Robot-assisted surgery offers well-recognized clinical advantages; however, its financial sustainability at the institutional level varies substantially across procedures and healthcare systems. We evaluated the institutional financial implications of robot-assisted urological surgery using an allowable cost framework designed to clarify how robot-related expenditures restrict practical robotic resource utilization. The allowable robot-related material cost (ARMC) was defined as the maximum robot-related variable material cost at which robot-assisted surgery achieves contribution margin equivalence with conventional laparoscopic surgery under existing reimbursement conditions. ARMC was calculated for representative urological procedures, including adrenalectomy, radical nephrectomy, nephroureterectomy, and radical cystectomy. For adrenalectomy, ARMC adjusted for operative time was additionally calculated to assess time-based economic efficiency and the impact of operative duration on contribution margin. ARMC values were 24,903 yen for adrenalectomy, 46,472 yen for radical nephrectomy, − 7,139 yen for nephroureterectomy, and 92,591 yen for radical cystectomy. The negative ARMC for nephroureterectomy indicates that contribution margin equivalence was not observed under current reimbursement and cost structures. In adrenalectomy, ARMC increased to 70,415 yen after adjustment for operative time, suggesting improved procedural efficiency and highlighting the economic importance of operative duration. Based on this allowable threshold, routine use of a three-arm configuration, including one camera arm, was necessary to maintain contribution margin equivalence. The financial impact of robot-assisted urological surgery is highly procedure dependent. The ARMC framework quantitatively defines procedure-specific tolerance for robot-related variable costs and clarifies practical constraints on robotic resource allocation, providing a pragmatic institutional framework for maintaining financial sustainability while preserving clinical benefit.
Kawashima et al. (Thu,) studied this question.