The da Vinci Surgical System is a robotic tool used by surgeons throughout the state and nation in a variety of procedures. The robot is controlled by a doctor who uses a control panel in the surgical area to manipulate the machine’s multiple arms—all while viewing the procedure through a camera inside the patient.
Doctors say robotic surgery is often less invasive for the patient, more precise and even more ergonomically friendly for doctors performing long and tiring surgeries. However, the robot’s high price tag can be a barrier for hospitals to adopt the machines.
Although robotics is not prevalent in every medical field—such as brain surgery—it is common in a range of surgeries mostly dealing with the digestive and reproductive system.
In some brightly lit offices at St. David’s North Austin Medical Center, a team of doctors and scientists are leading the way in how to best use robots in surgery and health care.
The Texas Institute for Robotic Surgery, or TIRS, started in 2011 and aims to understand how robotics influences surgeons, patients and medical costs.
Dr. Thomas Payne, the executive medical director of TIRS, said St. David’s North became serious about using robotics in its hospitals when the institute opened. Since then he said the use of robotics has rapidly expanded into all the St. David’s hospitals as well as most major hospitals in Central Texas.
“There was a need to really establish some standards of excellence,” Payne said. “With rapid technology adoption, it’s important to find the best practices and do it well.”
Dr. Randy Fagin is vice president of robotics with Hospital Corporations of America, which owns about 160 hospitals nationwide including St. David’s. He was previously the chief administrative officer at TIRS.
Fagin said the institute examines how robotics can be not only clinically effective, but cost-effective as well.
He said before the institute started, St. David’s North Austin Medical Center was one out of about 900 hospitals that used robotic surgery. So he said he went on a “pilgrimage” to better understand possible best practices.
“As we started the institute we needed to figure out what ‘best’ looked like,” Fagin said.
Fagin said he learned much of the information he was looking for was kept separated into different software packages that did not share information and were customized by individual hospitals.
He said he contracted a third party to build a database and convinced other hospitals to contribute.
“No one could learn as fast as us because we had way more information,” he said.
In the years since starting, HCA brought the database out of TIRS and up to the corporate level. Now, about 100 hospitals throughout the nation are now in the HCA’s data network. Fagin said the data collected shows TIRS and HCA how to best use robotics in the operating room and has become the largest database relating to robotic surgery.
“[The data] allows us to learn what patterns of behavior result in better outcomes,” he said. “[The data shows] how [can] we replicate those things to add value to our surgeons and our staff and our nurses.”
Fagin said the institute looks for interesting data “handshakes,” in which a piece of flagged data impacts another piece of data. They connect the data in ways that he says are “accurate and verifiable.”
Fagin said the methods used at TIRS could be applied throughout the health care industry. They chose robotics because it is a controllable sample size of the health care industry, and St. David’s North Austin Medical Center gave them the support to pursue best practices in robotics, he said.
While TIRS is examining data from throughout the nation, Central Texas hospitals continue embracing robotic surgeries.
Dr. Jinnie Bruce, a general surgeon at Seton Medical Center Williamson in Round Rock, said when she started her residency in the early 2000s there was no robotics training available.
She trained in laparoscopic surgery, also called minimally invasive surgery, in which small incisions are cut into the patient for the doctor to operate inside. A camera is inserted in one of the incisions for the surgeon to see inside the patient.
But after robotic surgery became available she started training to perform laparoscopic surgery with the robot instead of the traditional method, she said.
“It’s a natural extension,” she said.
She said in the years since her residency robotics has become quite prevalent in hospitals. She said patient interest has helped in that acceptance.
“Patients like to think their physicians are cutting-edge,” she said.
Dr. Nathaniel Polnaszek, a urologist at Scott & White Hospital-Round Rock, said he sees robotics becoming more prevalent throughout the field. As an example, he said when laparoscopic surgery was first introduced it required a fellowship to perform. But as training was integrated into residency the requirement fell away, he said.
“More and more urologists coming out of training know how to use and implement [the da Vinci robotic surgery platform],” he said.
Moving into the future
Although robotic surgery is prevalent in many fields, it is still a relatively new technology.
Bruce said she sees robotics as being in its infancy.
“It’s very exciting to be in the infancy stage, but it’s a little scary,” she said. “It makes you worry: Are we using it too much? Are we using it for things we shouldn’t be using it for? But really the technology is evolving.”
Polnaszek said for urology the robot is here to stay.
“The older urologists without exposure [to the robot], they’re being replaced with surgeons who have been trained in robotic surgery,” he said. “I think in another 25 years everybody is going to be trained who actually practices urology.”
Fagin said there has been no point in medical history that surgery has stopped advancing.
“For anyone to say we’re as good today as we’ll ever be is a false statement,” Fagin said.
He said robotics is not the “be-all, end-all,” but it is an increasingly important part of a surgeon’s tool set.
Ultimately Fagin said a robot will never replace a surgeon’s skill or judgment.
“You want to choose your surgeon by experience, not whether they use a robot,” he said.
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