Foley catheter for 7 days, and so they are often overwhelmed and
there's a lot of education that has to take place."
Of course, adding this surgery to your service lines does require sub-
stantial investments of time, training and capital. He puts the financial
investment at $1 million to $2 million per robot, "and each new per-
mutation costs a little more," he says.
"It's not for everyone, but there's a strong market force behind it,"
he says. "Some patients think that it must be better if it's being done
robotically, but that depends on the surgeon. The robot doesn't do
anything autonomously; every millimeter of movement is under the
surgeon's direction, so you really have to know what you're doing."
Christiana Care has 4 robotic surgical systems shared by multiple
service lines. The health system has standardized a credentialing path-
way, complete with training sessions. By the time the surgeon is doing
a robotic prostatectomy on a live patient, he or she has taken all the
necessary steps to be proficient with the system. Even then, the first
surgery is done with a proctor, and an in-house expert observes sever-
al cases after that.
"Every surgery is different; it's not like flying an airplane, where 95%
is the same and you have small degrees of variation," he says. "There's
a learning curve. You have to be able to think 3-dimensionally, and
you have to learn the visual cues and become a master at manipulat-
ing the robot."
From a business perspective — because of the capital costs, the
ongoing maintenance costs and the fact that a robotic prostatectomy
is not reimbursed at a higher rate — there are only 2 ways investing in
a robotics system makes sense, says Dr. Mitchell: bringing new
patients into the facility; or decreasing patients' length of stay. As far
he's concerned, robotics systems have helped Christiana Care do both
and then some. — Bill Donahue
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