Dr.Vipul Patel, Medical Director, Global Robotics Institute, AdventHealth
What are the current market trends you see shaping the Robotics Surgery space?
Robotic surgery is continuing to grow, not just in the United States but globally. I expect it will grow further, as we see improved access to the technology and more efficacious outcomes across specialties. For example, in urology the gold standard procedure for prostate cancer is radical prostatectomy. This procedure has certainly been revolutionized by the robot, and now is almost totally robotically performed —a standard of care with over 90% of the procedure being performed robotically in the U.S. As more patients and surgeons have access to the robot, robotic surgery will continue to increase across specialties. In the upcoming years, there will be some new robots being released which will probably help to increase the trend to robotic surgery.
While robotic surgeries are increasing by an average of 25 percent every year, this healthcare IT phenomenon was not the game-changer that many had hoped. Almost two decades from that first robotic operation, a number of setbacks have persisted—what are your views on this trend?
Robotic surgery has stepped into more specialties, and different types of operations, primarily because access to the technology is improved, along with better training and education. As a result of increased experience, the outcomes have started to get better for most of the procedures as well. It's been an evolution, with better outcomes and more access. On the contrary, some specialties have shown that maybe there is no benefit. Robotic surgery is not for all patients or all operations.
Going back to prostate cancer and prostatectomy, we have seen good effectiveness and improved outcomes using robotic surgery; however, some procedures have not seen the benefits of robotics. And so having a robot doesn't mean that you have a better outcome automatically; you do have to train, select the right patients and once you have a good experience then you could probably have the most benefit from using the robot. The bottom line is, just having a technology doesn't automatically mean it is better; it has to be demonstrated by having experience from the surgeon and then having good outcomes on follow-up. I have performed over twelve thousand robotic prostatectomies for prostate cancer, and we have an outcomes database for all these patients. Based on our decade and a half of experience we can say conclusively that we have good evidence-based medicine for robotic prostatectomy. In our hands, robotics has helped us surpass what outcomes we were able to deliver with open or laparoscopic surgery.
Please elaborate on the challenges that the organizations will need to address related to Robotics Surgery space.
One of the challenges is around training, as it’s not easy to train someone in robotic surgery. Training has improved over the years, and we have to continue to develop better training protocols. However, advanced training is not optimal yet and the learning curve is still quite significant.
Cost is another major challenge. It can take a few million dollars to purchase, maintain and use these robotic technologies. These technologies are expensive and cost-prohibitive in some places. The economics of robotics only makes sense if you have significant patient volumes, are efficient with the procedure, and have low complication rates. Robotic surgery can be very cost-effective if it’s done correctly
"It's not just about buying the robotic technology, but it's also about having the right team and the most experienced and innovative surgeons to make a program successful"
With the advent of new robots, we can see new challenges coming in. We've got to figure out how to use them most effectively. As multiple new robots will be released in the upcoming years, the challenge will be around us learning the latest technology and figuring out where it's effective and where it's not, and the whole training issue will surface again.
What are the major tasks for organizational CIOs at this point? Is there any unmet need in terms of Robotics Surgery space that is yet to be leveraged from the vendors?
The administration is one of the issues. They have to do a cost analysis on whether robotics is going to be effective at their hospital, if they have doctors that are trained or can be trained, or if we have enough volume to make robotic surgery effective to get overwhelming growth. So just buying robots will not help solve problems. We always recommend that if someone is going to buy robots, then they should have high-volume surgeons who can use it frequently and address the learning curve quickly, and start getting good outcomes. It’s not just buying the technology, but it’s also about having the right skilled surgeons and the right amount of patients to make a program successful.
To get one robotic system, you have to set aside over$2 million. In addition, you will now and then have to buy some disposable instruments for each case. This can make the costs add up for each use. It’s a balance — the technology used in the procedure often increases the expense. But if the procedure is performed more efficiently and effectively, then this reduces the cost of a procedure. The correctly selected procedure performed effectively can result in reduced costs for robotics over open or laparoscopic surgery.
What can organizations do to stay abreast of these challenges?
Currently, there is only one major robotic manufacturer for abdominal robotic procedures. So the company, Intuitive Surgical, gets to set their cost. I believe there is good competition coming and those costs will come down. Robots and disposables will become cheaper, and with anticipation, the cost of care will come down as well. As competition occurs, the cost of having robotic systems in surgery will go down naturally over time.
How do you see the evolution a few years from now in regards to the transformation that is happening?
The robot is a computer, and that computer technology continues to evolve quickly. We'll see the technology continuing to get better; these robots will get smaller, faster, and more accurate. The next step is imaging; our goal is to be able to have good imaging in surgery to help guide the robot and give us more information. Another key step will be around artificial intelligence which is vital and has a close link to the advances in robotic surgery in having these robots give us suggestions and help during the surgery.
What is your advice for budding technologists in the Robotics Surgery space? How do you see the evolution a few years from now with regards to disruptions and transformations within Robotics Surgery space?
For companies developing Robots:
We talk with a lot of companies that are developing robots, and we always advise them to ensure that they include the surgeon in their decision making because we have certain requirements for robot and they can guide us to meet those requirements. Our advice to them is around how to create a robot that's safe, effective, cheaper, and easier to use. That's our input as surgeons, as we are trying to help them build a better device that can be accessible to more people and countries, so the cost of care goes down and the patient outcomes improve.
Advice to Surgeons:
The key is having good training, continuing to learn and closely tracking your outcomes. To perform robotic surgery optimally you should perform procedures frequently so that the team learns the routine and the surgeon can improve skills. A surgeon should have a database that plots the outcomes of the patients, so you can ascertain how your outcomes are progressing. So for surgeons, it's about ensuring that they track their outcomes and keep advancing, learning, and improving their technique.