Advances in robotic surgery are not without problems such as size of the machines, technical issues and, of course, very costs.
Various graphs demonstrating the cost to purchase and maintain these machines
According to BMJ 2007 and da Vinci System 2004, the surgeon console, including the robotic arm cart and the video cart take up considerable space, approximately 25 square feet, whereas a human surgeon would occupy about 15 square feet. This is a huge difference because space is at a premium in hospitals. It also takes a substantial amount of time to prepare robotic surgeons for surgery. In addition, a bedside nurse is required (which adds to the space requirements).
In the area of technical issues, two problems draw a considerable amount of attention at the moment. The primary concern is the lack of tactile feedback available with the current system (da Vinci system 2004). However, new systems are being developed to address this. According to Robot-Assisted Surgery 2005, other issues include the possibility of system breakdown and some lack of flexibility with the surgical robotic arms. As said before though, these problems are always being worked on and will soon be overcome.
Cost is a major issue when it comes to robotic surgery. According to many studies (Harvard 2005, da Vinci 2004, Health and Wellbeing 2006), it is estimated that the initial cost for prototypes like the da Vinci system TM is around $ 3 million U.S. However, other systems can be much much more expensive. Perhaps if this was the whole cost, it would not be so grim. However, all over the world, these machines are being produced, so it is a constant three or so million dollars that is being spent (Harvard 2005). Along with the initial payment of around $3 million, there is tax for one, the fee of shipping, installation and warranty (if desired). These other costs bring the total cost to more than fees are anticipated to range from $1.1 to 1.4 million (da Vinci system 2004). Therefore, after ordering, shipping and installing the equipment, along with paying warranty and tax, one who wishes to purchase, a robotic surgeon, must have around 4.5 million dollars, which is a hefty sum of money for most hospitals.
The payment is still not over however. In addition to the initial cost of these machines, there are the costs of maintenance and replacement of the equipment. Health and Wellbeing 2006 states that, the average cost per surgery is now $4000 because parts must be replaced and/or repaired. After around 10 operations, many pieces of equipment must be replaced by new ones because they cannot function properly anymore (Harvard 2005). The estimated annual cost of maintenance and operating costs are $365 000 combined, and do not forget the tax (comes to around $365 000). Therefore, in the first year, on an average rate, it would cost approximately $5.2 million to purchase and operate a robotic surgeon.
To the cost of equipment, we must add the fee to train surgeons and nurses. To do so, hospitals must invest in simulators and actual bodies so that they can practice on. According to BMJ 2007, the cost to train a surgeon and his staff is $190 000.
During the first year alone, the total cost is approximately $5.5 million and $600,000 for every year thereafter.
On top of all this, each robot can only perform the one surgery for which it was designed. For example, a surgeon designed for knee surgery will not be able to operate on a hip surgery. Therefore, hospitals must buy multiple robotic surgeons for multiple surgeries, which results in millions and millions more (Harvard 2005).
There is one last issue with the cost; the hospitals themselves must pay for these costs, not the government (Health and Wellbeing 2007). Therefore, hospitals must charge patients a higher fee for robotic surgery, limiting the opportunity for many to have robotic surgery as it is quite expensive and patients resist paying more. Even though it is extremely expensive for hospitals to purchase and maintain robotic surgeons, studies seem to indicate that as time advances and technology improves, cost will decrease (Harvard 2005) and adoption will increase.