DISCUSSION
STERILE, NEUROMUSCULAR BLOCKADE
The outcome of the present study showed that comparing RVIHR and LVIHR, there is a
significantly higher average cost in robotic-assisted use. These costs are mainly
associated with prolonged surgical time, higher consumption of anesthetics, high
mobilization of human resources, and, evidently, material devices related to the
robotic machine. Knowing the costs of each variable related to the surgical
intervention is essential to better allocate resources and to depict a detailed and
precise budget impact analysis before implementing a robotic program in a public
health institution.Beyond material resources, the robotic system demands higher costs related to human
resources. In theory, the robotic system demands only one surgeon for each surgery,
decreasing the need for other surgeons during the procedures. In the United States,
the physician assistant, a mid-level health care provider, may act as a bedside
assistant and helps position the patient and docking, decreasing the costs related
to robot-assisted proceduresDue to the prolonged OR time and the complexity of the procedure, there is a demand
for more number and more qualified professionals during robotic surgery. Nurses in
robot-assisted surgery need to have high technical proficiency and active attitudes.
Their roles include scheduling, checking for supplies, system operating,
administration of circulating nurses, patient and console positioning, placing
robotic arms, robotic arm sterile draping, configuring equipment and instruments,
docking, and undockingProlonged surgical time implicates higher demand for more professionals in OR and
expenditure with the OR time. Besides, prolonged surgical time implies more use of
anesthetics and neuromuscular blockade agents. Anesthesia costs usually represent a
minority proportion of the perioperative costsRecent studies demonstrated the higher costs of the RVIHR compared with LVIHR.
Nationwide American studiesAll the studies quoted in the last paragraph were North American, and worldwide
extrapolations are questionable. The present study gives a picture of a robotic
program from a public institution in a middle-income country. Nonetheless, this
study has several limitations. First, it was conducted in a single center, lacking
external validity from other middle and low-income countries. In addition, only
direct costs were accounted for, and costs related to the rehabilitation facility,
days off work after surgery, and their impact on quality of life were not
considered. Another inherent issue with any cost-analysis study is due to the
fluctuation of the exchange rate over time, making it difficult to obtain a
definitive analysis of the costs involved in any longitudinal study. Well-designed
future cost-effectiveness and cost-utility studies can answer whether the high costs
of robot-assisted approach are justifiable for all countries. Economic studies
evaluating the robotic systems’ budgetary impact on health systems are crucial for
determining their utility in public programs in developing or underdeveloped
countries.The present study’s findings raise the question: “Is there a role for the RVIHR in a
public health system?” The answer is “yes.” If a robotic program does not root in
assistance, there will be a significant delay in the dissemination of trained
robotic teams and experienced surgeons and professionals worldwide, and
consequently, expenses lowering tend to linger. Nayeemuddin et al.