Telesurgery: An Entry From Gale's Gale Encyclopedia of Surgery by Stephanie Dionne Sherk

Author:Stephanie Dionne Sherk [Sherk, Stephanie Dionne]
Language: eng
Format: epub
Tags: Medical Books, Medicine, Surgery, General Surgery, Reference, Encyclopedias & Subject Guides, Medical
Amazon: B0024CDSEW
Published: 2007-10-26T05:33:09+00:00

Chapter 6 Robotic-Assisted Surgery: Low-Cost Options

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tants (i.e., surgeon and nurse) are significantly hindered in their movements.

Moreover, the screen for the assisting staff still provides only 2D images (Fig.

6.1c). This might be compensated by the installation of a large 3D screen. A me-

chanical manipulator as well as any 6-DOF instrument can be used at the OR

table, enabling the surgeon to have direct contact with the assistants and to

even the use of their instruments if necessary.

6.4.1.3

Learning Curve

Several groups could demonstrate that for both laparoscopic-experienced

and -inexperienced surgeons the learning curve of the device is short [1, 30].

Particularly, during operative steps requiring endoscopic suturing, the six

DOF of the end-effectors (i.e., needle holder) proved to be very helpful. In their

hands, the OR time could be reduced down to the level of open and laparoscop-

ic surgery. However, one might speculate about the advances these teams would

have made, had they continued the training program of standard laparoscopy.

Recently, Frede et al. demonstrated the transferability of laparoscopic exper-

tise at a center of expertise [15]. Early experience with 6-DOF instruments in-

dicates that they also require a learning curve, but this is shorter for conven-

tional laparoscopy.

6.4.1.4

High Investment and Running Costs

The most important reason for the limited distribution of the device in Eu-

rope is the high investment and running costs, which amount to actually about

$1,400,000 and $100,000 per year, respectively [9]. This means that the cost

per case might be increased by $2,000–2,500. With the actual reimbursement

situation in Europe, only a few urologic centers will be able to afford this. All

of the existing major laparoscopic centers in Europe have long waiting lists.

This means that – unlike in the United States – the investment in a robotic de-

vice will not increase the number of patients, and therefore any advertising ef-

fect is questionable. Recently, Lotan et al. [27] presented a cost comparison of

open, laparoscopic, and robot-assisted techniques using the results presented

by centers of expertise. Open retropubic radical prostatectomy was the most

cost-effective approach, with an advantage of $487 and $1,726 over laparoscop-

ic (LRP) and robot-assisted prostatectomy (RAP), respectively.

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