ners International in Addison, Texas. “ASC operating rooms (OR) are often smaller than those in hospitals and may not have as much room to store a piece of equipment as large as a robot. You need to assess whether you can put a robot in your OR and still per- form other procedures when the robot is not in use.”

miVIP Surgery Centers uses this 3D viewing monitor cart for its robotic surgical system. Introduce and Grow a Robotics Program

Research, plan and get physician buy-in before you act BY ROBERT KURTZ


hinking about starting a robotics program in your ASC? The time is

now, says Jess Lonner, MD, orthope- dic surgeon and member of Rothman Orthopaedic Institute in Philadelphia, Pennsylvania. Lonner has used robot- ics technology to perform surgery in multiple outpatient settings, including an ASC. “For many ASCs, price has been a significant barrier for the broader adop- tion of robotic technologies,” Lonner says. “The cost of the first generation of systems was quite prohibitive. As newer technology has evolved and pricing improved, we are seeing more ASCs investing in robotics systems.” Overland Park Surgical Suites in

Overland Park, Kansas, invested. “I started a robotics program at a hospi- tal in March 2018,” says Scott Abra- ham, MD, orthopedic surgeon and founder of the ASC. “After witness-

ing the benefits that come with using robotics, we thought we should see if we could add a system to the ASC.” The ASC had a growing number of patients asking for the technology and wanted to provide them with a choice about where they could undergo their total joint replacement using robot- ics. “We also believed the technology would help with outcomes.” The ASC launched its robotics pro- gram in October 2018. “These systems are not cheap,” Abraham says. “We carefully evaluated whether investing in robotics would be worthwhile from a return-on-investment perspective, which turned out to be the case.” The cost of purchasing or leasing a robotics system is not the only fac- tor ASCs should take into consider- ation before proceeding with a pro- gram, says Riley Orr, regional vice president with United Surgical Part-


Another potential challenge with space concerns sterilization require- ments, Orr says. “The instruments used by the robots are often longer than those typically used by an ASC. The containers these instruments go into so you can put them in the chemi- cal sterilizer tend to be larger as well. Many ASCs use tabletop-sized steril- izers but may need larger sterilizers to accommodate the bigger instruments. That would also be another cost to take into consideration.”

Foundation for Success The ability to afford and accommo- date a robotics system is not enough to justify the investment, Lonner says. The most important consideration, he says, is whether the technology will get enough use. “You will need either a single surgeon advocate for robotics or a group of surgeons with a sufficient patient base to make the upfront capi- tal costs and monthly or annual service costs feasible.”

Do not proceed unless you are con- fident in the community need and phy- sician support, Orr says. “The surgeons who will use the robot must be full believers in the technology and com- mitted to making the program work. You want to know that if you invest in the technology, you will have the full support of physicians in perfecting the program to provide these advanced capabilities to the community.” To better ensure a smooth program launch, allocate appropriate time for staff training, Abraham says. “That training will be critical to getting staff up to speed on what exactly will happen during procedures that use the robot.”

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