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may free up another highly skilled surgeon. Also, most patients
look at robotics as a sign that a facility invests in its surgical pro-
gram. This, in turn, might attract patients — even if they're not
candidates for robotics-assisted surgery — and elite surgeons
eager to use the system. Of course, robotics is no cure-all. Bear
in mind that the initial cost of the robot is significant — upwards
of $1 million — and, in general, the cost of a robotic hernia repair
will exceed that of either a traditional or laparoscopic hernia
repair. — Mark A. Reiner, MD
To me, the right mesh-fixation option will balance 3 primary factors:
how easy it is to use; how effectively it integrates the mesh with sur-
rounding tissue; and how much it costs. I find using 1 or 2 tacks to be
quite feasible from a cost perspective, and it's also often the quickest
and easiest option for getting the mesh fixated early, so patients can
get back to their routine within a few days of surgery.
A word of caution for less experienced surgeons: Don't assume that
something provides superior fixation just because it costs more. No sur-
geon wants to encounter a problem, so there may be a temptation to
hedge your bets by opting for the "best" (read: most expensive) option.
But chances are that once you've gotten a good result with a certain
device or technique, you'll never want to change. That's why you may
want to develop proficiency in multiple modes of fixation, including
those that can help you keep costs down without compromising patient
safety. A high-end biologic mesh could easily double your case costs,
compared with a synthetic polypropylene mesh, so you have to save
wherever you can in order to preserve your profit margin.
OSM
Dr. Reiner (mdreiner@aol.com) is a general surgeon at Mount Sinai Hospital in
New York City, as well as a professor in general surgery, obstetrics, gynecology
and reproductive medicine at Icahn School of Medicine at Mount Sinai Health
System.
