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Robotic Surgery

January 1, 2006
by Pamela Tabar
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Nancy Schlicting, president and CEO of Detroit's Henry Ford Health System (HFHS), still remembers the day when the chair of urology, Mani Menon, M.D., rushed to her office to tell her about a surgical robot named da Vinci. Menon had a new idea: using this robotic technology to revolutionize the way HFHS performed urologic procedures, especially prostate surgery.

Back then, most CEOs might have considered the $1.3 million investment too risky for a technology whose business case was then unproven. "I had to take a leap of faith," Schlicting admits. "But quite frankly, taking that risk, and having the opportunity to be out there first with this [new prostate] procedure, helped us attract business from around the globe. It's had a real halo effect on our organization."

When the robot arrived in 2001, Menon developed his new surgical technique and then taught others how to perform it. By 2005, HFHS had become the U.S. leader in minimally invasive prostatectomies.

HFHS decided to buy a second robot in 2003, for training purposes. Now, the second robot is so busy with real surgery cases that the health system is considering buying a third one very soon, Schlicting says.

Changing the limits
After five years of market maturation, the da Vinci system, manufactured by Intuitive Surgical Inc., Sunnyvale, Calif., is now the most pervasive robotic surgical system in the United States. Nearly every state has at least one. The system has two main components: A control console about the size of a voting booth where the surgeon sits, and, at the patient's side, a set of three robotic arms equipped with a stereoscopic camera and interchangeable surgical instruments at the ends.

When it merged with competitor Computer Motion in 2003, Intuitive also became the only remaining surgical robotics vendor in the country that already possessed a lengthy portfolio of Federal Drug Administration (FDA) clearances. Several dozen procedures were approved as of November 2005, primarily in the cardiac, urologic, thoracic and gynecologic arenas.

In an IT world that usually thrives on upgrades or replacements, this is a new, welcome business case: broaden the hospital's surgical portfolio by creating additional ways to use a technology the hospital already owns. "It's not about ideas for a new robot," says Eric Miller, Intuitive's senior vice president of marketing. "It's about 'where else can this be used?'"

At Philadelphia's University of Pennsylvania Health System (UPHS), surgeons in the Division of Head and Neck Surgery are busy exploring just that. Building on a project first launched by a medical student-in-residency, the UPHS surgeons are conducting an Institutional Review Board-approved study using the da Vinci system to perform throat and neck cancer surgeries.

Some of the operations were considered too risky, and some were practically impossible to do in a traditional way, says Gregory Weinstein, M.D., director of head and neck surgery at the University of Pennsylvania School of Medicine and a surgeon at UPHS. For example, in some cases, traditional methods would require splitting the patient's jaw and/or risking permanent damage to the voicebox, Weinstein says.

As of November 2005, UPHS had performed 20 robotic-assisted surgeries under the clinical study, with excellent results, Weinstein reports. The 65-patient study is expected to be completed by the end of 2005.

Since robotic systems can automatically adjust for a surgeon's hand tremors within a small space, it's no surprise that another promising application for robotic-assisted surgery is in pediatrics. In 2004, surgeons at Stanford Hospital and Clinics, Stanford, Calif., repaired a damaged bile duct in a two-month-old boy--the first time the technique had been performed with robotic assistance, let alone on such a small patient. In February 2005, surgeons at the University of Iowa Hospitals and Clinics, Iowa City, Iowa, used the da Vinci system to repair a hernia in a six-day-old infant who weighed only five pounds.

Partnerships between Intuitive and innovative surgical departments to conceive new uses for the robotic system are resulting in a triple-win for patients, hospitals and Intuitive's own medical presence, Miller says. Minimally invasive procedures are often better for the patient and the hospital, reducing both recovery time and business risk. Surgical departments that develop ground-breaking techniques often can earn a reputation as an innovative center of excellence, while their contributions of clinical study data also can entice the FDA to approve procedures faster, he says.

Primed for a new business case
Early adopters of robotics-assisted surgery readily confirm its impact on the surgical department's business model and its potential to improve surgical technique and patient safety. UPHS' Weinstein is already looking further ahead. "One of the things that's going to be very exciting in the future is doing it across the Internet--true telesurgery, where the robot console is in one city and the robot cart is in another."

Schlicting agrees that the IT investment paid off for HFHS. "Technology [investment] is kind of a game. It's not going to work every time. Going into it, you don't really know how the end is going to be written. You have to be willing to take some risk, and you have to have faith in the people involved."

Pamela Tabar is a freelance technology writer in Cleveland.