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.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: dannyramirez.md@gmail.com.
Daniel
D
Ramirez
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Vishnu
V
Ganesan
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Ryan J
RJ
Nelson
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Georges-Pascal
GP
Haber
D017046:Cost Savings; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000191:economics* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000295:instrumentation*