title: A da Vinci robot system can make sense for a mature laparoscopic prostatectomy program.
abstract: OBJECTIVE
  We sought to provide informed recommendations on transitioning from laparoscopic radical prostatectomy (LRP) to robotic-assisted radical prostatectomy (RAP) through a study of the da Vinci robot.
  
  
  METHODS
  We performed a cost-benefit analysis to determine the impact that purchasing a dollars 1.5 million da Vinci robot with a dollars 112,000 service contract per year and dollars 200 per case of disposables would have on profits of a mature laparoscopic prostatectomy program.
  
  
  RESULTS
  Seventy-eight cases per year are needed to cover the costs of a purchased robot, while only 20 cases per year are needed if a robot is donated. Once robot costs are covered, increases in caseload lead to increased income. Profit is not feasible at centers performing fewer than 25 cases annually. A donated robot lessens costs and allows reasonable revenue without drastic increases in caseload.
  
  
  CONCLUSIONS
  Our data suggest a high-volume LRP program can convert to RAP and maintain profits; however, the cost of the robot precludes equal income as that with LRP. Purchasing a robot is not fiscally viable in a low-volume program. Given comparable outcomes between LRP and RAP, hospitals need to decide whether market forces or the intangible benefits of robotics outweigh the expenses of obtaining and operating a robot.
authors.affiliation: Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Steinberg
authors.forename: Paul A
authors.initials: PA
authors.lastname: Merguerian
authors.forename: William
authors.initials: W
authors.lastname: Bihrle
authors.forename: John A
authors.initials: JA
authors.lastname: Heaney
authors.forename: John D
authors.initials: JD
authors.lastname: Seigne
mesh_terms: D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D009513:New Hampshire; D011468:Prostatectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012371:Robotics / Q000191:economics* / Q000706:statistics & numerical data