Institutional economics in robotic colorectal surgery

In this chapter, the different steps of setting up a robotic colorectal surgical program are analysed from both financial and clinical standpoints. Robotic surgery represents a further step forward in the evolution of minimally invasive surgery and is one of the major advances and innovations in the surgical field of the last decades. Nevertheless, higher costs and a still lacking evident clinical proof of superiority, when compared to conventional laparoscopic surgery, have limited its widespread acceptance. It is of paramount importance to define an institutional business plan when starting a robotic surgery program and many factors should be taken into account in order to reduce institutional financial burden and optimize clinical outcomes. Surgical volume and multidisciplinary use are fundamental to reduce per-case share of capital investment and avoid underutilization of the platform. An adequate structured training program is fundamental to ensure optimization of clinical outcomes since the beginning of surgical activity. Moreover, evaluation of the overall institutional financial burden should consider the potential for cost savings related to robotic surgery, such as reduction in complications and length of stay. A traditional direct costs’ assessment should shift toward a “total-episode” costs’ evaluation.