tag:blogger.com,1999:blog-32053362.post3407730490488929605..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: da Vinci Uncoded -- or, Surgical Robots Unite!Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger53125tag:blogger.com,1999:blog-32053362.post-75456360765363322562016-01-29T05:29:16.126-05:002016-01-29T05:29:16.126-05:00The latest generation da Vinci Si Robotic Surgical...The latest generation da Vinci Si Robotic Surgical System from M/S Intuitive Surgical INC. (USA) was installed at Sir Ganga Ram Hospital, New Delhi on 15th March 2012 and its first surgery (Robotic Thymectomy for Myasthenia Gravis) was successfully performed the very next day by <a href="http://www.drarvindkumar.com" rel="nofollow">Dr. (Prof.) Arvind Kumar,</a> Director, Institute of Robotic Surgery.Anonymoushttps://www.blogger.com/profile/12740030146517819005noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-67644674801693755262011-04-19T09:42:45.494-04:002011-04-19T09:42:45.494-04:00While filming a TV Commercial for Health First'...While filming a TV Commercial for <a href="http://www.health-first.org/hospitals_services/hrmc/robotics/index.cfm" rel="nofollow">Health First's</a> New da Vinci Robotic Surgery system there were a few out takes that did not make the final cut. We have put these outtakes together in one video for your viewing enjoyment.<br /><br />View the Video Here: <br /><a href="http://youtu.be/KmOIbNPQNj0" rel="nofollow">http://youtu.be/KmOIbNPQNj0</a>tom.affeldhttps://www.blogger.com/profile/09437895559133890596noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-51728391343400597492009-10-24T16:04:37.109-04:002009-10-24T16:04:37.109-04:00See here: http://runningahospital.blogspot.com/200...See here: http://runningahospital.blogspot.com/2008/11/uncle.htmlAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46708771358497143882009-10-24T11:50:04.758-04:002009-10-24T11:50:04.758-04:00Paul
It is now October 2009... what are your feel...Paul <br />It is now October 2009... what are your feelings about this technology now ....Knit-onehttps://www.blogger.com/profile/06093902361639256576noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31564040192539815372009-09-18T00:55:52.454-04:002009-09-18T00:55:52.454-04:00From a dumb doctor,
I am fascinated with the disc...From a dumb doctor,<br /><br />I am fascinated with the discussion as to the merits and demerits of an equipment where the benefitted do not even have to weigh in. A health care system where the consumer is out of the loop and not at risk for at leasta small portion of the cost of a service leaving you the profound people to make the decision onhis behalf leads to demented health care system. So here on record I propose that all health insurance be 50/50 insurance meaning the insurance portion has to be equal to deductible portion, that the deductible be kept bythe patient who does not use it and can invest similar to his IRA, that the government provide those that are not covered by employer again with the caveat they can keep it if they dont use it, similar to HSA accounts, that the employers who only use 50/50 be given deductibility for taxes. When you put the patient in the loop, he will make the decision and I believe this great country was built on those principle and is at risk of rapid demise because even our most educated and profesionals such as our illustrious CEO forgot what the problem is and is worrying about who is right and wrong. IMHOtantrikhttps://www.blogger.com/profile/00934168896943237067noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-69701049078355043022008-10-12T20:21:00.000-04:002008-10-12T20:21:00.000-04:00WOW...i really can not believe that Beth Israel De...WOW...i really can not believe that Beth Israel Deaconess Medical Center doesn't have a da Vinci....you can argue all you want about 'is it better', 'are there studies' and so on...but what you can not argue is the consumer demand for better outcomes (perceived or real). Think of it like this, if you had to have surgery would you pick A)24 hr hospital stay and back on the golf course in 3 weeks OR B)48-72 Hr hospital stay and at least 6 weeks of no golf....AND as a bonus if you pick option A we will toss in a much greater chance that you can get a stiffy again....the biggest problem is you are thinking like a CEO and not like a customer...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-7716869032838762712008-09-08T22:10:00.000-04:002008-09-08T22:10:00.000-04:00To answer your three questions: Yes, no, yes.To answer your three questions: Yes, no, yes.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4519379409122733382008-09-08T21:16:00.000-04:002008-09-08T21:16:00.000-04:00Paul, I am interested in your take on da Vinci ado...Paul, I am interested in your take on da Vinci adoption for hysterectomies and whether it will mirror what happened in prostatectomies.