Ramirez Daniel, Ganesan Vishnu, Nelson Ryan J, Haber Georges-Pascal
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urology. 2016 Sep;95:213-5. doi: 10.1016/j.urology.2016.03.067. Epub 2016 Jun 16.
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.
描述我们仅使用3种机器人器械进行机器人辅助腹腔镜前列腺切除术（RALP）和盆腔淋巴结清扫术的技术，以降低与机器人手术平台相关的一次性成本。
机器人手术的经济影响是真实存在的。虽然机器人平台的初始资本投资（包括设备本身的成本和维护合同）在很大程度上是固定的，但一次性器械的成本会因使用情况而有所不同。在此，我们描述我们的3器械机器人根治性前列腺切除术技术，该技术可通过限制一次性器械的使用来降低成本。
排除高成本的能量器械可使手术成本降低多达40%。此外，使用1把机器人持针器而非2把可使总成本再降低12%。在我们机构，我们已在成本效益方面采用了这些技术，并在机器人根治性前列腺切除术期间仅使用3种器械，进一步降低了成本。成功进行RALP所需的仅有的3种器械是机器人持针器、Prograsp钳和单极剪刀。
为了在利用机器人技术的同时提高医疗价值，我们必须在保持患者良好预后的同时，意识到将手术成本降至最低。我们在此展示了一种在保留成功进行RALP能力的同时降低手术室一次性成本的方法。
