Robotic vs. open radical prostatectomy: Who pays the cost?

There is no doubt that robot-assisted radical prostatectomy is more expensive than an open prostatectomy performed through a lower midline incision or a perineal approach. A recent report in the New England Journal of Medicine (2010; 363:701-4) stated that a robotic prostatectomy adds about $2,200 per operation for additional supply costs and operating room time. In addition, capital costs and maintenance add $400 to $4,800, depending upon the utilization of a specific machine.

What does the patient or society gain from the additional resources expended? Extensive marketing by surgeons and hospitals suggests major advantages, but proponents of robot-assisted radical prostatectomy have been unable to document them. At a 2-day conference, the world's leaders in robotic surgery performed an exhaustive review of the world's literature (Eur Urol 2012; 62:368-81). They concluded that robotic prostatectomy achieves cancer control equivalent to that of the more traditional open prostatectomy and may offer advantages in the postoperative recovery of urinary continence and erectile function. I suspect that experienced, high-volume surgeons performing either robotic or open procedures will have remarkably similar outcomes.

Dr. Albertsen, a member of the Urology Times Editorial Council, is professor of surgery and chief of urology at the University of Connecticut Health Center, Farmington.