Page 1 of 4 Licensee OAPL (UK) 2014. Creative Commons Attribution License (CC-BY) FOR CITATION PURPOSES: Khanna S, Das J, Kumar S, Mehta Y, Ahlawat R. Being intuitive: Starting a comprehensive multispecialty robotic surgery programme. OA Robotic Surgery 2014 Apr 15;2(1):8. Review Competing interests: None declared. Conflict of interests: None declared. All authors contributed to conception and design, manuscript preparation, read and approved the final manuscript. All authors abide by the Association for Medical Ethics (AME) ethical rules of disclosure. Adult & Paediatric Urology Being intuitive: Starting a comprehensive multispecialty robotic surgery programme S Khanna 1 , J Das 2* , S Kumar 3 , Y Mehta 4 , R Ahlawat 5 Abstract Introduction In the ever evolving field of medical sciences 'change' is the rule. We change our concepts, outlook, practice and guidelines based on the recent developments and recommendations. Amongst these, a few developments and technological advancements carry the potential to uplift the concerned specialty to the next level of clinical care and outcome. The introduction of robotic assistance into surgical practice can be considered to be the next milestone. With the increasing popularity of the robot, thanks to its well described benefits to the patient and surgeon in particular, more and more institutions worldwide are spreading out the red carpet to this recent technology. Setting up a protocolised perioperative care catering to multispecialty robotic surgeries is a mammoth task requiring meticulous planning, confidence building, business development strategies and training of operating room staff. Table 1 enumerates the surgeries that can be performed by robotic assistance. In this review we describe the essential building blocks for setting up and smooth functioning of a multispecialty robotic surgery programme with special emphasis on the problem areas. The aim of our article is to apprise the clinicians of the various technicalities and infrastructure requirements before starting the programme. Conclusion Aggressive marketing, well defined surgical advantages, lesser morbidity at least in certain procedures have popularised the robotic assistance in surgical field an exciting proposition for the patient and the surgeons. This in turn is the market force which is driving up the sale of robots. Introduction Starting a Robotic Surgery Programme The first step in the successful launch of any new programme is 'Planning'. Starting a robotic programme is a difficult proposition and needs a lot of bold decision making on part of the hospital administration. The cost of initial acquisition, annual maintenance and inventory management can be a real burden in a low turnover set up. The factors that need to be considered are the population catered, their affordability to high end healthcare, competition from nearby robotic surgery centres, the in-house specialties etc. A robotic core committee should be formed comprising of the medical director, marketing head and heads of involved surgical specialties. This is depicted in figure 1. It is very important to set realistic targets for the robotic programme and formulate ways to achieve the target. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) have set guidelines and consensus reports on Robotic surgery requirements for the Institution 1 . This can be a useful document in the planning and initial execution process. Worldwide, the number of surgical robots have gone up exponentially. Almost 2585 da Vinci systems have been installed worldwide till date 2 . In India itself, the number of institutes having a surgical robot have increased to 22 till December 2013 and many more are in the fray. For the institution and the surgical fraternity, it is a matter of pride and prestige to have a surgical robot. It also gives an insight into the institute's progressive vision and quality consciousness and commitment. On the flip side, procuring the surgical robot is in itself a major decision for the Institution. The cost of present day 3 rd generation da Vinci robotic system comes to approximately 1.5 – 2.5 million US Dollars 3 . Along with it comes the concerns of returns on investment and annual maintenance cost which in itself can come to around 10% of the capital acquisition cost. The cost of supplies and instruments accounts for nearly a third of average total cost. In the initial period, there is the added concern of loss of remuneration because of prolonged OR set up and operative time. Interestingly, hospitals are actually looking at this dismal picture from an entirely new angle. Their vision has shifted from cost accounting as the sole modality of financial decision making to newer metrics comprising cost accounting, planning and aggressive business development policies. A major downward shift in cost is observed when the number of cases increases from 20 to 100 per year. An increase from 100 to 500 cases per year can reduce the cost further by around 18% 4 . Probably one of the most important pillar of a successful robotic surgery programme is the presence of a chief robotic surgeon 5 in the Institute who actually acts as the Captain of a ship and initially sets the ball rolling. The presence of one principal surgeon *Corresponding author Email: reachjyotirmoy@gmail.com 1 Associate Director, Institute of Anaesthesiology and Critical Care, Medanta the Medicity, Gurgaon, India 2 Consultant, Institute of Anaesthesiology and Critical Care, Medanta the Medicity, Gurgaon, India 3 Consultant, Institute of Anaesthesiology and Critical Care, Medanta the Medicity, Gurgaon, India 4 Chairman, Institute of Anaesthesiology and Critical Care, Medanta the Medicity, Gurgaon, India 5 Chairman, Institute Urology and renal transplant, Medanta the Medicity, Gurgaon, India