S. Adam Ramin, MD, an expert in robotic urologic surgery and director of Urology Cancer Specialists in Los Angeles, and Isaac Verbukh, MD, President and CEO of miVIP Surgery, discuss the benefits of bringing robotic technology to the ambulatory surgery center setting.
Q: Why did you decide to introduce robotic technology to the ASC?
Dr. Isaac Verbukh: Our philosophy is to introduce the best equipment on the market as well as world-class surgeons trained to use that equipment to our outpatient center. That combination allows us to achieve the best outcomes for our patients. The robot allows the surgeon improved precision leading to minimal undesired tissue damage. Thus traditionally hospital grade surgeries become minimally invasive, short recovery time procedures and can be done on an outpatient basis.
Q: What are the advantages of bringing robotic technology into the surgery center?
Dr. S. Adam Ramin: Robotic surgery allows the surgeon to perform major operations in a minimally invasive fashion. Used by experienced surgeons, this technology will result in a much more precise and accurate procedure. Subsequently the patient will have less pain, recover faster, have less chance of complications, and return home earlier. It's important to note that because robotic surgery is highly technical and difficult to master, the surgeon's skills and level of experience are very important in ensuring excellent outcomes.
Like many other surgeons, I initially performed robotic prostate surgery only in a hospital setting. The technology resulted in a significantly lower chance of bleeding and other complications. Therefore it made sense to take the next step and start performing these procedures in a surgery center setting. The advantages of robotic surgery in an ASC are lower infection rates, easier access for patients, more personalized attention to the patient, safe operating standards for the patient, and more efficient operating room practices for the surgeon.
For patients, the surgery center is a more comfortable environment; they aren't in a big, intimating, sterile institution like a hospital. The surgery center staff can give more care and attention to each individual patient. Patients aren't as overwhelmed in a surgery center as in a hospital. Surgery centers are generally more efficient in beginning and ending the operation; as a result, patients spend a shorter period of time in the operating room under anesthesia.
IV: The main advantages are improved clinical outcomes and the fact that more procedures can be done robotically on an outpatient basis. Most insurance companies, however, will pay the same outpatient facility fee per procedure whether a robot is used or not. Thus the increased overhead can only be offset by increased volume. It is our experience that satisfied patients are our best marketing tool. However, it still remains to be seen whether word of mouth will offset the increased overhead.
Q: What does the robot add to the surgery center if physicians are already performing minimally invasive procedures?
SR: Without a robot, a skilled surgeon can still perform many procedures by "pure" laparoscopic techniques. However, I believe that there are many advantages in bringing robotic technology to an ASC. As mentioned, the surgeries are more precise, faster and cause less damage to surrounding structures. Robotic technology can also level the playing field for many surgeons. Those who are technically unable to perform "pure" standard laparoscopic procedures may learn and become very proficient in performing robotic laparoscopic surgery.
The robot can be used by urologists, gynecologists and general surgeons at an ASC. Right now the use of a robot for these procedures is much more pervasive in the hospital setting than in the surgery center. While currently small numbers of surgeons are trained in robotic surgery, it is definitely gaining ground. As more and more surgeons become proficient in the use of the robot, there will be a higher demand for performing these operations in an ASC.
IV: The robot allows the surgeon to perform more procedures on an outpatient basis safely and effectively. The use of the robot improves the surgeons precision leading to improved outcomes and shorter length of stay.
Q: Do you think the robotic technology will eventually be the standard around the country for these procedures?
SR: As of two years ago, the number of prostate cancer surgeries done robotically surpassed those done open in the United States. Furthermore, the fastest growing field in robotic surgery is currently gynecological surgery. I personally perform robotic surgery on all my patients who need surgery for prostate cancer, kidney cancer, bladder cancer and pelvic prolapse.
In a sense, the future is already here; and the field of robotics will only continue to grow. Because of the wide array of robotic applications, surgery centers are poised to take advantage of robotic procedures. Many types of robotic surgeries can be performed safely and effectively on an outpatient basis. Some examples include cholecystectomy, prostatectomy, hernia repair, varicocelectomy, hysterectomy, ovarian cystectomy, myomectomy and vaginal prolapse surgery. In the urologic arena, my experience has shown that prostate cancer, infertility and hernia surgeries can be done very safely and effectively in the ASC using a robot.
