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Archive Hot Technology 2018

Building Trust Between Surgical Teams and Robots

Q&A with Joshua Tyler, MD, FACS, FASCRS

Joshua Tyler

Joshua Tyler, MD, FACS, FASCRS


Joshua Tyler

Is demand for robotic-assisted surgery growing?

I think so. My practice for non-emergency surgeries is about 90% robotics. The technology is arguably the standard of care for urology, GYN and oncology. General surgery and general surgery subspecialties are in a rapid adoption curve, particularly for hernia, colorectal and thoracic procedures. I'm the founding director of the Institute for Defense Robotic Surgical Education. The federal owned, federal-run site has trained over the past year 41 surgeons from 21 different federal and military facilities. Demand is so high that we project to have a year-long backlog.

What makes the training program different from others?

The bulk of robotic training focuses on the surgeon. However, robotics is a very specialized way to do surgery, so the surgeon will struggle if the entire team is not comfortable with the robot. That's why we also train circulator nurses and surgical techs along with the surgeons. As robotics becomes more widely used, getting teams to trust the robot and themselves will be key to successful implementation of the technology.

What are common misconceptions about robotic surgery?

That it takes longer to operate with the robot and cases cost more than standard laparoscopic surgery. Excellent data show that those beliefs are absolutely not true. Clinical databases capture cost and outcomes data for all surgeons, regardless of whether they're performing their first case or their 200th. Individual surgeons are publishing studies that show they operate no slower with the robot — in fact many are able to go faster — and perform cases at a cost-savings compared with laparoscopic or open procedures.

How are those cost savings realized?

The direct costs of robotics are what you'd expect — the expense of acquisition, instrumentation and OR time. Indirect costs in this era of value-based purchasing are related to cost-consequence avoidance such as limiting post-op length of stay and avoiding complications such as surgical site infections and anastomotic leaks. Disposable supplies might cost more for robotic cases, but you must consider the cost of the platform as it relates to the overall episode of care. The best outcomes I've ever given my patients came using robotics. I see significant decreases in post-op pain, SSI rates and length of hospital stay. OSM

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