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Hon says this recognition is trans- lating into increased focus by robotics companies on specialties and proce- dures common in ASCs. “Some of the new systems on the market are able to help with precision surgeries involv- ing the retina and endoscopic interven- tion. There are also recent efforts for more robotic system utilization in more general surgeries, specifically in hernia repair, colon or rectal surgeries and tho- racic surgeries, thereby transitioning a more invasive surgery to one that is less invasive because of a robotic system.” Helping further drive adoption of


robotics is the development of instru- mentation specifically for use with the systems, Bhasker-Rao says. One example he cites is a stapler he first used in February in a robotic-assisted sleeve gastrectomy. “It is what I would call an ‘intelli- gent’ stapler,” Bhasker-Rao says. “The surgeon controls the stapler from the robot’s console. When you apply the stapler on tissue, it reads the tissue thickness and lets the surgeon know whether this is tissue you can safely fire through with a complete formation of staples. It eliminates any guesswork.” Such advancements in instrumen- tation are likely to appeal greatly to surgeons on the fence about robotics, he says. “Before this stapler, bariatric surgeons using a robot would need to instruct their assistants at the bedside on when to fire the stapler. Now surgeons can control everything on their own. This instrument has widened the spec- trum of robotic capabilities and made bariatric surgeons more excited about adopting the technology.” While North Valley Surgery Cen- ter is using its robotic system for par- tial and total knee replacement surger- ies, Lessner says one of the appeals of acquiring the technology is what the sys- tem might eventually allow the ASC’s surgeons to do. “There have been talks about expanding the robot’s applications into other orthopedic procedures. One of the great things about the system we use


is that adding such functionality should only require a software download.” One of the things you need to think about when making the decision about whether to purchase a robotics sys- tem for your facility is whether the equipment can grow with your facil- ity, she says. “How does the vendor support upgrades? Software upgrades that expand the system’s uses are fast and easy. Hardware upgrades are more likely to be substantial and expensive.”


Looking Down the Road The market for ASC robotics appears primed to experience rapid growth, Hon says. With the expiring of patents associated with one of the major robotic surgery systems, the market will likely continue to see more players in this field. Any time there is more compe- tition, technology seems to advance at a faster pace. “I anticipate that we will see costs go down and more innovative trials with robotics and artificial intel- ligence (AI),” she says. “I am closely watching how AI is going to work with robotics in the future. The industry is looking forward to robotic-assisted sur- geries that use the available openings in the body, referred to as natural orifice surgeries, instead of reliance on making large incisions.” Bhasker-Rao is excited for the


future of outpatient robotics. He antic- ipates more innovation in the coming years, which he believes will make


outpatient robotic surgery even bet- ter. “We are already seeing single- site, robot-assisted surgery, which is a robot that supports the performing of major procedures through a small, sin- gle incision about the size of an inch. This technology is definitely coming to ASCs in the near future. It is proba- bly only a matter of time until we have a robot that can sew up a patient more precisely than a human.”


Asserting that robotics is no fluke, Lessner says, “We are going to see an increasing trend of robotics moving toward outpatient settings.” Payers looking to align themselves with centers of excellence could help accelerate that movement, he adds. “The use of robotics can help an ASC achieve great outcomes and eventually center of excellence status.” Bhasker-Rao


believes surgeon


exposure will accelerate the use of robotics in ASCs. “As more surgeons take the time to sit down, work with a robot and see what they can accom- plish using the technology—and expe- rience that ‘aha’ moment—adoption will grow exponentially,” he predicts. Patient comfort also will be a sig-


nificant factor, Hon says. “In the world of apps and Fitbits, consumers are embracing the role new technolo- gies, including AI and robotics, can play in enhancing their medical and surgical experience.”


ASC FOCUS JUNE/JULY 2019 | ascfocus.org 13


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