To the Editor:The economics of robotic prostatectomy are very important, considering the fact that prostate cancer is the most common cancer in men and radical prostatectomy is one of the main treatments for localized disease. The rapid adoption of robotic prostatectomy has resulted in the widespread availability of robotic systems and significant utilization by surgeons with little prior laparoscopic experience.[1] The study by Steinberg et al[2] evaluates the potential cost-benefit of adopting the robotic approach to an established laparoscopic program. This study found that it is possible that an increase in surgical volume will result in sufficient profits to offset the added cost of the robot (purchase cost of $1.5 million plus maintenance cost) and equipment. A major requirement is that robotic prostatectomy will be profitable for a hospital and that a sufficient rise in surgical volume is achievable. The authors conclude that a high-volume laparoscopic radical prostatectomy (LRP) program can convert to robot-assisted prostatectomy (RAP) and maintain profitability but may not reach the level of LRP.I think that the issue of achieving profitability is very important for hospitals that take on the entire burden of purchasing and maintaining the robot. If hospitals lose money on their robotics program, then this may sway further hospitals in competitive markets from purchasing a robot. One of the key assumptions in this article is that the cost of disposables for the robot is only $200/ case. This seems to be unreasonable as each robotic case requires a minimum of 4 instruments (scissors, grasper, and 2 needle drivers), and robots with 4 arms will use 5 or 6 instruments. Since each instrument costs over $2000 and has a limit of 10 uses, there is a minimum added cost of over $1000 per case over the cost of an LRP. Furthermore, the authors assume a profit of $5,409 per case. This profit may be achievable with certain insurance companies, but Medicare reimburses around $7,000 per case such that a high profit margin is not achievable for many patients who are over 65. Based on the above consideration, it is unlikely that the predictions regarding the profitability of RAP will be achievable under current market conditions. A decrease in the cost of the robot and/or equipment will be required to improve the cost-effectiveness of RAP.Finally, as more hospitals obtain a robot, the added draw of having a robot diminishes such that acquiring a robot may not significantly increase the patient volume for the fourth or fifth hospital in a region compared with the first or second robot in the region.