The Untold Economic Advantages of
Robotic Surgery
Robert Poston, MD
Chairman, Cardiothoracic Surgery
St Francis Medical Center, Trenton, NJ

Conventional Wisdom: Robotic
surgery is more expensive than
open or laparoscopic surgery

LIMITATIONS OF LITERATURE: ACCOUNTING FOR DYNAMIC COSTS

• Standard accounting practice for
determining ROI
• Spread out fixed costs of capital over the
timeframe in which revenue is generated
• Hospitals allocate fixed costs to the
responsible department
Decision to Purchase a Robot Decision to Use a Robot
• Not standard practice for calculating
costs/profitability of specific procedures
Allocate fixed
robot costs
only to
robotic cases
Costs/case
increased
for robotics
More cases
done open/
laparoscopc
Decreased
volume of
robotic
cases
Sunk cost fallacy
LIMITATIONS OF LITERATURE: AMORTIZATION OF CAPITAL EQUIPMENT

AVAILABLE SAFEGUARDS
Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
LESSINVASIVENESS
Sternotomy
• Standardized, automated
• Prerequisites understood
• Easy access to safety net (CPB)
LESSINVASIVENESS
AVAILABLE SAFEGUARDS
Safe

Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
Sternotomy
• Standardized, automated
• Prerequisites understood
• Easy access to safety net (CPB)
safety frontier Unsafe
Safe
Culture of safety
- “no blame” approach
- psychological safety
- collaboration
LESSINVASIVENESS
AVAILABLE SAFEGUARDS

Expectations
Time
Performance
Low
High
Low
High
Rapid Improvements
1st case …Nth case
Expectations-
reality gap
Robotic program
introduced
Trial and error
Status quo
Life Cycle of Robotic Surgery

Conclusions
1. Control for costs that are dynamic or sunk
2. Focus on the opportunity costs
3. Tie value into the “big picture”
Rational economic analysis of robotics: