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INITIATION OF A ROBOTIC PROGRAM IN A COMMUNITY AFFILIATE HOSPITAL SETTING-SAFELY AND COST-EFFECTIVELY. IT’S NOT JUST FOR UNIVERSITY TEACHING HOSPITALS ANYMORE!

Marian P Mcdonald, MD, MEd, FACS. St. Luke’s University Health Network

INTRODUCTION: Robotic surgery has resurged in recent years in Urology, Gynecology/Oncology, and General Surgery.  Technology and training have improved whereas most major teaching hospitals have at least one “robot” in use.  Community hospitals have developed an interest in robotic programs for many of the same reasons that robotics is becoming favored in teaching hospitals–advanced laparoscopic techniques resulting in improved surgical outcomes.  

METHODS: We describe a community affiliate hospital program, initiating a Robotic program within nine months, with training of their Bariatric surgeons, General Surgeons, and aiding in recruiting Urologists and Gyn/Onc surgeons to the institution, increasing the OR utilization by these surgeons.  All involved surgeons adopted an aggressive approach to campaigning for the robot and demonstrated cost savings to the hospital, so much so that the Intuitive robot was upgraded within ten months of acquiring the Si Robot.

RESULTS: In the initial quarter of the acquisition of the Robot, with just Gyn/Onc and Urology only using the Robot, only 16 cases in a quarter were using the Robot. Within nine months, the number of cases jumped to 88 per quarter, the vast majority of them were Bariatrics and General Surgery.  Interestingly, the number of Gyn/Onc and Urology cases also increased during that time when General Surgery came on board. 

For General Surgery, a significant cost savings was determined for inguinal hernias and laparoscopic cholecystectomies.  For one surgeon, the cost savings for ventral hernia repair robotically was $75,744 (per year) and for inguinal hernias, the savings was $97,836, for a total of $176,211 for these two cases alone, using the robotic techniques.  (This was not including the service agreements, which decreased significantly per case the more the robot was utilized.)  In robotic inguinal hernias, there was demonstrated improvement in pain control postoperatively, with decreased opioid use.

CONCLUSIONS: Robotic surgery is not just for advanced teaching hospitals any more.  The benefits of a robotic program can be demonstrated in common surgical procedures performed by community surgeons.  A dedicated team approach is necessary to make the program safe and cost-effective. We describe how a community hospital can indeed develop a robotic program with the support of administration, a dedicated OR nursing team, and the collaboration of diverse surgeons interested in improving cost and patient outcomes. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94795

Program Number: P701

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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