The case for a robot for Christmas

This year’s Kootenai Health Foundation Festival of Trees will be raising money to help fund a second da Vinci surgical robot at Kootenai Health. While surgical robotics might sound like something performed in only the most advanced hospitals in major metropolitan areas, it has been improving patient care right here in North Idaho for more than 11 years.

Locally, 15 surgeons across five specialties have treated nearly 2,400 da Vinci surgery patients at Kootenai Health since March 2008. Five more surgeons plan to begin doing robotic surgery as soon as a second surgical robot is available to provide needed additional capacity.

Robotic surgery has grown in popularity for several reasons. More than 22,000 published peer-reviewed clinical studies in aggregate support benefits such as a reduced need for blood transfusions, reduced risk of infection, less time patients must spend in the hospital post-surgery, fewer complication rates, lower readmission rates, and a shorter recovery time. Today there are more than 3,459 da Vinci surgical robots in use across the United States, including organizations such as Johns Hopkins Medicine, which has several surgical robots. Beyond the research-validated improvements are the human stories from patients and physicians.

“As a surgeon, one of the most rewarding aspects of my work is providing patients the help they need to restore good health,” said OB-GYN Brenna McCrummen, M.D., who uses the da Vinci surgical robot. “By the time surgical intervention is needed, people have often been dealing with pain and an element of fear for some time. Providing needed care quickly is not only the appropriate thing to do clinically, it is also the compassionate thing to do. Additionally, every individual in our care is more than a patient; he or she is also a person, who has work to do, a family to care for, and other responsibilities. The opportunity to recover more quickly isn’t a luxury; it can be life-changing.”

Although the hard costs for a hospital to invest in a surgical robot and for surgeons to add robotic surgery to their skill-set are real, Medicare, Medicaid and most insurance carriers do not reimburse more for surgeries done robotically. Of the patients Kootenai Health currently serves, 92 percent have no additional expense for robotic surgery.

Anecdotal conversations show that even when patients are responsible for a greater out-of-pocket cost, they believe the shorter hospitalization, reduced pain and quicker recovery are worth the cost. The investment in robotic surgery is driven by the need to provide patients a higher standard of care. If Kootenai Health was not investing in robotic surgery, patients would routinely seek that higher level of care out of state.

Robotic surgery has rapidly become the preferred standard of care for many surgical procedures. Internationally, more than 1 million robotic surgeries were performed in 2018. Locally, these include procedures such as prostatectomy (full or partial prostate removal), hysterectomy (uterus removal), hernia repair, NISSEN fundoplication (for gastric reflux or GERD), lung tumors, partial nephrectomies (kidney-sparing surgery), cystectomies (bladder removal), pyeloplasty (surgical reconstruction of a part of the kidney), and sacrocolpopexy (repairing pelvic organ prolapse). With two robots, Kootenai Health anticipates performing 1,000 robotic surgical procedures in 2020.

With the growing prevalence of surgical robots, particularly at teaching hospitals, new surgeons are learning to do procedures robotically. As we look to recruit new surgeons to our community, having the tools they have been trained to use is an important part of that recruiting effort. Many of these surgeons can choose to live and practice anywhere. Without surgical robots, we would struggle to recruit and retain surgical talent and local patients would be forced to go elsewhere for the care they need.

“Many local surgeons, myself included, have been vocal advocates for the addition of a second surgical robot at Kootenai Health,” said Dr. McCrummen. “We are pleased that the Kootenai Health Foundation and our local community will be working to help support that goal at the Festival of Trees this week. On behalf of these surgeons, and more importantly, our patients, thank you for your support.”

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Shannon Arrendale, RN, MBA, is Kootenai Health executive director of Perioperative and Women’s and Children’s Services.