That's also great news for patients and many providers, because it
reduces the learning curve associated with the other minimally inva-
sive approach and thereby potentially opens the door for surgeons
who aren't comfortable doing hernias laparoscopically.
The learning curve with robots is likely to vary, depending on
whether you have laparoscopic experience. I had already mastered
laparoscopy, so it took me only about 10 cases before I felt comfort-
able using the robot without having a skilled surgeon beside me, and
about 50 cases before I felt like an expert.
The ideal scenario in my mind wouldn't be to have surgeons go
directly from open surgery to robotic surgery — in part because you
have to get used to operating with no tactile sensation — with no
laparoscopic experience in between, but it's happening across the
nation, and so far, the outcomes seem to be fine. If it increases the
number of minimally invasive inguinal hernias performed, that's a
good thing.
Of course, there's no getting around it. Robots are expensive —
typically in the $600,000 to $2 million range. But robotic procedures
can actually be less expensive to perform, because many surgeons
use expensive disposables like balloon spacemakers and tackers
with laparoscopic hernia repairs. You don't need those disposables
when you operate robotically. All you need is suture and mesh. So
while the initial cost is high, you begin to pay back the hundreds to
thousands or dollars per case with the money you can save on dis-
posables.
That's the good news. The bad is that robots aren't really within
reach for the average freestanding surgery center, at least for now,
because surgery center reimbursements for inguinal hernia repairs
still don't cover the fixed costs of the operation.
On top of the cost of the robot, the required instruments, which typi-
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