<BR/><BR/>My rough understanding of da Vinci prostatectomies is as follows: Though clinical proof is arguably elusive, most doctors believe they are able to spare more nerves and patients have shorter recovery times. Since nerve sparing can mean better continence/sexual performance, there is strong patient demand for the da Vinci. This has led to widespread adoption by hospitals (to avoid losing patients, to attract top urologists/oncologists, and to market hospital as cutting edge.)<BR/><BR/>I am wondering whether the hysterectomy story will be different. Similarities abound, but it seems that nerve sparing is less of a concern. Also, trans-vaginal or lap-assisted trans-vaginal present less invasive alternatives to the robot. <BR/><BR/>As a hospital CEO, are you seeing demand for da Vinci from gynecologists that mirrors prostatectomy demand from a couple years back? Are insurance companies starting to reimburse for the higher cost of da Vinci? Or does this remain a questionable investment for the hospital to make, in the absence of hard data that supports better patient outcomes.<BR/><BR/>Thanks for any insight you can provide.. I appreciate your time.Paul DeMotthttps://www.blogger.com/profile/03338288463301953270noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35631322671687514402008-05-01T00:54:00.000-04:002008-05-01T00:54:00.000-04:00This blog site is rather humorous.As another exper...This blog site is rather humorous.<BR/><BR/>As another experienced robotic prostatectomist (over 150 cases) I can tell you tell you several things.<BR/><BR/>1) Every single chief of urological oncology in our surrounding area has said, in the past, that they see no need to do a surgery robotically when they do such a good job open. Well, all of those surgeons are now doing robotic prostatectomy, and are touting the results.<BR/><BR/>2) Along the same line as 1)...any surgeon, academic or not, that scrutinizes robotic surgery has ABSOLUTELY no idea what they are talking about until they try it.<BR/><BR/>3) In my experience, yes it is anectodal for now, but will be published...... 95 percent of patients go home post op day one. The transfusion rate is less than 1 percent. The positive margin rate is better than with open surgery....10 percent...most of those positive apical margins, focally, which we know are not true positive margins....not one has had a detectable PSA. One half of patients take no pain meds. Return to full activity is 2-3 weeks!...definitely faster than in open surgery. Continence is much quicker, and return of erections is far superior.<BR/><BR/>One cannot compare the two (open vs robotic) without having experienced MORE than the thirty cases discussed in the one study mentioned in this blog. It does take time to learn the technique...but once one gains the experience....the visualization is far superior...there is NO COMPARISON in nerve sparing.....the anastamosis robotically is FAR SUPERIOR and completely WATERTIGHT..completely visualized during the procedure...<BR/><BR/>Yes, there are no randomized studies showing superiority yet...however, Dr. Academic Urologist...I challenge you to get an answer from any academic urologist who has experience in this procedure to agree with your scepticism. Experience means more than 100 cases.... Outcomes are most definitely different than with open surgery. One sitting in their Ivory Tower just thinking about these things and looking at one study comparing 30 patients is completely blind. Open your eyes and see what is going on in the real world.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-25313322558310558912008-03-20T19:42:00.000-04:002008-03-20T19:42:00.000-04:00I think one of the CLEAR factors to the sham... is...I think one of the CLEAR factors to the sham... is that Urologist tend to get into ANY business that makes money and has good outcomes: ESWL or Lithotriptors... they will fight to STOP a hospital from purchasing one... so they can rent theirs. They buy lasers, and other equipment to rent to the hospitals. THEN since they can't make money in an LLC with their own Robot... they stron arm a hospital to take the "bath" on the device and lose significant amounts on each prostate.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-27358118241099395602008-01-28T08:48:00.000-05:002008-01-28T08:48:00.000-05:00Would like to know how this delicate situation has...Would like to know how this delicate situation has continued to unfold. I am aware of the robotic situation in the Boston area and since the last posting a number of things have happened.<BR/><BR/>Lahey Hospital in the northern suburbs has installed a second machine and hired a second robot doctor. Winchester Hospital has installed a machine. Partners has finally installed a machine at MGH which goes on line late Feb 2008. In addition the BWH gyn-oncologists have all jumped on that machine as the 'second' wave adopters and BWH is installing a second machine to handle that demand.