Maximizing Your Investment In Robotic Surgery

Unlocking The Productivity of Every Instrument

Robotic Surgical Instrument Investment Chart

More than 9,500 da Vinci^® surgical systems are installed worldwide¹, and over 10 million robotic-assisted surgical procedures are performed every year.² Robotic-assisted surgery (RAS) isn't the future; it is a dominant technology today.

As these systems expand, hospital administrators must work to maximize their return on investment, especially with hospital margins trending down, while cost per patient is trending up.³ The initial investment for an RAS system is between $2.0 and $2.5 million, plus annual maintenance costs of over $100,000 a year.^4,5

To maximize the use of a robotic surgery program, hospital systems need to maintain properly educated staff, specialized instruments, and accessories for specific procedures. With over 78% of US surgeons expressing an interest in adopting robotic surgery techniques⁶ and nearly all new medical school graduates receiving some robotic surgery training⁷, the "doctor" part of the equation is easy.

Challenges arise, however, when doctors are "fighting for time" on the robotic surgery systems. Many hospitals might be fully using the available schedule of their robotic suites, leading one to believe the way to increase revenue and profit is with an additional robotic system. However, this is not always the case as it takes more than "a doctor and a robot" to manage a successful robotic surgery program. Adding more robotic systems requires significant financial expenditure, as demonstrated by the cost chart “RAS System Price Tag”.

Forward-thinking healthcare facilities can maximize profit by delving into the processes outside the procedure, including instrument reprocessing workflow, inventory management, and equipment outside the robotic surgery system.

Getting The Most Out Of Every Robotic Instrument

If an instrument is ineffectively reprocessed two times in its life, a hospital only gets 87-90% of its value.

Robotic instruments are a costly investment, and while they're reusable, they have a limited number of uses. These instruments have a "reprocessing life," meaning they can only be reprocessed (washed, disinfected, and sterilized) a limited number of times before they must be discarded and replaced. That number is typically 15 to 20 times, depending on the instrument.

Before we look at maximizing instrument use, let's review the steps required to reprocess robotic instruments. We will then look at how an automated process can help ensure you get the most out of each instrument to maximize your return on investment.

Reprocessing Robotic Instruments, Faster

Because of their complexity and delicacy, robotic instruments require specialized training and equipment for reprocessing. Manufacturer instructions for use (IFU) show that cleaning of robotic instruments can take up to 284 minutes for a set of four instruments, which is the approximate number of instruments used in a case, depending on the procedure.

The chart to the right with 15 labeled steps illustrates the manual reprocessing steps of a set of four commonly used robotic instruments.⁹ Add to that time inspection, packing, sterilization, and sterility assurance, and it's easy to see how shifting to a more efficient process can make a significant difference.

Robotic Surgery Manual Reprocessing – 15 Steps

Remove Accessories
Check Indicator
Prepare Solution
Prime
Soak
Flush
Spray
Brush
Rinse
Ultrasonic Cleaning
Flush
Final Rinse
Final Decon Inspect
Thermal Disinfection (optional)
Transfer

In contrast, see the cleaning process of the same instruments using the AMSCO^® 7052HP Washer/Disinfector with the RAS cycle, RAS 12 Rack, and Prolystica^® Ultra Concentrate HP Cleaning Chemistry in the chart, labeled 10 steps.

There are still necessary steps, even with automated cleaning and disinfection, but notice that this process only requires 10 steps. Adding the validated automated cleaning process to the workflow for these robotic instruments provides a 25% reduction in manual cleaning per set of four instruments, with an overall direct labor savings of 66 minutes.⁹

Robotic Assisted Surgery Reprocessing – 10 Steps

Remove Accessories
Check Indicator
Prepare Solution
Prime
Soak
Spray
Brush
Inspect
Automated Cleaning and Disinfection
Transfer

Back To The Operating Room, With Confidence

A surgical instrument that arrives in the operating room (OR) and is opened, whether used or not, must be reprocessed. If residual soil is found, additional reprocessing becomes an unrecoverable cost, requiring more instruments to be purchased more frequently and adding to the overall average cost per procedure.

