A da Vinci Robot System Can Make Sense for a Mature Laparoscopic Prostatectomy Program

BACKGROUND AND OBJECTIVES: 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 $1.5 million da Vinci robot with a $112,000 service contract per year and $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.