Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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A P R I L 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 2 3 interface is more user-friendly and it's increasingly being used for a wider variety of operations. "Robotic surgery has gone in 2 dif- ferent directions at the same time," says Dr. Bourne. "It is always trying to improve its current platform to ensure current uses are improving, but the technology has grown into more complex surgeries, and is making minimally invasive surgery even less invasive." Some of the newest technology allows for robotic single-port access, an example of the increasing options for minimally invasive surgery, says Dr. Bourne. That new feature uses a 5-lumen port that provides access for 2 single- site instruments, the 8.5 mm 3DHD endoscope, a 5/10 mm accessory port and the insufflation adapter. The port allows entry though a 1.5 cm incision. Dr. Bourne says single-port technology is currently used for simpler cases like cholecystectomies and hysterectomies. He notes that while the single incision improves cosmetic outcomes, it still requires a larger incision than ports used during single-incision laparoscopy. The wristed-action arms are one of the robot's best features, says Dr. Bourne, since they remove the "chopstick" constraints of traditional laparoscopic instru- ments. The technology, which allows for movement similar to a human wrist, has recently been updated to include stapling and vessel-sealing instruments that let the robot access hard-to-reach anatomy. "It brings a new level of maneu- vering to complex equipment," says Dr. Bourne. Another improvement is the robotic system's new fluorescent imaging tech- nology, says Dr. Bourne. The technology is compatible with new models of the robot, and uses a near-infrared light to let the surgeon more precisely see tissue and blood vessels. It's helpful to identify target arterial branches and create a W hile the robot might be a tech- savvy doc's dream, it's hard to ignore the cloud of controversy that surrounds the technology, says Jay Redan, MD, FACS, president of the Society of Laparoendoscopic Surgeons and medical director of minimally invasive general surgery at Florida Hospital-Celebration Health in Kissimmee. Plenty of surgeons and facility leaders are con- cerned about so-called "bad robot surgery," although he stresses it's not the machine's fault. "As with laparo- scopic surgery when it first started, there's a lot of injuries," says Dr. Redan. "It's not the robot's fault. It's the training that's been a problem." The high price tag and surge in patient demand for the technology is putting pressure on hospitals to have more doctors use the equipment, says Dr. Redan. Andrew E. Bourne, MD, a urologist with Siouxland Urology Associates and chairman for robotic surgery at Mercy Medical Center in Sioux City, Iowa, notes that each hospi- tal has its own credentialing process that typically requires a surgeon to demonstrate proficiency in robotics. But that's not always the case, says Dr. Redan. "Hospitals have been so frantic to use this machine — they've invested so much money — they've been lax in credentialing doctors to use it," he says. To fix that, Dr. Redan says, a robotic training program called Fundamentals of Robotic Surgery (frsurgery.org), which uses online exams and in-person skill tests, should be a standard part of credentialing surgeons to use the robot. Cost is also an issue preventing more widespread adoption of robotic technology. The $2.1 million price tag, plus annual maintenance costs that can total more than $300,000, and limited research showing its advantages over laparoscopy, have many facilities wondering if adding a robot is worth it. "The controversy now is, is the robot really a multi-mil- lion dollar laparoscope?" asks Dr. Redan. "Yes, you do have incredible visualization and wristed-motion instru- ments, but those have not translated into a technology that's showing any proven pluses over laparoscopy, aside from some benefits during gynecologic oncology cases." Regardless, many surgeons believe robotic is the better option. "Doctors are saying 'I can do the operation better and my back doesn't hurt at the end of the day,'" says Dr. Redan. "I hear that and I totally understand, but we need to see improved clinical outcomes. And right now they're not there." — Kendal Gapinski z TOUGH SELL Some experts think robots are more marketing tool than surgical aid. CLOUDED IN CONTROVERSY Are Robots Worth the Hefty Price Tag?