Today's robotic systems come with two surgical consoles, one for the primary surgeon and one for the assistant or the surgeon in training. For the newer, less experienced surgeons, this dual console robotic system allows for direct hand on training. Furthermore, the assistant becomes more involved and invested in the surgery.
IV: Surgery centers interested in performing additional procedures and improving their patient outcomes will be interested in this equipment. Strict policies and procedures and quality assurance will have to be in place to ensure patient safety. A core of surgeons that are robotically trained and interested in using the facility will have to be identified.
Finally, a management and operations team dedicated to the robotic program will have to be in place.
Q: What obstacles are there for surgery centers wishing to incorporate robotics into their facility?
SR: The two biggest obstacles to surgery center ownership of a robot are the cost and finding enough surgeons to bring robotic cases to the center. Busy surgery centers associated with large numbers of surgeons who perform minimally invasive surgeries are best situated in purchasing a robotic system.
IV: Increased overhead due to the cost of the robot can be prohibitive and financing may prove to be difficult. Additional safety equipment may be required. Extra training is required for the supporting staff.
Q: What will it take for more surgery centers to adopt robotic technology for these procedures?
SR: There are a large number of factors important to the success of a robotics program at a surgery center:
1. Adequate number of robotically trained surgeons: At least 10 surgeons per robot
2. Representation of a variety of surgical specialties: urology, gynecology, general surgery and bariatrics.
3. Adequate working capital: This includes not only the purchase, but support of the program. The program will need vision, direction, money, marketing strategy, and strong safety standards.
4. An administrator solely responsible for development of the robotics program.
5. Support for the surgeons: purchasing the necessary equipment, marketing their practices and skills, helping to increase their case load that can be brought to the surgery center.
6. Close relationship with the robotics company
Traditionally, surgery centers have been at the forefront of advancing the limits of minimally invasive surgeries. I believe that the next frontier in this evolution is robotic surgery at the ASC setting.
IV: Surgery centers interested in performing additional procedures and improving their patient outcomes will be interested in this equipment. Strict policies and procedures and quality assurance will have to be in place to ensure patient safety. A core of surgeons that are robotically trained and interested in using the facility will have to be identified.
Finally, a management and operations team dedicated to the robotic program will have to be in place.
More Articles on ASCs:
5 Steps to Reducing Patient Non-Compliance in Surgery Centers
7 Core Concepts to Leverage ASC Data in Payor Negotiations
6 Points on Medicare Reimbursement Trends in Surgery Centers
Q: Why did you decide to introduce robotic technology to the ASC?
Dr. Isaac Verbukh: Our philosophy is to introduce the best equipment on the market as well as world-class surgeons trained to use that equipment to our outpatient center. That combination allows us to achieve the best outcomes for our patients. The robot allows the surgeon improved precision leading to minimal undesired tissue damage. Thus traditionally hospital grade surgeries become minimally invasive, short recovery time procedures and can be done on an outpatient basis.
Q: What are the advantages of bringing robotic technology into the surgery center?
Dr. S. Adam Ramin: Robotic surgery allows the surgeon to perform major operations in a minimally invasive fashion. Used by experienced surgeons, this technology will result in a much more precise and accurate procedure. Subsequently the patient will have less pain, recover faster, have less chance of complications, and return home earlier. It's important to note that because robotic surgery is highly technical and difficult to master, the surgeon's skills and level of experience are very important in ensuring excellent outcomes.
Like many other surgeons, I initially performed robotic prostate surgery only in a hospital setting. The technology resulted in a significantly lower chance of bleeding and other complications. Therefore it made sense to take the next step and start performing these procedures in a surgery center setting. The advantages of robotic surgery in an ASC are lower infection rates, easier access for patients, more personalized attention to the patient, safe operating standards for the patient, and more efficient operating room practices for the surgeon.
For patients, the surgery center is a more comfortable environment; they aren't in a big, intimating, sterile institution like a hospital. The surgery center staff can give more care and attention to each individual patient. Patients aren't as overwhelmed in a surgery center as in a hospital. Surgery centers are generally more efficient in beginning and ending the operation; as a result, patients spend a shorter period of time in the operating room under anesthesia.
IV: The main advantages are improved clinical outcomes and the fact that more procedures can be done robotically on an outpatient basis. Most insurance companies, however, will pay the same outpatient facility fee per procedure whether a robot is used or not. Thus the increased overhead can only be offset by increased volume. It is our experience that satisfied patients are our best marketing tool. However, it still remains to be seen whether word of mouth will offset the increased overhead.
