da Vinci Prostatectomy

heartICU · May 26, 2005

Hey guys ... I get to be in a robotic radical prostatectomy in the morning and was wondering if anyone's had the chance to see this machine in use? That includes, CRNAs, SRNAs, AAs, MDAs and OR staff! I'm excited about it ... :)

I have...we do about 4 or 5 daVinci cases a week. Just be prepared for a long case...there is a ton of equipment, and the surgeon actually sits like ten feet away from the patient, manipulating the controls. We always have lots of people in to observe...I guess not a lot of institutions have the daVinci. MAke sure you bring enough drugs into the room with you! It's kind of neat...the machine looks like a big spider, huge legs with these tiny little "fingers" at the end. Kind of a neat concept.

Pete495 · May 26, 2005

If you don't mind, what hospitals are you guys doing these at? That would be awesome to be involved in something like that. I guess it doesn't change the anesthesia much, or does it?

By the way, how are the robotic parts sterilized, just like anything else I imagine?

jwk · May 26, 2005

I have...we do about 4 or 5 daVinci cases a week. Just be prepared for a long case...there is a ton of equipment, and the surgeon actually sits like ten feet away from the patient, manipulating the controls. We always have lots of people in to observe...I guess not a lot of institutions have the daVinci. MAke sure you bring enough drugs into the room with you! It's kind of neat...the machine looks like a big spider, huge legs with these tiny little "fingers" at the end. Kind of a neat concept.

But is it worth it?

We're getting one in the near future - actually it's here, but has to be installed, which will take some remodeling of two small OR's into one big one.

But really - what's the point? Does robotic minimally invasive surgery have any advantages over the current way of doing it? I understand the possibilities for remote surgery at some point, but what's the advantage when the patient and surgeon are in the same room?

PLUS - what about costs? And not just equipment cost. What about professional fees? My understanding is that these cases take much longer than doing it robot-less. 10 hour robotic prostatectomies on a Medicare patient is a money-losing proposition for many practices.

versatile_kat · May 26, 2005

But is it worth it?
We're getting one in the near future - actually it's here, but has to be installed, which will take some remodeling of two small OR's into one big one.
But really - what's the point? Does robotic minimally invasive surgery have any advantages over the current way of doing it? I understand the possibilities for remote surgery at some point, but what's the advantage when the patient and surgeon are in the same room?
PLUS - what about costs? And not just equipment cost. What about professional fees? My understanding is that these cases take much longer than doing it robot-less. 10 hour robotic prostatectomies on a Medicare patient is a money-losing proposition for many practices.

I agree - we were in the room at 0630 and dressings were on at 1330! The machine is expensive, but our blood loss was less than 100. That's quite a difference from open radical prostatectomies.

Our patient had a cardiac history, so maybe this route was more patient friendly. I don't know.

To Pete - my program's clinicals are at Carolinas Medical Center in Charlotte. I believe heartICU is at the Cleveland Clinic (forgive me if I'm worng!). I'd guess that the larger level 1/teaching hospitals would either have a da Vinci or be in the process of obtaining one.

heartICU · May 26, 2005

I agree - we were in the room at 0630 and dressings were on at 1330! The machine is expensive, but our blood loss was less than 100. That's quite a difference from open radical prostatectomies.
Our patient had a cardiac history, so maybe this route was more patient friendly. I don't know.
To Pete - my program's clinicals are at Carolinas Medical Center in Charlotte. I believe heartICU is at the Cleveland Clinic (forgive me if I'm worng!). I'd guess that the larger level 1/teaching hospitals would either have a da Vinci or be in the process of obtaining one.

Yep, I'm at Cleveland Clinic. I have done three or four robotic cases....a couple prostates and a reversal of a tubal ligation. To me, there was a clear benefit for the robot, at least with the tubal - because they are doing such 'fine' work on the fallopian tubes, it is difficult to do it laparascopically - takes a very slick MD to do it well. With the robot, apparently it is easier. I stuck my hands in the controls after the case was over to see how the robot moves...it was kind of neat.

As far as sterilization, the instruments on the "legs" of the robot are detachable - and are sterilizable.

