Surgical Robotics: Creating a New Program

Abstract

Objective: To share our recent experience in developing and implementing a program for computer-assisted, robot-enhanced surgery.Background: Minimally invasive surgery has revolutionized our approach to the surgical patient during the last decade. While robotic surgery does promise the ability to operate at a distance, thus providing surgical skills in remote and hazardous areas, we have found several features that could enhance our abilities as surgeons in the same room with our patient. These include tremor filtration, motion scaling, movement indexing, provision of a wrist at the end of the intracorporeal instrument, movements of the instrument that are intuitive in that they follow the surgeon's hand, and a steadier image controlled by the surgeon. It is our view that robotic surgery is the next logical step in performing more complex procedures on smaller patients in a minimally invasive manner.Methods and Procedures: We defined a core group of individuals who shared our vision: pediatric surgeons, our institutional research director, a biomedical engineer and physicist, and our hospital chief executive officer. We then identified the individuals and corporations who are working with surgical robotics. After extensive comparisons and site visits we chose a single corporate partner. Our partnership was not just a plan to purchase instrumentation but also an agreement to continue research and development of equipment and surgical techniques. We developed short-term and long-term educational, research, and business plans. We shared information on surgical robotics and our business and research plans with our hospital administration and our hospital board of trustees to garner support. The staff of the hospital development office was also involved in generating financial support. We developed and implemented a robotic surgery training program and started to perform robotic surgery procedures in humans and to develop new procedures and technology in the laboratory.Results: Institutional and private donor support has allowed us to implement a robotic minimally invasive surgical suite in our operating room and in our research building. Within one year of embarking on our program we performed our first robot-assisted minimally in-415 vasive surgery on a patient. Many of our pediatric subspecialty colleagues in cardiac, plastic, otolaryngology, orthopedic, ophthalmology, and neurosurgery have been utilizing our suites for procedure development in their areas of interest.Conclusions: The key elements in developing a new program are to define a core group of committed individuals, define your vision, create corporate partners, and garner financial support with a sound educational, research, and business plan.

Purchasing high-cost medical devices and equipment in hospitals: a systematic review

“…For example, Langenburg et al described a programme combining technical, financial and clinical criteria condensed in a training, implementation and development programme for surgical robotics, and found that cooperation of surgeons, staff and a corporate partner was key to the development of a successful new programme (eg, within 1 year minimally invasive surgery on a patient is performed). 30 Nisbet and Ward describe a process in which financial and technical considerations were taken into account to decide on whether to lease or purchase radiotherapy equipment. 33 Li et al ranked the factors that influence purchasing decisions and demonstrated that clinical evidence and cost-effectiveness are more important than personal preference, regardless of the stakeholder role.…”

“…In some studies, this balancing process was emphasised, but no formalised approaches were followed to achieve it. For example, Langenburg et al described a programme combining technical, financial and clinical criteria condensed in a training, implementation and development programme for surgical robotics, and found that cooperation of surgeons, staff and a corporate partner was key to the development of a successful new programme (eg, within 1 year minimally invasive surgery on a patient is performed) 30. Nisbet and Ward describe a process in which financial and technical considerations were taken into account to decide on whether to lease or purchase radiotherapy equipment 33.…”

“…29 Although not always the primary focus of the study, it was made explicit that some form of approach that unifies how various purchasing stakeholders come together is important: Langenburg et al, for instance, describe their new process as developing a 'vision' with paediatric surgeons, research director, a biomedical engineer and a physicist and the hospital chief executive officer, to collaboratively (with industry partners) develop a shortterm and long-term education, research and education plan for robotic surgery. 30 Haselkorn et al also described the importance of an organisational culture as a crucial component for success in the procurement process. 31 Regardless of it being a cultural or difference in vision, fundamental differences in purchasing projects can be identified.…”

Purchasing high-cost medical equipment in hospitals: A systematic review

“…Although not always the primary focus of the study, some made explicit that some form of approach that unifies how various purchasing stakeholders come together is important: Langenburg et al 2003, for instance, describe their new process as developing a 'vision' with paediatric surgeons, research director, a biomedical engineer and a physicist and the hospital chief executive officer, to collaborative (with industry partners) develop a short-and long-term education, research and education plan for robotic surgery. [31] Haselkorn et al (2007) also described the importance of an organizational culture as a crucial component for success in the procurement process. [29] Regardless of it being a cultural or difference in vision, fundamental differences in purchasing projects can be identified.…”

“…[27] A suggestion to streamline the management process is the implementation of a management information system described by Larios et al 2000,[32] where necessary information for specification and selection of medical equipment can be documented and it is found to improve timeliness, procedural efficiency, consistency and information integration. For the development of new programs a business plan is essential), according to two studies [29,31] and proper planning and management can result in prevention of unnecessary buying according to Verma and Peacock 2014. [47] With regards to tendering, Satta et al 2019 described a process in which stringent specifications were laid out in a tender specifications for an ophthalmic surgery femtosecond laser, but note the disadvantage that their whole process of laying such specific specifications and conducting trials took about 4 years.…”