To robot or not to robot — how community hospitals can get the best robot-assisted surgery without breaking the bank

The rise of robot-assisted laparoscopic surgery is putting pressure on small hospitals to fall in line with the mounting trend to compete and retain surgical patients in an increasingly consumer-centric healthcare environment.

Surgical robots offer more dexterity than traditional laparoscopic instrumentation and provide surgeons with 3-D, high-resolution visuals capable of magnifying the surgical site. The technology facilitates the performance of minimally invasive procedures and has been heralded by some experts as the most significant technologic advancement in the surgical field in decades, according to a 2017 report from U.S. News & World Report.

The implementation of this technology has increased substantially over the last 10 years. In a 2017 study, researchers at Stanford (Calif.) University School of Medicine analyzed data on kidney removal procedures compiled by 416 hospitals from 2003 to 2015. In 2003, just 1.5 percent of these procedures were robot assisted. By 2015, the percentage of robot-assisted procedures increased to 27 percent.

While robot-assisted laparoscopic surgery seems positioned for further adoption in coming years, the equipment carries a hefty price tag in the millions. Such an investment can prove fiscally challenging for smaller community hospitals without the financial clout of large academic medical centers.

During a Feb. 28 webinar sponsored by Olympus and hosted by Becker's Hospital Review, Kent Bowden, DO, general surgeon with Munson Healthcare Cadillac (Mich.) Hospital, discussed his organization's experience when assessing the value of a robot-assisted laparoscopic system implementation at a 47-bed community hospital with a $32 million annual operating room budget.

Find the sweet spot

To determine whether to implement a robotic-assisted surgery program at Cadillac Hospital, leadership hired an independent consulting firm for guidance. After a months-long analysis, the firm came back with a list of recommendations to maximize the value of implementing a Da Vinci robotic system. The list included reducing readmissions and surgical site infections, limiting the number of instruments used per surgery and reducing the hospital's cut-to-close times. The consulting firm determined that achieving these improvements would make the hospital quality and price competitive for patients seeking laparoscopic procedures, thereby improving the hospital's payer mix.

Hospital leadership found the consulting firm's recommendations comparable to the goals of most surgical quality improvement initiatives — but were unconvinced the Da Vinci model was best suited to their needs. The hospital needed a high-functioning, high-value product that would create a surgery services "sweet spot" where surgical teams could leverage new technology to achieve optimal outcomes at minimal costs.

"We wanted to be able to reach some of the dexterity and some of the mobility that you have with Da Vinci, but we wanted to do it at a cost that was more in line with [traditional] laparoscopy," said Dr. Bowden during the webinar.

While traditional laparoscopic equipment comes at a low cost, it also has limited function and dexterity compared to robotic-surgical solutions. However, products like Olympus' ENDOEYE FLEX 3D camera system and FlexDex, a minimally invasive surgical tool that allows for wristed-laparoscopy, can deliver a comparable experience to robotic-assisted surgery. When used dually, the products grant surgeons improved mobility and depth perception compared to traditional laparoscopy equipment — at a lower cost than the latest robotic tools.

"When we looked at FlexDex, we basically found that with the cost we were paying for different things such as tackers, endo-stitches and endo-stich reloads … FlexDex would be essentially cost-neutral but would give me the tactile ability to emulate what is being done on the Da Vinci platforms," Dr. Bowden said.

The hospital opted to implement FlexDex. Dr. Bowden said the equipment and an altered suture supply better suited for the technology allowed him to have "better fixation," treat large inguinal hernias and accomplish "better peritoneal closure[s]."

A low-maintenance timesaver

With both the FlexDex and ENDOEYE FLEX 3D in play, Dr. Bowden reduced his time in the operating room by about 18 percent. The time savings is significant, as each hour in the OR at Cadillac Hospital amounts to about $5,000 in overhead costs. When surgeries exceed an hour, each extra minute is associated with an average cost of $289. 

For turnover times to remain low, surgeons must maximize the utility of their time in the OR when it is fully staffed. The combined use of ENDOEYE FLEX 3D and FlexDex permitted Dr. Bowden to achieve strong success in this regard by enhancing his surgical efficiency and precision.

Additionally, the equipment does not require the annual maintenance costs related to computerized robotics, which can range from $150,000 to $175,000. Also, the devices do not require annual or biannual software updates or special staffing requirements.

"The beauty of the FlexDex is you are the computer," Dr. Bowden said. "There are no special staffing requirements when adding these new technologies. We didn't have to send anyone out to do any training."

Additionally, Dr. Bowden lauded the independence granted to surgeons with the FlexDex as perhaps one the most significant benefits of the equipment.

"If I was on-call … and I needed to use [3D and FlexDex] in the middle of the night, I don't have to call in the robotics team, I don't have to open the robotics room, I don't have to do anything different," Dr. Bowden said.

To view the webinar, click here.

To view the webinar slides, click here.

To view past webinars, click here.

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