More and more, hospitals and health systems are shifting to minimally invasive surgeries to promote better patient experiences and quality outcomes.
For Huntington (N.Y.) Hospital at Northwell Health, a trend of increasingly complex bariatric cases and a clear vision of a pathway to improvements spurred a successful initiative that offers robotic surgery for more patients, where applicable.
Becker's Hospital Review recently spoke with two clinical leaders at Huntington Hospital — Nick Fitterman, MD, executive director and David Buchin, MD, director of bariatric surgery — to learn more about the growth they're seeing in their robotics-focused bariatric program, their investment strategy, as well as benefits among surgical staff, care teams and patients.
Note: Responses edited for length and clarity.
Question: Tell us about where you are seeing growth within your surgical services — are there specific trends that have stood out to you as an organization?
Dr. Nick Fitterman: We have recognized that more surgeons are coming out of residency, fellowship and their respective training prioritizing minimally invasive surgery. With that growth there has been a focus on performing surgeries using da Vinci robotics and a deliberate effort to forecast and stay ahead of that trend, partnering with Intuitive on the accelerated minimally invasive program (AMP) to make sure our physicians have unfettered access to a da Vinci robot.
Dr. David Buchin: Prior to adopting robotics, our bariatric program was high volume with a robust offering of weight-loss procedures. There has been a shift in medical weight loss, where patients are now requiring more complex and advanced weight-loss operations like single anastomosis duodenal switch. Our da Vinci program has enabled our practice to take on all complexities with the same standardized approach and has increased efficiency in all bariatric procedures, from sleeve to complex revisions.
Q: What is the strategic importance of your hospital having a robust bariatric surgery program, and how has that been reflected in your hospital's prioritization and investment strategy?
NF: Our focus at Huntington Hospital is to give every patient in our community the gold standard in quality of care. With that, it's important to be strategic in our approach to services and "skate to where the puck is going to be, not where it has been." We have prioritized bariatrics very early on as a key part of our strategy, and it makes up for a large contribution margin among our surgical specialties. Since inception of our bariatric program, pre-dating robotics, Dr. Buchin's team has provided every patient that walks through the door with exceptional care, exceeding our expectations year over year and providing fantastic weight-loss results with very little variability. This has resulted in predictable outcomes and financial margin for our hospital. His program is one we continue to prioritize investing in, recognizing the financial and quality value it brings to our hospital.
Q: How did you gain alignment in your hospital between surgeons, care teams and executives to build your bariatric program?
DB: When I reflect back on when we started our bariatric da Vinci program, I ask myself, "Is there anything we could have done better or differently?" I ultimately realized that we should have done it earlier. I needed to go all in, and I'm glad we took that leap. My patients are doing fantastic, and my body from an ergonomic standpoint feels amazing.
I would encourage all physicians not to wait, and ask for what you need for your patients. In my case, I went down to my CEO's office and told him I needed the capital to replicate what I'm doing laparoscopically, and my plan is to convert my entire practice to da Vinci to drive increased quality and financial value of my practice to the hospital. I then went to my operational leaders, directors of perioperative and nursing teams to explain my "why" and how this was going to result in more efficient operative days for them, as well as greater patient quality and physician ergonomics.
From there, we took a very organized, structured approach and met with our Intuitive team. We leveraged every resource from their robust ecosystem to build a plan. We worked with Intuitive’s Genesis team, a specialized consulting, training, and education program, to replicate as much as we could from our efficient laparoscopic practice; we pulled data before we launched to track progress, built an operational taskforce to meet with weekly and standardized our instruments to reduce variability for our nursing teams. We also created a process to roll up data, wins and areas for improvement on a daily, weekly and quarterly basis to share with our executive and operational teams. We acted as if we were launching a program for the first time.
NF: I have an open-door policy at my hospital. My "ask" as a leader is to have a plan and provide continuous updates on the initiative. Dr. Buchin is the expert in his field; I find it critical to acknowledge that and apply a growth mindset to any of his ideas, given the quality of care he offers here. When he presented me with a plan, we leveraged our partnership at the corporate level with Northwell's robotics committee to then leverage the greater partnership with Intuitive to maximize their ecosystem.
We are fortunate to have strong alignment at the integrated delivery network level with Intuitive, but if you don't, I would recommend working with Intuitive to ensure your surgeons do not have access issues at your hospital. They have flexible acquisition models and will partner to ensure your patients receive the care you strive to provide.
Q: Can you describe the results you're seeing from both surgeon and care team members and your patient population?
DB: After more than 15 years of six to eight cases per day, two to three times per week, laparoscopic bariatric surgery was killing my back. My practice is about 40% primary sleeve/gastric bypass, 45% revisional surgery and 15% general surgery with the trend continuing toward more revisional work. Laparoscopically, we were taking on all patient populations and operations from primary sleeves, elective gallbladders and inguinal hernias to single anastomosis duodenal switches and recurrent giant paraesophageal hernia repairs. I can say that since we started using da Vinci, my body is feeling better, and we are more efficient than we were with laparoscopic procedures across my practice. I could have forecasted that for the complex procedures but never thought that would happen for the "simple" cases.
Our laparoscopic results were great, but we are seeing slightly better results with da Vinci — decreased operative times, reduced pain, reduced bleeds, reduced leaks, fewer readmissions and decreased lengths of stay. We are utilizing the platform to improve operations by reducing incisions from four or five to three. In using da Vinci sleeve gastrectomy on our patients, the vessel sealing and stapling technology is best in class, and using da Vinci for cholecystectomy, in my opinion, should be standard of care. The vision, articulation and control have promoted standardization and reduced variability, driving down cost compared to laparoscopy. I will echo again: My patients were doing fantastic and I was already using minimal laparoscopic tools, but our results have improved, and I should have done this earlier.
Q: How are you educating patients inside and outside of your community on the benefits of da Vinci bariatric surgery?
DB: In our market, there are many large health systems and large bariatric practices vying for the same patients. Prior to robotics, we were using print, digital and television marketing strategies for our group and hospital. Intuitive Hub is a platform that I plan to maximize to its fullest potential in recording my procedures to share with patients, referring physicians and community members. We use patient testimonials to share our results for a human element, but Intuitive Hub will take our intraoperative recording to the next level.