According to market research conducted by BCC Research, Wellesley, Mass., use of medical robots and computer-assisted surgical equipment is growing in the U.S. The market was worth about $648 million in 2008 and is projected to reach $676 million in 2009, up 4.3%. By 2014, the market will be worth $1.5 billion, according to the report, up about 130% from 2008. Surgical robot systems were the largest product in that market as well, accounting for 54% of the market share. That share is expected to increase to 65% by 2014, according to the BCC report.
With that growth occurring, the design of training remains critical. And it's an issue that has been a concern among physicians for some time. There are a range of surgical opportunities that open up through the use of robotics, writes Richard Satava, a physician who is a professor of surgery at the University of Washington, Seattle, in a 2007 article. His column was published in the Bulletin of the American College of Surgeons, where he discussed the need for the right kind of training.
The robotics console “is the overall architecture that will provide even greater capabilities in the future—and this is just the beginning,” Satava writes. But without first incorporating education that matches high-tech surgery, robotics can't reach its full potential. “Thus, it is necessary to incorporate the basic principles of adult education, curriculum design, setting of quantitative performance metrics for outcomes and validation of the curriculum,” he writes.
Murphy, with the robotics college, agrees. “Robotics surgery is still in the pioneer stage,” he says. There is a deep body of knowledge about robotics that hasn't been available to all physicians, and there wasn't a way to be trained. He views his role and his colleague Srivastava's role at the college as being one of leaving a legacy. “We wanted to put some of our effort into teaching other people rather than just do a bunch of cases,” he says.
The college Web site has a full curriculum, including its Da Vinci Connect program to broadcast presentations into hospital conference rooms; practice laboratories; and the teaching of small procedures that focus on gaining proficiency with the technology, he says.
Beyond just training, there are other obstacles to adding robotics to surgical programs, Murphy says. The hospitals have to be willing to pay more than $1 million for the system, plus maintenance fees, and surgeons need time to access the systems. Also, while doctors are learning how to use the machines, their productivity drops, Murphy says. “It takes real institutional commitment to have a robotics team.”
Still, it's worth it, Murphy says—a point he hopes to help drive home through the robotics college. Being proficient at using the robotic system has enhanced doctors' technical abilities and has allowed them to perform safer surgeries on patients who didn't have the minimally invasive option before, he says.
Patients who are obese, who have thicker muscular structures and broader chests, or patients with abnormal skeletal structures would have required open surgeries, because doing minimally invasive surgeries on them is too difficult, Murphy says. With the robotics involved, doctors can gain access more easily.
Financial incentives also play a role. “You don't get paid more for doing the surgery robotically,” Murphy says. At the same time, a surgery using the robotic arm can cost $12,000 to $15,000 less than a typical surgery, with fewer complications and a shorter length of stay, he says.
Those metrics alone should make providers consider robotic surgery with more enthusiasm, says Julian Schink, chief of gynecologic oncology at 787-bed Northwestern Memorial Hospital in Chicago, which has had the da Vinci equipment since 2007. Schink has not undergone robotics training through St. Joseph's college, but has been trained through the da Vinci system's manufacturer, Intuitive.
Patients experience less bleeding, less pain and are back to work faster after procedures done robotically, which saves costs for hospitals, Schink says. Once his team demonstrated that the number of hospital days among oncology patients was down 60% to 65% over a year, it was easy to get a buy-in from the hospital, he says. “It was absolutely astounding” data.
The same resolve should start to apply to doctors, as well, Schink adds. As patients start to learn more about the advantages of robotics and demand more minimally invasive procedures, doctors will have to become proficient. “That strikes me as the future of medicine,” he says.
St. Joseph's already understands the business case for robotic surgery and views the college as a strategic move forward in surgical services, according to Kirk Wilson, president and CEO of St. Joseph's. In addition, the health system is planning to develop a total of five surgery rooms designed especially for robotic surgery. St. Joseph's is finishing the plans now and needs regulatory approval before starting to build, which is expected to take about a year.
Initially, robotic surgery is not more profitable than traditional surgeries, but the cost per case is starting to decline, Wilson says. “In our view it can only get less costly.”