6. July 2010 07:53
So how do you start a robotic program? First and foremost everyone involved has to recognize that it is a program all stakeholders need to support. It is not something you can dabble in and hope to be successful. For our cardiac robotic program we started with three essential things. First, we had a surgeon that was keenly interested in developing his skills with this technology. He spent endless hours traveling to many different countries learning the ropes. Our group invested thousands of dollars in support to make this happen. Our support was both monetary and through filling in for his practice while he was traveling. This is much less of an issue nowadays since there are numerous places in this country where a surgeon can be trained on the robot. Our program is one of them. Our lead surgeon, Dr. J. Michael Smith, can teach you whatever you want to know about valve surgery with the daVinci system and Dr. Karen Gersch runs point for using the robot for coronary artery bypass grafting.
The second thing you need is a hospital administration that is willing to support such a venture. This support comes in a variety of forms. As I mentioned last week, this is one expensive tool. Only one company makes it so there are no competitors to help keep the lid on pricing. Each robotic system goes for between one and a half to two and a half million dollars. Each system needs a maintenance contract. These go for a solid six figures each year. Each of the two or three robotic arms has a reusable tool at its end. The ones you use the most to hold things and sew with can be used a total of twelve times. After the twelfth use the device gets locked out by the robots computer and a new one must be used. Each of these goes for about five grand. As you can see this device runs the meter pretty fast. Given this, the hospital administration has to have the financial stability to wait for its return on investment. Tough to come by in the current era when hospital operating margins are typically wafer thin.
The third essential thing is a strong referral base that is willing to help patients understand exposure to a new and developing technology. Oddly enough in the beginning the cardiologists that worked in our first robotic facility were, on average, lukewarm about referring their patients. What helped carry the day for our surgeon were all the other surgeons in our group working with their referring cardiologists to send appropriate patients to Dr. Smith. This results in a much higher volume of patients early on when the learning curve is in greatest need of reinforcement. This latter point is critical and yet is perhaps the most often overlooked.
With these things - a motivated lead surgeon, a supportive administration and a dedicated referral base - a robotic heart surgery program can be created with a high probability of producing good, consistent results. Much like a table with three legs, the absence of any one of them leads to certain failure. Make sure the hospital you decide to use knows how to make a solid piece of furniture.