Gregg Kai Nishi, MD, a general and bariatric surgeon and director of the Institute for Minimally Invasive and Robotic Surgery at K and B Surgical Center in Beverly Hill, Calif., describes the process of bring the da Vinci Surgical System to the ASC and building a robotic surgery division. Is a robotic surgical system right for your center? Financial consideration
Robotic technology is an expensive investment; there are hospitals that hesitate because of the costs involved. The first step in considering the addition of robotic surgery is to decide if it is financially feasible. Dr. Nishi and his colleagues initially spoke with a team at da Vinci about learning to use the system at a nearby hospital and lightheartedly suggested bringing the system to K and B Surgical Center instead. What began as an offhand remark started to make more and more sense. The center had the resources to make the initial investment and the physician support to make the future of a robotics program sustainable.
Physicians
The da Vinci Surgical System is most often used in specialties such as:
• Colorectal surgery
• Urology
• Gynecologists
• Bariatric surgery
• General surgery
"We began with prostate procedures and then moved on to GYN," says Dr. Nishi. "It is starting to be used in general and colorectal surgery." ASCs considering the addition of robotic technology will already have established service lines in the specialties corresponding to the robotic surgical system or be prepared to recruit physicians.
At K and B Surgical Center, Dr. Nishi's partner Theodore Khalili, MD, FACS, was a pioneer in robotic surgery for weight loss. The center's urology physicians planned to undergo the training necessary to use the system for prostate procedures. The center had a solid physician base to support a robotics program.
"There is no margin for error in the outpatient setting," says Dr. Nishi. "Find the surgeons that are the best in their fields." Nine physicians in the specialties of urology, general surgery, colorectal surgery, bariatrics, pediatrics and gynecology perform procedures using the da Vinci at K and B Surgical Center.
Case volume
If an ASC has a solid core of physicians trained and prepared to use the robot, the next step is finding where the technology is best served. Dr. Nishi has found that da Vinci is useful tool in bariatric surgery, but that it truly provides a distinct edge in gallbladder and hernia surgery. The center's urologists and gynecologists were already performing the vast majority of cases robotically. With this in mind, the center was able to focus on the areas that made the most sense for the robot and to build case volume.
Benefit to patients
Robotic surgery is gaining traction in the outpatient setting, but it has primarily been performed in hospitals. ASCs offer patients lower infection rates and higher satisfaction. The benefits of robotic surgery, single incision, less bleeding and quicker recovery times, can be combined with the benefits of an ASC environment. "The robot is really just another instrument [to offer high quality care]," says Dr. Nishi.
Return on investment
The acquisition of robotic technology is a business decision and ROI is a key factor in that decision. Procedures done robotically do cost more without an increase in reimbursement. "Your ROI comes from increased case volume," says Dr. Nishi. The presence of robotics program has the potential to attract more patients and more physicians interested in what the technology has to offer.
Above all else, a successful robotics program will have the support of an ASC's entire team. "It is an easy transition to make, but ASC leaders have to be mentally prepared to do so," says Dr. Nishi.
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