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Current status of robotic surgery in oncology
Book price for the da Vinci systems is typically $ 1.5m - $ 2m , recurring costs for accessories and instruments range from $ 700 - $ 3,500 per procedure , and service fees total c .$ 150k per year
Robotic systems offer more degrees of freedom and enhanced dexterity Robotic systems offer a more lifelike and natural experience for the surgeon than laparoscopic methods . They eliminate the fulcrum effect ( Figure 34 ) where the distal end of the instrument moves in the opposing direction to the surgeon ’ s hand . This can cause a steeper learning curve and ensures less precision than robotic systems . Increasingly , robotic systems are offering more dexterity with 360 rotation and mimic open surgical tools . Momentis Surgical are releasing the first surgical robot with humanoid arms incorporating shoulder , elbow , and wrist joints to further enhance dexterity in difficult operations . Robotic surgery now allows movement with 7 degrees of freedom ( planes of movement ) compared to 36 in open surgery and 4 in laparoscopic . Considering the advantages , we have mentioned for both the patient and surgeon , we expect robotic assisted surgeries to become dominant in general surgery including surgical oncology . Economic benefits include shorter recovery times for patients and therefore less hospital stays and occupancy .
Figure 35 : Drivers of robotic surgery adoption
Clinical
Economic
Scientific
• MIS is associated with lower infection rates and shorter hospital recovery time
• Robotic surgery facilitates MIS uptake due to lower skill-based barriers to entry
• MIS promoted by earlier diagnosis
• Increased availability of lower cost robotic technology
• Elimination of the cost gap between robotic and manual laparoscopic procedures
• Shorter OR time and hospital stay improve hospital economics
• Reduced economic burden as a result of quicker recovery and lower infection
• Intuitive Surgical patent expiration facilitates new entrants joining the market
• Innovation drives the development of enabling tools due to higher competition
• Drive towards integrated solutions for the OR as a whole
Abbreviations : MIS , minimally invasive surgery Source : goetzpartners Research
Constrained healthcare budgets and smaller hospitals have struggled to justify the significant capital outlay for currently marketed robotic systems
Continued health pressures and high cost of capital restrict adoption With the continued global impact of the COVID-19 pandemic and rising inflation worldwide , there were concerns over purchasing robotic systems with high cost of capital . Tighter controls on health budgets coupled with increasing cost of goods and a $ 2m initial capital for one robot is often unfeasible for hospitals with stretched budgets . Intuitive Surgical have had a monopoly in robotic surgery for 20 years due to patents and have been able to maintain a high price strategy . Their patents have now mostly expired and competitors such as Medtronic are coming to the field , but find it a difficult landscape to enter . Many surgeons have only used the da Vinci system and now teach their junior trainees on this system . Despite offering trade-ins to reduce costs for hospitals wanting to upgrade models this has not offset the costs yet . As more competitors develop systems this may reduce costs in the future .
Figure 36 : The benefits of robotic surgery for stakeholders
KEY BENEFITS OF ROBOTIC SURGERY
FOR PATIENTS FOR SURGEONS
FOR HOSPITALS
• Lower blood loss
• Lower infection risk
• Shorter surgery time
• Reduced scaring
• Faster recovery
• Fewer complications
• Improved ergonomic posture
• Superior dexterity
• Eliminates tremour
• Supress fulcrum effect
• Reduced fatigue
• Shorter hospital stay
• Attracting key personnel
• Reputational value
• Quality standardisation
• Higher procedure volume
• Increased productivity
HIGHER STANDARD OF CARE
Source : goetzpartners Research
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