robotic program optimization

Robotics 101:



One of the biggest problems confronting robotic surgery remains the persistent lack of understanding regarding the basic, fundamental tenant of robotics.

First and foremost: robotic surgery is a reproduction of open surgery, not laparoscopic surgery.  

Laparoscopic surgery is a series of “shortcuts” like tacking instead of suturing, stapling or energy ligation instead of “clamp, cut, and tie,” and balloon dissection instead of manual dissection.  Shortcuts are necessary because a surgeon is limited in manual dexterity with laparoscopy and, therefore, instruments such as tackers were created to replace normal “open” tasks.

The problem with these “shortcuts” is that they are much more expensive and less reliable than their open counterparts.

One of the best examples is examining how a surgeon deals with ligating a large cystic duct.  The common laparoscopic approach is to use a laparoscopic stapler across the cystic duct, and often taking another step to “endoloop” the stump because of the concern of leakage through clips. This laparoscopic solution costs $400, while the integrity of the closure may provide postoperative concerns for the surgeon.  The traditional open solution, however, involves just a single silk tie ligation. It costs pennies and the surgeon does not worry about the integrity of the closure.  By reproducing open surgery in robotics, the benefits of minimally invasive surgery can be delivered in a financially and clinically advantageous compared to laparoscopy. This is Robotics 101 in action.

Please note, however, that I’m not suggesting that laparoscopic instruments do not have a place in robotic surgery.  They do, especially in the learning curve of a surgeon transitioning from laparoscopy to robotics.  During a learning curve, for example, a surgeon should worry only about getting through an operation safely and at a comfortable pace.  Concerns of the financial implications and the need to speed up to save on indirect time costs or select disposables based on reduced cost should not burden the “apprentice” surgeon.  During this period, disposables such as the V-loc suture or tackers can provide the “apprentice” surgeon with comfort or reassurance and provide a positive experience to a learning curve case in the form of time efficiency and convenience.

CAVA Robotics Illustrates the Importance of Robotic Program Governance

CAVA Robotics has has produced a short video in which we discuss the importance of Governance in your Robotic Program.  See how the proper implementation of your Robotic  Program can make the difference between booming success or crushing disappointment for your facility.

CAVA’s Advice To Hospitals on Robotics Equipment Contracting (Part 2)

As we indicated last week…always make sure you are aware of the limitation of current robotic models and their pricing before you commit to final contracting.

Don’t be pressured by:

  • Discounts on the latest model, “advanced technology,” training, proctoring, instrument credits / returns “ONLY IF you take possession by next week or end of month or end of quarter”
  • Surgeons demanding the newest system because they were convinced that they “need it to perform their robotic surgery”

Time-sensitive offers are often not truly time-sensitive, with the exception that trade-in values may go down over time. Many new financing options are also now available including renting, leasing, and leasing-to-own.  Also, keep in mind that the newest, most expensive system may not be the ideal choice for a robotic program. Fact: The needs of your robotic program must dictate the right system, and that is a multi-faceted strategic decision. 

Finally, the robotic marketplace will be changing.  New vendors to the market may be available as early as 2017 / 2018, offering “faster, safer, better and cheaper” technology in response to the needs and wants of the robotic market. These vendors have every intention of being responsive to their customers in every way.

Please contact CAVA if you have any questions or need some help.

CAVA’s Advice to Hospitals on Robotics Equipment Contracting (Part 1)

There were two friends, Mr. Impulse and Mr. Patience. Both were interested in buying a new car to replace their current vehicle. 

Mr. Impulse went to a nearby auto dealer where he saw a shiny new sports car and was quickly approached by the salesperson.  He was shown the newest gadgets that were being offered in the model year and was promised it was the “car of the future.”  The salesperson told him “they were running a special for a limited time only” in which discounts on the service, maintenance, and add-on features were being offered for “thousands off their usual price,” but Mr. Impulse would need to take possession of the car today to take advantage of the opportunity.  Mr. Impulse naturally agreed, signed the contract, and drove away happy.

Mr. Patience, on the other hand, researched the available sports cars online and discovered that while the current models were attractive, next year’s models were much more promising.  Not only were they equally “fast,” equipped with more luxurious features and “cheaper,” but the cost of service, maintenance and fuel economy were also much less costly.  The dealerships were offering a “pressure free” buying experience, and were willing to talk to potential buyers to plan a deal and payment structure that fit their lifestyles.  While waiting for the newer model from the dealer, Mr. Patience took good care of his current car with basic maintenance and upkeep, and made sure it ran reliably.  Mr. Patience waited a year to buy his new sports car, one that was ultimately “faster, safer, better, and cheaper,” as well as more advanced than the one that Mr. Impulse bought.

A few months later, Mr. Impulse saw Mr. Patience’s new sports car and he thought to himself, “Oh! Why didn’t I wait like Patience and be smarter in my purchase?”

CAVA’s simple advice to hospitals: Be patient when purchasing your next robotic system.  Do your homework and learn WHAT you need and WHY you need it.  Understand the limitations of the current models and make sure you are aware of the pricing, contracting, and relationship advantages of future technology BEFORE you buy.  Learn the options available to sustain your current robotic program until new vendors and technology come to market.

Please contact CAVA if you have any questions or need some help.

(Part 2 next week.)

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