The True Cost of Robotic Surgery: What the Price per Procedure Leaves Out

Introduction

The NHS England and GIRFT (Getting It Right First Time) implementation guide says robotic programmes need high volume so that fixed costs, such as capital purchase and annual servicing contracts, are spread thinly across each case.¹The cost per case depends on total programme costs and the number of procedures performed.

Three different figures can be called “cost per procedure”: what the supplier charges when a procedure is billed, what the procedure costs the trust once fixed, variable and operating costs are allocated to it, and what the NHS pays the trust for performing it. They don’t move together as activity grows.

Part 1 looked at the structure around the platform. This part looks inside the price: what it contains, who wrote each part of it, and when anyone looks at the whole.

Procedure Volumes and Utilisation

Start with the count. The GIRFT guide reports 41,134 episodes coded as robotic in England in 2023/24, up from 3,099 in 2011/12, and says the figure is probably an underestimate because coding is incomplete.¹NHS England’s projection starts from 70,000 operations in the same year.²The two come from different sources. A per-procedure cost is only as stable as the count beneath it, so the choice of count matters. Which one will the 500,000 be measured against, and which does each trust’s business case use?

The guide also records over 140 robotic systems, excluding orthopaedic, installed in NHS trusts in England, taken from the National Equipment Tracking and Inventory System and again probably an underestimate.¹It notes a gap between existing…