Robot surgery adds €2k to operation

LOWER risk of blood transfusion and shorter hospital stays are among the advantages of using a robot during certain kinds of surgery, but the cost may be difficult to justify, a report has found.

A health technology assessment of robot-assisted keyhole surgery during prostatectomies and hysterectomies found it added €2,487 and €3,019 respectively per procedure, based on volumes per robot of 200 prostatectomies or 300 hysterectomies per year.

However, the benefits to patients who get this surgery instead of open surgery include improved outcomes in urinary continence and sexual function after removal of the prostate gland, as well as shorter hospital stays and lower risk of transfusion.

Women who undergo hysterectomies where robot-assisted surgery is used, also enjoy shorter hospital stays and less risk of transfusion. However, the benefits of robot-assisted prostatectomy over conventional keyhole approaches are minor.

The study, compiled by the health technology assessment (HTA) unit of the Health Information and Quality Authority (HIQA) found the incremental budget impact over five years for introducing a single robot in the publicly funded system is predicted at €3.1 million to €4.5m for prostate surgery and for hysterectomy procedures, respectively.

National demand for robot-assisted prostatectomy could be about 300 cases per year and national demand for robot-assisted hysterectomy would be significantly higher.

A single robot may not meet demand in either programme.

The report also found:

* The number of days for a patient to return to normal activity is significantly shorter after robot-assisted surgery, compared to open surgery.

* Based on the procedure volumes referred to above, there was a projected reduction in bed days per robot of 360 and 565 annually in the prostatectomy and hysterectomy models, respectively.

* There may be extra costs associated with programme introduction, for example in optimising theatre space or in training.

HIQA’s Martin Flattery, head of HTA research and planning, said their advice to the HSE — which requested the assessment — was that to invest further in a robot-assisted surgery programme would have a significant incremental cost per procedure and a significant budget impact.

The report has also been submitted to Health Minister James Reilly.