Q: What does the robot add to the surgery center if physicians are already performing minimally invasive procedures?
SR: Without a robot, a skilled surgeon can still perform many procedures by "pure" laparoscopic techniques. However, I believe that there are many advantages in bringing robotic technology to an ASC. As mentioned, the surgeries are more precise, faster and cause less damage to surrounding structures. Robotic technology can also level the playing field for many surgeons. Those who are technically unable to perform "pure" standard laparoscopic procedures may learn and become very proficient in performing robotic laparoscopic surgery.
The robot can be used by urologists, gynecologists and general surgeons at an ASC. Right now the use of a robot for these procedures is much more pervasive in the hospital setting than in the surgery center. While currently small numbers of surgeons are trained in robotic surgery, it is definitely gaining ground. As more and more surgeons become proficient in the use of the robot, there will be a higher demand for performing these operations in an ASC.
IV: The robot allows the surgeon to perform more procedures on an outpatient basis safely and effectively. The use of the robot improves the surgeons precision leading to improved outcomes and shorter length of stay.
Q: Do you think the robotic technology will eventually be the standard around the country for these procedures?
SR: As of two years ago, the number of prostate cancer surgeries done robotically surpassed those done open in the United States. Furthermore, the fastest growing field in robotic surgery is currently gynecological surgery. I personally perform robotic surgery on all my patients who need surgery for prostate cancer, kidney cancer, bladder cancer and pelvic prolapse.
In a sense, the future is already here; and the field of robotics will only continue to grow. Because of the wide array of robotic applications, surgery centers are poised to take advantage of robotic procedures. Many types of robotic surgeries can be performed safely and effectively on an outpatient basis. Some examples include cholecystectomy, prostatectomy, hernia repair, varicocelectomy, hysterectomy, ovarian cystectomy, myomectomy and vaginal prolapse surgery. In the urologic arena, my experience has shown that prostate cancer, infertility and hernia surgeries can be done very safely and effectively in the ASC using a robot.
Today's robotic systems come with two surgical consoles, one for the primary surgeon and one for the assistant or the surgeon in training. For the newer, less experienced surgeons, this dual console robotic system allows for direct hand on training. Furthermore, the assistant becomes more involved and invested in the surgery.
IV: Surgery centers interested in performing additional procedures and improving their patient outcomes will be interested in this equipment. Strict policies and procedures and quality assurance will have to be in place to ensure patient safety. A core of surgeons that are robotically trained and interested in using the facility will have to be identified.
Finally, a management and operations team dedicated to the robotic program will have to be in place.
Q: What obstacles are there for surgery centers wishing to incorporate robotics into their facility?
SR: The two biggest obstacles to surgery center ownership of a robot are the cost and finding enough surgeons to bring robotic cases to the center. Busy surgery centers associated with large numbers of surgeons who perform minimally invasive surgeries are best situated in purchasing a robotic system.
IV: Increased overhead due to the cost of the robot can be prohibitive and financing may prove to be difficult. Additional safety equipment may be required. Extra training is required for the supporting staff.
Q: What will it take for more surgery centers to adopt robotic technology for these procedures?
SR: There are a large number of factors important to the success of a robotics program at a surgery center:
1. Adequate number of robotically trained surgeons: At least 10 surgeons per robot
2. Representation of a variety of surgical specialties: urology, gynecology, general surgery and bariatrics.
3. Adequate working capital: This includes not only the purchase, but support of the program. The program will need vision, direction, money, marketing strategy, and strong safety standards.
4. An administrator solely responsible for development of the robotics program.
5. Support for the surgeons: purchasing the necessary equipment, marketing their practices and skills, helping to increase their case load that can be brought to the surgery center.
6. Close relationship with the robotics company
Traditionally, surgery centers have been at the forefront of advancing the limits of minimally invasive surgeries. I believe that the next frontier in this evolution is robotic surgery at the ASC setting.
IV: Surgery centers interested in performing additional procedures and improving their patient outcomes will be interested in this equipment. Strict policies and procedures and quality assurance will have to be in place to ensure patient safety. A core of surgeons that are robotically trained and interested in using the facility will have to be identified.
Finally, a management and operations team dedicated to the robotic program will have to be in place.
More Articles on ASCs:
5 Steps to Reducing Patient Non-Compliance in Surgery Centers
7 Core Concepts to Leverage ASC Data in Payor Negotiations
6 Points on Medicare Reimbursement Trends in Surgery Centers