<BR/><BR/>In essence the number of robots in the Boston area has jumped from 3 at the beginning of 2007 to 7 by the end of Feb 2008. How long can the 25yr referral pattern at BIDMC remain relatively intact in the face of such penetration of a 'disruptive' technique.<BR/><BR/>Many thanks<BR/>MatthewAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-61817744649860870772007-10-22T22:09:00.000-04:002007-10-22T22:09:00.000-04:00So far the debate has been on the robotic assisted...So far the debate has been on the robotic assisted laparoscopic surgery against the open surgery.<BR/><BR/>Not quite a fair comparison.<BR/><BR/>There is evidence (see ref below ) that the pure laproscopic surgery provides the similar surgical benefits at the cost of the open surgery. <BR/><BR/>The pure laparoscopic surgery does not provide as much operation comfort as the robotic assisted version, but it is cheaper with nearly all the benefits. (Intuitive now provides a special chair for the operating surgeon now.) <BR/>When money isn't the issue, I am sure everyone would choose da Vinci S with the ($100k+) HD endoscopic system. But in other countries, they may not be able to afford these. That is why so far there is one da Vinci in Russia, two in China (one of the two in Hong Kong), one or two in India. <BR/><BR/>Prostatectmy require fairly high precision, so the operation comfort is important though not essential. But for hysterectmy and many other surgeries, precision isn't that critical as there is no nerve sparing etc ...<BR/><BR/>Da Vinci has a lot of (over complicated) mechanical parts that are unreliable. The rate of abort-conversion-to-open is an indication of the failure cases. Normally surgeons abort and convert after no more than two locks. So the $100k annual service is unavoidable.<BR/><BR/>Any comments from surgeons on promoting the use of the cheaper pure laparoscopic surgery?<BR/><BR/>Reference;<BR/>Alternative technologies to the robot to improve outcomes of laparoscopic radical prostatectomy. Poster. Julio M. Pow-Sang, Alejandro Rodriguez. World Congress of EndoUrology September 2006 Cleveland, OH. H. Lee Moffitt Cancer Center Tampa, Florida, USA.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-74395533349076168412007-09-07T13:19:00.000-04:002007-09-07T13:19:00.000-04:00This is a wonderful blog for anybody contemplating...This is a wonderful blog for anybody contemplating prostate surgery and Paul, I congratulate you. However, I think you underappreciate the bigger picture - that this is the way of the future, not just for prostate surgery but for many other types of procedures.<BR/><BR/>In 10 years time, this will likely be the preferred method for gynecologic surgery, many forms of cardiac surgery, and maybe even neurosurgery.<BR/><BR/>Hospitals that get a reputation as leaders in robotic surgery will be able to leverage this in the other fields and, at the other end of the spectrum, those that get a reputation as trailers will be disadvantaged.<BR/><BR/>BTW, Paul what is the latest status of the debate at your hospital?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-71782923762519920452007-04-23T13:51:00.000-04:002007-04-23T13:51:00.000-04:00My father recently passed away as the result of hi...My father recently passed away as the result of his prostate cance. That being said, I vividly recall the days following his initial diagnosis and subsequent open surgery which was performed by a very competent surgeon. He suffered a great deal during recovery. <BR/><BR/>As anyone who has had surgery will surely attest, surgery under anesthesia is not memorable. Recovery following surgery is most memorable.<BR/><BR/>As I am now of the age where I must closely monitor the health of my prostrate, I feel some comfort in knowing a procedure exists which offers improved post-surgery recovery and less blood loss.Unknownhttps://www.blogger.com/profile/14016730351815743328noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78371019858807457952007-03-26T13:22:00.000-04:002007-03-26T13:22:00.000-04:00Paul, in these comments you write,"Sorry, Dr. Sava...Paul, in these comments you write,<BR/><BR/>"Sorry, Dr. Savatta, but I can't make decisions based on anecdotes."<BR/><BR/>True -- yet, in the initial posting you write,<BR/><BR/>"The verdict from their surgeon: 'Dr. Richard Babayan, chairman of urology at Boston Medical Center, said he's found no difference in continence rates in the 30 robotic cases he's done, compared with traditional surgery.'"<BR/><BR/>Is that not the epitome of anecdotal? And are one's surgeon's continence rates the whole picture?<BR/><BR/>Presuming you have done more reading than you reference in your post, what has that told you about outcomes?