This is an area where a validated automated cleaning cycle can reduce the risk of human error, which may lead to wasteful reprocessing of robotic instruments. Additionally, if a dirty or damaged instrument is found once the set is opened in the OR, the case may need to be delayed or rescheduled, costing facilities valuable resources.

Cost of Delayed Surgical Procedure Graph

This is critically important when considering the cost of a delayed or canceled case, which sometimes exceeds $2,000 per minute.¹⁰ Automation provides consistency and confidence that instruments are cleaned right, every time, which can reduce the risk of delayed procedures to help maximize robotics program ROI.

Efficient Low-Temperature Sterilization

Typically, robotic assisted surgery procedures use an endoscope as well as robotic instruments. The endoscopes used are heat-sensitive and must be processed using a low temperature sterilizer. The V-PRO™ maX 2 Low Temperature Sterilizer processes two da Vinci endoscopes in just 30 minutes, compared to 60 minutes with other systems. This time savings helps optimize your processing and enables staff to reprocess the endoscopes more efficiently.

Let's follow 12 robotic instruments (which would be enough for three cases, depending on the type of procedure) through the reprocessing workflow to see how this works.

Reprocessing 12 Instruments = 3 Cases. 409 minutes manual cleaning + 110 minutes VHP

267 minutes optimized workflow (142 minutes saved) + 61 minutes VHP (49 additional minutes saved)

As the chart indicates, over two hours are saved via automated washing and disinfection, and three robotic endoscopes can be sterilized in nearly 50% less time using the V-PRO™ sterilizer and CELERITY™ 5 HP Biological Indicator versus competitive products. This combined overall time savings⁵ enables the sterile processing department (SPD) staff to concentrate on other critical tasks, making the SPD overall more productive.

Maximizing Robotic Instrument Usage

Improved reprocessing speed and the ability to be ready for more procedures each day aren't the only benefits automation, and an optimized workflow, provide. Automated washing and disinfection results in more reliable, repeatable cleaning, so instruments are cleaned right the first time, reducing possible rework. When more instruments arrive more often in the OR without being returned because they are dirty, overall instrument inventory utilization improves.

Let’s assume a hospital performs 425 RAS procedures each year. When considering the instrument costs per procedure, these instruments become a significant line item for the operation. The cost of purchasing another full set to keep up because of slow, unreliable reprocessing adds up quickly. As the chart illustrates, reprocessing instruments so that they are used to the maximum amount of the "reprocessing life counts" can mean hundreds of thousands of dollars in saved versus stranded, wasted costs. Yearly Instrument Costs - Average instrument costs 2,000 per case Slower Manual Reprocessing requiring 2x time + Unreliable reprocessing/dirty instruments requiring rework and less instrument 'life'

Not using the instruments for 100% of their use life can hurt a hospital's bottom line. Adding more instruments to cover for mistakes during manual cleaning and a workflow that isn't optimized isn't the answer. In the example above, when just 50% of additional instruments are needed to cover unreliable manual workflows, the results are $425,000 in annual costs, which adds $1,000 per procedure in unnecessary costs.^{5, 8}

Robotic Reprocessing Equipment

While the initial costs of an RAS system run upwards of $2 million, as we've seen, the investment in reprocessing equipment is just a fraction and can help maximize the system's capacity and yield cost savings via maximum use of instrument inventory.

While automation via washer/disinfector and the most efficient low temperature sterilization and sterility assurance provide the greatest time and efficiency savings, other best practices greatly aid the effectiveness of reprocessing. These include:

