Robotics in Hernia Repair - another fad and way too expensive
-
Upload
andrew-wright -
Category
Health & Medicine
-
view
554 -
download
2
Transcript of Robotics in Hernia Repair - another fad and way too expensive
The Robot in Hernia Repair-another fad and way too expensive
Andrew S. Wright MDUniversity of Washington
@andrewswright
Experience
UW Biorobotics Lab
• RAVEN Surgical Robot
• Telerobotics
• NASA/Military application
Clinical Robotics Experience
• 70+ robotic cases (primarily foregut)
Experience
UW Biorobotics Lab
• RAVEN Surgical Robot
• Telerobotics
• NASA/Military application
Clinical Robotics Experience
• 70+ robotic cases (primarily foregut)
• Quit using robot due to lack of benefit/increased OR time/increased cost
Experience
Director, UW Medicine Hernia Center
• 80+ Inguinal hernia/yr– 80% TEP
– 10% TAPP
– 10% Open
• 60+ Incisional/Ventral/yr– 50% lap
– 50% open AWR
• 2 partners who do robot-assisted TAPP/umbilical/IPOM
Defining Value
Value = OutcomesCost
Value to whom?
• Patient (pain/recurrence/return to work)
• Surgeon (ergonomics/marketing/reimbursement)
• Hospital (marketing/cost/income)
• Insurer (cost)
• Health Care System (cost/outcomes)
What are Downsides to Robot?
• Lack of haptics/tissue feel
• Need for bedside assist
• ? Need for 3rd arm/extra port
• Lack of adequate instruments
What are Downsides to Robot?
• Lack of haptics/tissue feel
• Need for bedside assist
• ? Need for 3rd arm/extra port
• Lack of adequate instruments
• Learning Curve
Possible Benefits of Robot
• Visualization
• Stable platform
• Dexterity
• Cool factor
• Marketing
• Practice expansion
What about robot incisional/TAR/AWR?
• Cool videos!
• No Data
• Possible overuse of TAR
– Lot of videos of roboTAR for 6-8cm defects
What about costs?
• OR Times– Lap Inguinal
• 127 mixed lap inguinal hernia, 6 surgeons• Case time 96±38 (min 27, max 188)• Room time 127±39 (min 57, max 213)
– Robot Inguinal• 44 mixed robot inguinal hernia, 2 surgeons• Case time 82±22 (min 50, max 143)• Room time 114±21 (min 77, max 173)
What about costs?
• OR Times– Lap Inguinal
• 127 mixed lap inguinal hernia, 6 surgeons• Case time 96±38 (min 27, max 188)• Room time 127±39 (min 57, max 213)
– Robot Inguinal• 44 mixed robot inguinal hernia, 2 surgeons• Case time 82±22 (min 50, max 143)• Room time 114±21 (min 77, max 173)
• Contribution to Margin– $2400 less per case– Exclusive of cost of robot
What about cost of robot?
• Accounting basis
– 5-year lease, $2 Million
– Amortized at $51/case
• Cost allocated to entire department
What about cost of robot?
• Accounting basis
– 5-year lease, $2 Million
– Amortized at $51/case
• Cost allocated to entire department
– Amortize only to robot cases
• $1042/case
What about cost of robots?
• Only 25% cases done w/ robot
– To get to 100% would need to lease 2 additional machines
What about cost of robots?
• Only 25% cases done w/ robot
– To get to 100% would need to lease 2 additional machines
– $167k/month
What about societal cost?
• 37 Hospitals in WA state with robot
– Pullman Regional 25 beds
• 40 robots = $80 million
What about societal cost?
750k inguinal hernia repairs annually (US)
60 robot cases/month/robot
$30k/month/robot
What about societal cost?
750k inguinal hernia repairs annually (US)
60 robot cases/month/robot
$30k/month/robot
$375 Million/year
Is there value in robot hernia repair?
Value = OutcomesCost
Patient – no evidence
Surgeon – maybe
Hospital – probably not
Is there value in robot hernia repair?
Value = OutcomesCost
Patient – no evidence
Surgeon – maybe
Hospital – probably not
Insurance Companies – nope
Is there value in robot hernia repair?
Value = OutcomesCost
Patient – no evidence
Surgeon – maybe
Hospital – probably not
Insurance Companies – nope
Health Care System/Society – Hell no!