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Durability of reusable instruments and hidden costs in robotic-assisted surgery: a retrospective multidisciplinary
Sosuke Niwa1, Shuzo Hamamoto2, Tomoki Takeda1
1Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1Mizuho-Ku, Nagoya, Kawasumi, Mizuho-Cho, 467-8601, Japan.
Background:
The use of robotic surgery is increasing across multiple disciplines; however, the durability of reusable robotic instruments and associated hidden costs remain underexplored. Therefore, this study aimed to analyze the incidence of instrument failure in robotic surgery as well as investigate the associated factors and costs.
Methods:
This retrospective analysis involved 757 reusable robotic forceps used in 1906 robotic surgeries performed between January 2022 and December 2024 at a single tertiary center. Instrument usage data, failure rates, and hidden costs, including reprocessing costs and financial losses against failed instruments, were examined. Risk factors for mechanical failure, particularly disk and cable damage, were evaluated using multivariate logistic regression.
Results:
Of the 757 instruments, 598 (79.0%) completed their designated life cycles, while 148 (19.6%) failed prematurely. The overall device failure rate per operation was 7.8%. Disk and cable failures accounted for 8.2 and 5.7% of all instrument failures, respectively. Fenestrated bipolar forceps had the highest failure rate (45.9%). Financial loss due to unreimbursed instrument failure amounted to $75,950 over 3 years, corresponding to approximately $39.8 per surgery based on 1906 procedures. A multivariate analysis identified a disinfectant concentration change from 1.0 to 0.5% as a protective factor for disk failure (odds ratio: 0.38; p = 0.001).
Conclusion:
Reusable robotic instruments demonstrated variable durability, with approximately 20% failing prior to their usage limit in our cohort, contributing to substantial hidden costs. Optimization of reprocessing protocols and strategic instrument selection may help mitigate this economic burden.
