Da Vinci robots are no longer a disruptor in the healthcare technology space. They are a vital instrument to help healthcare provider organizations not only solve some of their biggest challenges but also fuel overall health system growth.
One of the nation’s leaders in robotic surgery, NYU Langone Health, New York, an academic medical center with six hospitals and several outpatient centers and faculty group practices, performs more than 2,000 minimally invasive, robotic-assisted surgeries each year in multiple specialty areas. Several factors go into developing a sustainable, growth-oriented robotics program. Following are keys to NYU Langone Health’s success.
A Purposeful Structure
A robotics program can take different shapes, depending on an organization’s size, patient population, mission and other factors. For NYU Langone, a centralized, strategic approach has proven successful, according to Andrew Brotman, MD, executive vice president/vice dean, Clinical Affairs, and chief clinical officer.
“We have moved to the point where we now have 24 robots systemwide, and the amount of robotic surgery has skyrocketed,” he says. “In great part, it’s a shift from other types of surgery like laparoscopic surgery or open surgery but also new growth because we’re doing something that previously wasn’t done.”
In an effort to drive communication and disseminate best practices throughout the health system, three robotics-focused committees bring representatives together: a steering committee, a credentials committee and an operations committee. Each hospital with a robot also has its own robotics committee. In addition to surgeons and specialty leaders, committees comprise leaders from perioperative, nursing, finance and operations.
There is representation from executive, clinical and operational pillars within the health system and at each individual hospital location, and all work cohesively in partnership with supplier partner Intuitive to align on strategic goals and then develop ways to execute and achieve those goals.
“We use a centralized-structure approach because leaving it to an individual surgeon or a department chair frequently results in uninformed decisions,” Brotman says. “A laparoscopic surgeon, for example, who is averse to change, may say, ‘There’s no reason to do robotics.’ Then, you might not get a robot in an area where perhaps you should have a robot.”
A Multidisciplinary Approach
The integrated, systems approach to robotics carries over into NYU Langone’s ORs. Kathy Huang, MD, surgical director, Perioperative Services, director, Endometriosis Center, and clinical associate professor, cites the organization’s multidisciplinary collaboration on robotic surgical cases as a benefit for patients and surgeons.
“We see a lot of specialties collaborating on cases, and that’s invaluable,” she says. “I moved to NYU in part because it has robotic colorectal surgeons whom I can collaborate with on more difficult cases.”
For instance, Huang can now perform the dissection undertaking of an endometriosis surgery robotically, and at the same time another surgeon can complete a bowel resection robotically, if the patient requires it. This creates access to more minimally invasive procedures and prevents the need to perform an open surgery that could have a much longer recovery time.
There is not only a benefit for the patient and surgeons but also for NYU Langone, where collaboration among robotic surgeons serves as a recruitment and retention tool. Huang and colleague Collin E. Brathwaite, MD, professor of surgery, NYU Grossman Long Island School of Medicine, and chair of the Department of Surgery, NYU Langone Hospital Long Island and Long Island Community Hospital, note that some of the best robotic surgeons from across the country want to come to their organization because of the collaborative environment and access to robots.
Data Assists With Continuous Improvement
At the core of the NYU Langone robotics program is data. Quality metrics, such as length of stay, complication rates, surgical site infection rates, readmission rates and conversion rates, are shared openly across the health system. Also shared are data about how individual surgeons and teams are using the robots and costs associated with their use. Data is used in all aspects of decision-making, whether it’s determining if the health system needs to add another robot or whether operational or clinical improvements need to be made.
“The data is fine-tuned all the way down to the provider,” Brathwaite says. Identifying surgeons who use fewer resources while still achieving great outcomes can lead to adoption of more efficient, standardized approaches.
“We can dig into the data for the actual procedures, determine best outcomes and try to move people toward those best outcomes,” Brotman says.
Outcomes Demonstrate Benefits
NYU Langone’s robotics program continues to grow successfully because of the benefits it has demonstrated compared to alternative surgical approaches. The health system anticipates this growth to continue in the future, which is why it has decided to invest so heavily in its robotics program.
“Our outcomes speak for themselves,” Brathwaite says. “We see clear benefits in terms of length of stay, reduced complications, reduced blood transfusions, reduced surgical site infections, reduction in the conversion rate from minimally invasive surgery to open, and fewer patients requiring re-operations.”
The use of robotic surgery also has resulted in cost savings. For example, the health system conducted a two-year analysis (2019–2020) that revealed significant savings—$783,000—when comparing gastric bypass surgery completed robotically versus laparoscopically, according to Brathwaite. He notes the health system is also seeing significant savings with respect to robotic emergency general surgery and other areas. Brathwaite, Brotman and Huang all mention a culture of excellence and continuous improvement as contributors to the success of NYU Langone’s robotics program, in addition to recognizing the importance of investing in technological and medical advancements that go where science is going.
“In our culture, there’s a commitment to excellence in all aspects, and there’s a mindset of continuous improvement,” Brathwaite says. “I think the future of robotic surgery is bright. I can see a time where we won’t be saying ‘we’re going to do a robotic surgery, we’re going to do surgery,’ and the expectation is that it is robotic.”
For more information, please contact Samantha Martin, senior group marketing manager, Executive Education, Intuitive, at executive.education@intusurg.com.