Robotic system takes surgery ‘step forward’ at HUMC

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Hackensack University Medical Center is one of 16 hospitals in the U.S. to acquire the next generation da Vinci single port surgical system from Intuitive Surgical Inc. for complex urological procedures.

Hackensack University Medical Center is one of 16 hospitals in the U.S. to acquire the next generation da Vinci single port surgical system from Intuitive Surgical Inc. for complex urological procedures.

Dr. Michael Stifelman, chair of urology and director of robotic surgery, said that the technology is transformational because surgeons can put all surgical instruments through a one-inch incision.

“This is truly a step forward,” he said. “The one thing that has eluded minimally invasive surgeons for decades is being able to do all the surgery through one small incision. We can reach the most hard-to-access areas in the body and perform the most complex procedures.”

While it’s too soon to tell, Stifelman said that the new system has the potential to decrease infection and improve outcomes and recovery time.

The hospital is the only one in New Jersey to acquire the technology.

While the new system is currently FDA-approved for urology procedures, Stifelman said surgeons soon expect to use it for ear, nose and throat surgery and eventually rectal cancers.

Surgeons are currently training on the robot that is expected to be delivered to the hospital next month. Stifelman said the first procedure will be performed by the end of the year.

Data from iData, a medical market research company, show that more than 693,000 robotic-assisted procedures were performed in the U.S. in 2017. Minimally invasive surgeries accounted for approximately 86 percent of total robotic surgeries performed in the U.S. and as more physicians are trained in these techniques and the technology becomes more widely available, that number will increase.

A 2016 commentary from the Agency for Healthcare Research and Quality reported robotic-assisted surgery offers both benefits and risks.

On the plus side: smaller incisions, decreased blood loss, shorter hospital stays, faster return to work, improved cosmesis and lower incidence of some surgical complications. On the other hand, RAS shares similar risks of open and laparoscopic surgery, including the potential for infection, bleeding and the cardiopulmonary risks of anesthesia.

The takeaways for RAS, according to AHRQ:

• Robotic surgery is a rapidly expanding technology that has found a niche in multiple different surgical specialties worldwide;

• Although robotic-assisted surgery shows some short-term benefits surrounding the direct perioperative period, it has fairly equivalent long-term outcomes when compared to open surgery;

• Robotic surgery is generally safe with low overall complication rates, but adding the robot to the surgical equation inserts another potential entry point for error into an already complex and risk-fraught arena;

• In general, surgical outcomes are ultimately a direct manifestation of the skill and experience of the surgeon, not the technology or approach used; and

• Potential areas for improvement and reduction of error in robotic surgery include more standardized training and credentialing practices, improved reporting systems for robotic-associated adverse events and enhanced patient education.

While cost factors vary depending on the kind of surgery that’s being performed, a peer-reviewed article in the June 2016 issue of Value in Health looked at the economic value of robotic-assisted laparoscopic prostatectomy.

The analysis demonstrated a 38 percent to 99 percent probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs were offset by a decreased hospital stay, lower complication rate and faster return to work, the study’s authors concluded.