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| Archive : Winter 2007 |
PAGING DR. DA VINCI:
Scissors? Check. // Forceps? Check. // Cameras? Check. // The newest doctor can remove prostates, repair heart valves and reattach tissues. And it’s not even human.
Meet:
The Robot Surgeon [page 2]
 By Charles Slack // Additional reporting by Andrea Appleton
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Skeptics, though, while marveling at what robotics seems to offer, worry that hype is outpacing reality, pushing hospitals to invest in expensive technology before its benefits have been established. What’s needed, they say, are more randomized, controlled tests of the sort used to validate other kinds of medical advances. Yet, while several such studies are under way, many hospitals worry that they can’t wait for the results. Often pressed by staff physicians to provide the latest technology, the institutions must base their decisions on little more than educated guesses.
A surgical robot can dent the budget of even the most financially secure institution. In addition to the purchase price—$1.5 million for the latest model—a da Vinci requires extra personnel in the operating room, an annual maintenance fee of $100,000 after the first year and a host of “disposables,” instruments that can be used just once or only a few times before being replaced. That alone adds $1,500 or more to the cost of performing a procedure. Unless a hospital can devote an operating room solely to robotic surgery, there are also costs to set up and take down the machine between uses. Meanwhile, most insurers pay a flat rate for a procedure, regardless of whether it is performed using open, laparoscopic or robotic techniques.
Of course, the more you use an expensive piece of equipment, the more economically viable it becomes. Tewari performs about 300 prostatectomies a year. He says that sitting at the console, in a relaxed position, enables him to do more procedures than he could if he were standing upright over a patient. And because reimbursements are the same regardless of how long a patient is in the hospital, shorter stays should save money, to the tune of the hundreds of dollars a night it costs for an inpatient bed. “If you get a patient who would have been in the hospital three days out in just one day, you essentially have three times the beds,” Tewari says.
A hospital then can handle more patients and receive more reimbursement. And there are other benefits too. Less loss of blood means less stress on the blood bank, and robotic-surgery patients tend to be pleased with their results. Weill Cornell is getting so much use out of its one da Vinci robot that it is considering buying a second, says E. Darracott Vaughan, chairman emeritus of the urology department and a force behind the hospital’s adoption of robotic surgery.
Hospitals that manage to keep their surgical robots busy tend to be big supporters of the technology. Hackensack University Hospital in New Jersey now has four da Vincis, and surgeons there, in addition to performing prostatectomies, increasingly turn to the robot to perform another delicate procedure—colectomy, the removal of a section of a diseased colon. Last summer, addressing a robotic-surgery conference in New York City, Hackensack surgeon Garth H. Ballantyne asserted that “there is no question anymore that laparoscopic colectomy is superior to open colectomy.” Yet because of the difficulties posed by laparoscopic procedures, Ballantyne said, “there are few people who are doing it. So I believe that robotic surgery is the solution.”
Nevertheless, other administrators, particularly at smaller hospitals, hesitate to break the bank. At Mercy General Health Partners, a 282-bed facility in Muskegon, Mich., the issues surrounding a potential purchase came into sharp focus last summer after a competitor, Hackley Hospital, got a da Vinci. Mercy General officials ultimately decided to pass after determining that the local population would generate, at most, 50 to 100 robotic-surgery candidates per year. |
Next page | Pages: 1 2 3 4
Photographs by Max Aguilera-Hellweg |
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