The cost of learning robotic-assisted prostatectomy.
OBJECTIVE
To describe the costs associated with the learning curve of robotic-assisted prostatectomy (RAP).


METHODS
A theoretical model of the cost of operative time during the learning curve for RAP was constructed. Within the theoretical model varying rates of improvement were considered, and once the learning curve was complete, the total cost of operative time was calculated. This cost was then compared with an actual series of RAP, whose operative time and associated costs during the learning curve were also calculated.


RESULTS
In the theoretical model, surgeons improved at rates of 1, 5, or 10 minutes per case, and began the learning curve that required 8 or 9 hours to perform a single RAP. At the end of the learning curve it took either 3 or 4 hours. The most expensive learning curve was 360 cases long and cost $1.3 million; the least expensive learning curve was 24 cases and cost $95,000. The literature search involved 8 series, with a range of learning curves from 13 to 200 cases. The least expensive learning curve was $49,613 and the most expensive learning curve was $554,694. The average learning curve was 77 cases and cost $217,034.


CONCLUSIONS
Costs associated with operative time while learning RAP are substantial, and should be considered when deciding whether to implement RAP at an individual institution. RAP may best be suited to high volume prostatectomy centers, in which the learning curve can be rapidly traversed, and associated costs minimized.
Steinberg
Peter L
PL
Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Peter.L.Steinberg@hitchcock.org
Merguerian
Paul A
PA
Bihrle
William
W
Seigne
John D
JD
D002983:Clinical Competence / Q000191:economics* / Q000706:statistics & numerical data; D015331:Cohort Studies; D004180:Direct Service Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018803:Models, Economic; D011468:Prostatectomy / Q000191:economics* / Q000193:education* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000193:education* / Q000706:statistics & numerical data; D013997:Time Factors