAtlantaUSA

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