Pre-treatment of instruments to prevent the drying of soils and protect instruments immediately post-procedure and during transport to the SPD. Pre-Klenz™ Soak Shield Kit follows the manufacturer's reprocessing instructions and keeps soils from drying for up to 72 hours, greatly aiding the efficiency of the cleaning process.
Sinks to accommodate robotic instrument size and requirements, with bays wide enough to hold instruments
Toothbrush style cleaning brushes with ridged nylon bristles to remove soil at the sink while remaining gentle on the instrument
High-capacity InnoWave™ Pro Sonic Irrigator that can process 18 instruments per cycle (three to four cases worth) versus those that only can handle one case worth or six instruments
V-PRO maX 2 Low Temperature Sterilizers that can sterilize up to two RAS endoscopes in just 28 minutes
Celerity HP Biological Indicators provide results in just five minutes
Robotic Arm Instrument Cards help mitigate the risk of puncturing the sterile barrier of robotic instruments during and after steam sterilization
The SPM Instrument Tracking System provides guided workflows that help technicians with the complex IFUs of robotic instruments. It also tracks the "life" use of robotic instruments and helps SPD managers track every reprocessing aspect, so the right instruments are delivered at the right time to the OR.

Ultrasonic Cleaner for Robotic Instruments

Offsite Reprocessing Technician using Robotic Instruments

Adopting an automation reprocessing strategy for RAS instruments means more cases can be performed more efficiently in the OR, and instruments can more consistently achieve maximum value, driving key revenue and improved patient access. This creates an opportunity for hospitals to thrive and succeed using the latest robotic-assisted surgery technology and techniques now and into the future.

Learn more about STERIS Robotic Instrument Processing Products Here

Related Resources

Link to Guide to Reprocessing Robotic Surgery Instruments

Article References

¹ Intuitive Surgical 3Q 2024 Earnings https://investor.intuitivesurgical.com/news-releases/news-release-details/intuitive-announces-third-quarter-earnings-4#:~:text=Third%20quarter%202024%20revenue%20of,the%20third%20quarter%20of%202023.

² OR Management News. As Robotic Technology Surges, Sterilization Lags Behind. David Taylor, June 13, 2022

³ KaufmanHall. National Hospital Flash Report. January 2023. https://www.kaufmanhall.com/sites/default/files/2023-01/KH_NHFR_2023-01.pdf

⁴ AHRQ (Agency for Healthcare Research and Quality). Cost and Effectiveness of Surgical Robots. January 9, 2020

⁵ Wiley: The International Journal of Medical Robotics and Computer Assisted Surgery. Cost of ownership assessment for a da Vinci robot based on US real-world data. Josh Feldstein, Bjoern Schwander, Mark Roberts, Herbert Coussons. June 4 2019

⁶ Bain & Company. Navigating the Next Way of Surgical Robotics. Mayuri Shah, Jason Asper, Cate Miller Goldstein. https://www.bain.com/insights/navigating-the-next-wave-of-surgical-robotics

⁷ American College of Surgeons. Robotic Surgery Is Here to Stay – and So Are Surgeons. Jim McCartney. May 10, 2023. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/may-2023-volume-108-issue-5/robotic-surgery-is-here-to-stay-and-so-are-surgeons/

⁸ ALES (Annals of Laparoscopic and Endoscopic Surgery. Robotic surgery: finding value in 2019 and beyond. Rafael E. Perez, Steven D. Schwaitzberg. May 2019. https://ales.amegroups.org/article/view/5205/html

⁹ Utilizing 12 da Vinci X/Xi RAS Cycle with RAS 12 Rack, PUCHP Cleaning Chemistries in the AMSCO 7052/53HP Washer/Disinfector allows time savings of 142 minutes. V-PRO maX 2 Sterilizer can reprocess 2 da Vinci endoscopes in 28 minutes, as compared to 1 hour with other brands. Using Celerity 5 Biological Indicator has a read-out time of 5 minutes, which is 10 minutes faster than other brands.

¹⁰ NIH National Library of Medicine. Preventable Operating Room Delays in Robotic-Assisted Thoracic Surgery: Identifying Opportunities for Cost Reduction. August 13, 2022 https://pmc.ncbi.nlm.nih.gov/articles/PMC10020819/

¹¹ The V-PRO maX2 Low Temperature Sterilizer can reprocess 2 da Vinci endoscopes in 28 minutes. Other brands can only reprocess 1 endoscope every 30 minutes.