Here is a link about the machine itself.

http://www.intuitivesurgical.com/products/index.html

Also, when I worked as a RN in the ICU, one of our cardiac surgeons was doing open heart procedures using a robot. Not sure if it was the daVinci though.

heartICU · May 26, 2005

If you don't mind, what hospitals are you guys doing these at? That would be awesome to be involved in something like that. I guess it doesn't change the anesthesia much, or does it?
By the way, how are the robotic parts sterilized, just like anything else I imagine?

As far as anesthesia goes....any patient movement looks HUGE to the surgeon, because they are looking through the microscope. The robot is not as stimulating as a regular laparascopic procedure, so they may require less anesthetic. I do know that robotic patients seem to complain less of the chest and shoulder pain (from the insufflation) postop than regular laparascopic procedures.

People who have had the robotic surgery have researched it and usually have chosen their doc specifically because s/he uses the daVinci.

sproutsfriend · May 26, 2005

But is it worth it?
PLUS - what about costs? And not just equipment cost. What about professional fees? My understanding is that these cases take much longer than doing it robot-less. 10 hour robotic prostatectomies on a Medicare patient is a money-losing proposition for many practices.

It is well worth it. I was at an institution in Bham Al. which was one of the first doing the davinci robotic procedure. They've now done over 500 cases. The patient has less pain, the average blood loss is 50 cc's compared to 2500 cc's and the procedure is 2 hours 15 minutes typically. Recovery time is shortened and hospital discharge is sooner so lenght of stay is less so more DRG money for the hospital to retain. The surgeon (not surgeons) sits at his console in the corner and it looks as though he's playing a video game while the robotic arms are being manipulated. When I need my prostate taken out this is the way I'm having it done.

rn4cicu · May 28, 2005

Nice topic guys. I start clinicals in Jan. and I am looking forward to having DaVinci experience. If I am not mistaken a cardiologist at Pitt County Memorial Hospital in Greenville, NC was instrumental in developing the DaVinci system or is a pioneer in valvular repairs with the DaVinci and this facility is where I will be practicing.

jwk · May 28, 2005

It is well worth it. I was at an institution in Bham Al. which was one of the first doing the davinci robotic procedure. They've now done over 500 cases. The patient has less pain, the average blood loss is 50 cc's compared to 2500 cc's and the procedure is 2 hours 15 minutes typically. Recovery time is shortened and hospital discharge is sooner so lenght of stay is less so more DRG money for the hospital to retain. The surgeon (not surgeons) sits at his console in the corner and it looks as though he's playing a video game while the robotic arms are being manipulated. When I need my prostate taken out this is the way I'm having it done.

We've done several hundred laparoscopic prostatectomies without the robot. I'm trying to understand what a robotic procedure brings to this that is superior.

As far as recovery time and time to discharge being shorter, that is inherent with a laparoscopic approach in any procedure. Again, I don't see how the robotic procedure makes any further difference.

And as far as $$$, I'm thinking more of anesthesia charges. Again, laparoscopic techniques already decrease in-hospital time compared to open procedures. That's not the question. If you have a procedure that takes 8 hours instead of 3-4 as it does with our current laparoscopic prostates, that is a significant increase in anesthesia and OR charges for the robotic procedure over a laparoscopic one.

The same problem exists with robotic hearts on Medicare patients. A practice might make money doing 2-3 hr open CABG's for $700 flat rate. But a 10 hr robotic heart? That comes out to $70 per hour. I don't know about your practice, but that's a money-loser in mine.

P_RN, ADN, RN · May 28, 2005

http://www.davinciprostatectomy.com/

Pic of the da Vinci. It says it cannot be programmed and doesn't function independently. So is it really a robot?

sproutsfriend · May 28, 2005

If you have a procedure that takes 8 hours instead of 3-4 as it does with our current laparoscopic prostates, that is a significant increase in anesthesia and OR charges for the robotic procedure over a laparoscopic one.

I may be missing something here but the robotic prostatectomies I've done (as stated in an earlier reply) took only 2 hours and 15 minutes not 8 hours. 2:15 is shorter than 3-4 hours. Also, I'm not sure what if any advantages the robot has over the conventional laparoscopic approach. I will say this however, that there were no wasted movements (which could also occur with the conventional laparoscopic approach). One last advantage which doesn't deal with anesthesia charges but does save health care dollars in theory is that the robot is manipulated by ONE surgeon only which eliminates the 2nd surgeons charges which could or could not occur in a lap technique and an open technique.