Urology Fellow Washington University in St. Louis School of Medicine
Introduction: The robotic platform drastically changed urologic surgery, from surgical approach, to hospital stay, pain control, blood loss, and cost. These characteristics have been well described for robot assisted laparoscopic prostatectomy (RALP) and robot assisted partial nephrectomy (RAPN) for previous iterations of robotic technology, but with development of newer platforms - such as the daVinci Single Port (SP) system - the operating room (OR) costs warrant analysis.
Methods: At a single institution with multiple robotic surgeons, we retrospectively analyzed billing data from the OR for da Vinci SP and XI RALPs and RAPNs from January 2019 - January 2021. Due to institutional regulations, direct costs of instruments cannot be disclosed.
Results: Overall, 290 XI and 102 SP RALPs were performed. The mean OR cost per XI RALP was $2,271. The mean OR cost per SP RALP was $3,100. Per case, SP RALPs were $829 (36.5%) more expensive than XI RALPs (Table 1).
For RAPNs, 223 were performed with the XI and 20 were performed with the SP platform. The mean OR cost per XI RAPN was $2,326. The mean OR cost per SP RAPN was $3,233. Per case, SP RAPNs were $907 (39%) more expensive than XI RAPNs (Table 1).
The main cost drivers are the robotic instruments and drapes (Table 2). SP monopolar scissors were $240 more expensive than their XI counterpart. The Maryland bipolar and needle drivers were $200 and $230, respectively, more expensive for the SP system. Non-energized graspers were $215 more expensive for the SP than the XI system. Draping the SP system costs $207 more than the XI. Trocars for the SP system cost $78-728 more than the XI, depending on usage and size of the Gelpoint. There is a sub-$50 cost for the Veress needle used only in the XI system.
Conclusions: With newer versions of robotic technology, previously described advantages still stand, but the costs should be re-examined. Our analysis shows that OR costs for RALPs and RAPNs are approximately 40% more when performing them using the SP compared to the XI system. Further prospective studies are needed to incorporate other hospital costs related to these surgeries.
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