Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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1 5 2 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 4 Laungani, MD, a high-volume urological surgeon in Atlanta. "It plays a huge role in healing and maintaining good urine output, to make sure the wound is draining well and to make sure it doesn't cause post- operative bowel issues. These are all things we monitor during that 24-hour hospital stay." On top of that, the center has to have contingencies for an intraop- erative or post-operative emergency. "If a patient has acute bleeding, that's a life-and-death situation; and you have to have the ability in surgery to convert to an open procedure," says Dr. Laungani. "One complication in an outpatient setting could be disastrous." Besides the hurdles of patient care, other logistical issues must be resolved before RARP can be a truly common, same-day procedure. Robotic procedures require longer operative and turnaround times than non-robotic laparoscopic surgery, and finding skilled physicians and OR staff can be a challenge, according to Lori-Lynne A. Webb, CPC, an independent coding specialist who's lectured on robotic sur- gery. Also, as Dr. Laungani points out, "Having a patient sit in a recov- ery room for 6 hours is not productive for an ASC." The da Vinci surgical robot, the standard equipment for RARP, costs up to $2 million to purchase, and then needs a dedicated surgical suite. On top of that comes the maintenance contract, which can run another $200,000 a year. The costs of disposables can add up to $250 per case as well. "All the money a surgery center makes on gall blad- ders would go to the cost of a robot," says Dr. Laungani. To justify the investment, the procedure needs to turn a profit. At Emory St. Joseph's Hospital in Atlanta, Dr. Laungani has calculated it takes 269 RARP cases a year to turn a profit. In his facility, the cost of RARP is about $14,000 compared to $17,000 for an open radical prosta- tectomy. However, in many facilities, RARP is more expensive than open surgery. U R O L O G Y