<BR/><BR/>And are you looking at this strictly through the lens of one type of procedure? In evaluating whether to make this purchase, isn't this a more strategic question of whether your hospital wants to be involved in robotic surgery in general in the 21st Century -- rather than a smaller question of marginally better/worse protestectomy outcomes?scot s whttps://www.blogger.com/profile/08947031962111227317noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-53162431635328960232007-03-15T05:33:00.000-04:002007-03-15T05:33:00.000-04:00how many radical prostatectomies must be done to p...how many radical prostatectomies must be done to prevent one death from prostate cancer? this thread concerns a fancy way of doing an operation that has marginal utility. this is true of a great deal of what is being done in medicine and surgery today.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-42544856155750887432007-03-12T17:18:00.000-04:002007-03-12T17:18:00.000-04:00I thought that this article may be of interest: ht...I thought that this article may be of interest: http://www.medicineatyale.org/v3i1_jan_feb_2007/robot.htmlAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39925450670880284802007-03-09T14:10:00.000-05:002007-03-09T14:10:00.000-05:00Unfortunately there will be no randomized controll...Unfortunately there will be no randomized controlled trials to evaluate robotic surgery. Urologists don't seem to believe in this approach to clinical medicine. We still don't know if PSA screening saves lives. But complications such as blood loss are low (see my post regarding article in European Urology from Henry Ford Hospitals -kattlovecancerblog.blogspot.com) and most surgeons can learn the procedure. Sure a great surgeon is probably as good, but how many of them are there?Herman Kattlovehttps://www.blogger.com/profile/05458439068718137585noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-17684955665942260552007-03-05T16:20:00.000-05:002007-03-05T16:20:00.000-05:00Paul;Here is a link from the Washington Business J...Paul;<BR/><BR/>Here is a link from the Washington Business Journal re what is happening in Baltimore with the da Vinci system. For a mere 0.5 mill more, you can now get 4 arms! Seriously, perhaps it will help pay for itself with TCV surgery and/or training capabilities....<BR/>http://washington.bizjournals.com/washington/othercities/baltimore/stories/2007/03/05/focus1.html?b=1173070800^1424991Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-49043050175475101252007-03-02T21:25:00.000-05:002007-03-02T21:25:00.000-05:00My husband had a robot assisted (da Vinci Surgical...My husband had a robot assisted (da Vinci Surgical) prostatectomy on December 20, 2006. <BR/><BR/>An hour and a half into the surgery a high intensity light bulb on the control tower exploded splattering glass onto the operating room wall. The surgeon converted to open surgery. During the open surgery my husband required three blood transfusions. His pulse went up to 190. He spent the next two days in intensive care and two more days on the cardiac floor. Recovery time went from three weeks to six weeks. <BR/><BR/>At first it looked like the hospital, Central Dupage Hospital, Winfield, Il was pointing the finger at Intuitive Surgical. A representative from Intuitive flew out the evening of the occurrence to inspect the equipment. There was speculation that a fan that cooled the light bulb had failed which caused it to overheat and eventually explode. <BR/><BR/>I called the hospital yesterday and the VP of Operations that was so caring in December was less than responsive in March. <BR/><BR/>Both the hospital and Intuitive Surgical are not saying much about the event now. I feel like a victim. Everyone else has glowing reports of this procedure. <BR/><BR/>We did our research and thought we had chosen the best procedure. We certainly didn't anticipate this outcome.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-70416938243790711772007-02-28T23:35:00.000-05:002007-02-28T23:35:00.000-05:00In reply to Richard, what he doesn't realize is th...In reply to Richard, what he doesn't realize is that he and many like him could have had the same outcome with an open or no-robotic lap surgeryas with the costlier robot. No matter, however, as many men in his shoes are also 'wowed' with the robotic technology and gravitate to it despite no multi-institutional, long term data, and that pattern of American consumer behavior won't change unless studies prove the robot vastly inferior (unlikely). In reply to Domenico, the prospective study comparing hundreds of robotic, laparosocpic, and open prostatectomies he's requesting is under way as part of a national HRQOL study funded by an NIH grant. Participating hospitals included BIDMC, MGH, Brigham, Cleveland Clinic, Washington University, UCLA, MD Anderson, University of Michigan, and UCLA. Accrual was completed in March 2006. Preliminary findings were reported in part at last year's AUA meeting, and an expanded evaluation will be reported at this year's AUA meeting in May 2007. It will take another year for the analyses to complete the peer-review process and be published. In the meantime, as a surgeon who has performed prostatectomy using each of the three principal techniques - robotic, laparoscopic, and retropubic - and as an investigator familiar with data presented in these preliminary analyses, I can relate three concerns that any surgeons who have expertise with all three would likely confirm: 1) Lap or robot techinques have less blood loss than open, due not to the robot but instead to reduced venous pressure from pneumoperitoneum that is required for laparoscopic surgery; 2) Lap or robotic techniques bring the dissection closer to the prostate, and whether or not this leads to worse cancer control (leave cancer behind) will not be clear for several years; 3) The robot is not a magic bullet that eliminates incontinence or impotence; 4) The robot does make the laparoscopic operation substantially easier for the surgeon, reducing operative time and inter-surgeon variance and thereby facilitating patient access to more consistent surgical care. Large cost, modest gain - and probably sufficiently meritorius to warrant an investment now for your hospital to keep pace with the cutting edge and impact the evolution of prostate cancer care. It's not that different than the reality of MRI 20 years ago...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-20052422707361483952007-02-28T09:01:00.000-05:002007-02-28T09:01:00.000-05:00I must admit that my primary care is provided thro...I must admit that my primary care is provided through BIDMC. That my prostate cancer was diagnosed at BIDMC. But, after my exhaustive research, when it came time to have my surgery, I went to BWH which has the DaVinci robot. The post-op recovery was remarkably uneventful and almost painless. I am a strong advocate of the procedure and highly recommend it to others.<BR/><BR/>RichardAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-38297485950690797012007-02-25T22:26:00.000-05:002007-02-25T22:26:00.000-05:00Hi Paul,I am neither a urologist, a robot marketer...Hi Paul,<BR/>I am neither a urologist, a robot marketer, nor am I am a wealthy potential donor. I understand it the outcomes of "daVinci surgery" (clinical and pathological) are comparable to the gold standard. If the surgery is less invasive, the blood loss is less, and the recovery is quicker then the questions are about cost effectiveness. This is not based on "surgical outcomes" (as this is the same) but quality of life issues in terms of possible increases patient satisfaction, patient volume (due to increased speed, and the bit you are appropriately uncomfortable about "market acceptablity" of robotic surgery), decreased time to return to work and related issues. I suggest that you get someone to do an assessment of the level of benefit necessary (including and excluding assumptions about the impact on patient volumes) to justify the outlay. You may have already done this. Anyway you have used the blog well in that you have raised issues about what should influence our decisions. Will be watching to if: <BR/>A) The daVinci rep lets you have one to test for a year <BR/>B) A daVanci machine is delivered along with and a blank cheque for a year's worth of supplies <BR/>C) You continue just fine without it <BR/>D)?Arthurhttps://www.blogger.com/profile/10366255301186912444noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-72003592352953497042007-02-24T10:50:00.000-05:002007-02-24T10:50:00.000-05:00The Da Vinci carries about $1.4M start up tag (las...The Da Vinci carries about $1.4M start up tag (last time I did a pro forma and negotiated-6 months ago) and frankly unless you have a very busy Urology practice or more like the only one in Boston, your IRR will take 2 to 3 years or longer and frankly the outcomes do not support such a purchase in most hospitals or soon physician owned surgical clinics. it is what us consultants call a "toy for tots"...a new gimmic for doctors to play with but as an administrator don't think it will impact outcome or core measures and ultimately help you with Medicare Pay for Performance etc...you know it will not...it is an expensive capital outlay that looks most excellent in a brochure for branding but at the end of the day grow your INR and Geri business...and do some FQHC outreach expansion to start managing your ever increasing charity and indigent cases coming into the EDs and the frequent flyers becasue we all need care but the appropriate level of care....and a Da Vinci is not promote better anything but darn it is fun to play with at the demos...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-37692554988793908172007-02-23T18:47:00.000-05:002007-02-23T18:47:00.000-05:00How do you define value?daVinci can help with surg...How do you define value?<BR/>daVinci can help with surgeon recrutiment and retention. It's Video capabilities also can be a great tool to educate the physician referral pattern on the clinical advantages (anecdotal eveidence). With more procedures perahps there would be more evidence.Michaelhttps://www.blogger.com/profile/05339546346835062481noreply@blogger.com