Gynecological surgeon Dr. Richard Taylor describes operating with the da Vinci surgery robot as “like walking around inside the patient with a magnifying glass.”

 Since purchasing the equipment in February 2011, Kalispell Regional Healthcare doubled its projections of robotic-assisted procedures, leading to the purchase of a second system.  

“The business side of our organization predicted we would be doing 150 cases per year,” Taylor said at a recent seminar. “We thought five surgeons would be credentialed within the first year in two specialties.”

Instead, 10 surgeons representing five specialties were credentialed to operate the da Vinci robot. The hospital has logged close to 300 robotic-assisted procedures a year.

Attractions for patients include quicker recovery, reduced post-operative pain and reduced blood loss.

“We have cases of robotic surgery where we joke about losing one or two red blood cells,” Taylor said. “It’s actually sometimes less than what we draw for pre-op labs.”

The tiny incision plus the carbon dioxide gas injected form a pressurized environment for the procedure, reducing patient bleeding. Also, the technology provides a three-dimensional visualization of the area allowing surgeons to operate more precisely even around corners.

“The precision is incredible and definitely ergonomic,” Taylor said. “That part will definitely extend my surgical career at least 10 to 15 years.”

Although people may envision a robot as acting alone, a surgeon actually performs the operation from a console watching a video screen and using controls that manipulate robotic arms inside the patient. Taylor contrasted the view provided by the robot-assisted video with that of the camera used with laparoscopic surgery.

“I equate that to speaking to someone in a social situation,” he said. “You generally have your social space. With robotics, you would be nose to nose.”

Even with these advantages, studies have not yet shown better procedure results with robotic assistance over other minimally invasive techniques. Surgeons say a critical need exists for randomized research into the area.

Just the same, institutional competition and patient demand have driven the expansion of robots. Since 2001, Intuitive Surgical has grown from having just four da Vinci robot systems in hospitals to 1,600 in the United States and another 400 to 500 worldwide.

Urologic surgeon Dr. John Andenoro said prostatectomy, removal of the prostate, is the procedure that gained the most from robotic-assisted technology.

“Robotics has had a huge impact on prostate surgery,” he said. “Between 2004, as robotics began to proliferate, and 2008, the number of overall prostatectomies grew prodigiously.”

He said Medicare literature shows that 80 percent of prostatectomies done in 2011 used the surgical robot. Andenoro said hospitals that acquired a robot saw this procedure increase by 100 percent between 2000 and 2011.

“There are some benefits — a 50 percent decrease in the length of stay,” he said. “The 30-day readmission, according to urologic data, had dropped impressively.”

However, Andenoro said the data has not shown a consistent, statistically proven benefit over open prostatectomy in the major areas of retaining erectile function and urinary control and achieving cancer cure. But he points to a reduction in complications and blood transfusions as helping mitigate the higher cost of robot-assisted surgery.  

Andenoro added that patients also experience only a modest reduction in post-operative pain over open procedures.

 Also, research has shown that robotic systems have increased surgeons’ comfort level and confidence for doing partial kidney removal, allowing patients to stay off dialysis and saving them thousands upon thousands of dollars.

“Even though cost of robotic surgery will be more expensive with upfront costs, the benefit over their lifetime is substantial,” Andenoro said. “I don’t see how any institution that doesn’t have a robot is going to be able to attract a urologist under 45 years of age.”

 Dr. Thomas de Hoop, a specialist in obstetrics and gynecology, said he also considers robotic capability crucial for recruiting young surgeons. He recalled that residents resisted training on the da Vinci when the system first came on the scene at his previous institution in Cincinnati.

“By the time I left, every resident was clamoring to get robotic cases because the hospital they were going to had one and they needed to be trained,” he said.

Also a specialist in obstetrics and gynecology, Dr. Gwenda Jones said she found robotics extremely useful for removing fibroid tumors and some very large uteruses. But she cautioned that physicians must base their choice of treatment on the patient’s pathology.

“Surgery may not always be appropriate,” she said. “It may not always be appropriate to do it robotically or necessary to do it robotically.”  

Jones quoted a New England Journal of Medicine study that calculated the robot would add $2.5 billion to the cost of medicine if used on every surgical procedure in the U.S.

“We need to not use it on every case,” Jones added.

HealthCenter and Kalispell Regional Heathcare shared the first system, which required moving the three-unit system between the two buildings for operations in urology, gynecology, general surgery and surgical oncology.

 Tate Kreitinger, chief executive officer of HealthCenter, said the da Vinci surgical robot lists for $1.7 million.

“We did a good job negotiating to get the second one for $1.45 million,” he said.

Disposable items and maintenance add annual costs of $145,000 a year. Procedures performed with the equipment must cover the capital investment plus the ongoing expenses. But, according to Taylor, Kalispell Regional Healthcare remains “very competitive on the lower end” of fees for robotic surgery in the Northwest.

His partner, gynecologist Dr. Robert Rogers, said this institution leads the state with its average of 20 cases per month and the number of cases has continued to grow.

Wrapping up the presentation, Rogers said the investment in a second system was based on surgeon demand, the average patient waiting time of one to two months, the need to recruit young surgeons and those high use numbers. He lauded that decision.

“This is not a gimmick,” he said. “This is a true advance in surgical technique.”

Reporter Candace Chase may be reached at 758-4436 or by email at cchase@dailyinterlake.com.