Nine years ago, East Georgia Regional Medical Center moved into robotic-assisted surgery with the installation of a da Vinci robotic surgical system. In January, the hospital upgraded to a da Vinci Xi, a more advanced device.
The new surgical robot represents a further investment by the Statesboro hospital and its parent company, Community Health Systems. EGRMC is also owned in part by physicians.
“We’re excited to be able to make the investment like this,” said Paul Theriot, the hospital’s CEO. “We still consider ourselves a community hospital. We’re here to serve Bulloch County, and for us to make this kind of investment, we consider to be significant because you don’t have to drive to Augusta, to larger tertiary centers to have this service.”
Theriot did not disclose how much the hospital paid for the device, which he said is proprietary information.
Original cost range
Various sources, searched for independently by the reporter, show the typical cost of such a system is in a range of roughly $1.5 million to more than $2 million. In April 2014 when the Food and Drug Administration cleared the Xi model for release by da Vinci manufacturer Intuitive Surgical, the unit price was reported as between $1.85 million and $2.3 million by the health care organizations consulting firm Advisory Board at www.advisory.com.
More recent reports on healthcare and technology sites show that Intuitive released a later model, the da Vinci X, designed to be a somewhat lower-cost option. It was approved by the FDA in the spring of 2017. But the manufacturer’s website, www.intuitive.com, still describes the Xi as “our most capable system.”
“This is as good as you’re going to get, so we feel very fortunate to be able to do that,” Theriot had said in the interview.
Although called surgical robots or “robotic systems” throughout the industry, these are not robots in the sense of operating autonomously, like a self-driving car. Instead, the da Vinci Xi is remote-controlled from a console by a surgeon who has received special training in the use of the equipment. It is designed to give the physician control of tiny surgical implements through smaller incisions than required for hands-in surgery and more precise control in situations where it is needed.
The da Vinci Xi has four arms, three of which are used to position instruments that can bend and rotate farther than a human wrist. Typically two of the arms are used for things such as graspers and sutures inserted through a tubular instrument called a trocar. The third arm may support an insufflator, which introduces a gas or fluid to separate tissue, and the fourth arm positions a magnified, high-definition camera said to provide a “3D” view.
The concept of minimally invasive surgery, through the use of devices such as trocars and fiber-optic laparoscopes, predates robotic-assisted surgery. But the robotic system adds the factor of the robot’s stability, Theriot said. At moments when a surgeon would need to hold his or her hand very still, the robotic arm instead holds the surgical instrument, reducing fatigue for the physician.
Additionally, robotic systems introduce what Theriot called scalability, allowing larger movements of a surgeon’s hands to be translated into much smaller movements of a device doing the work inside a patient.
“So now we’ve taken minimally invasive surgery and we’ve added a level of control for the surgeons,” Theriot said.
For patients, the advantages of robotic-assisted surgery are much the same as those reported for other minimally invasive techniques. These include “less pain, less scarring, shorter hospital stays, and quicker return to normal activities,” East Georgia Regional Medical Center stated in a press release.
The da Vinci Xi offers functional advantages over the hospital’s previous, earlier model da Vinci system, according to Theriot.
“The platform that the patient is on can be moved, which assists the surgeon during surgery,” he said. “He can position the patient much better and more precisely.”
As this implies, the previous system had a stationary platform. The new Xi also has instrument arms that were redesigned for greater ease and range of positioning.
At East Georgia Regional Medical Center, robotic assisted surgery has been used for general, gynecological and urological surgeries. Hernia repairs and hysterectomies are among the procedures performed.
Theriot and Erin Spillman, EGRMC’s director of marketing, counted at least seven physicians affiliated with the hospital who have received the training and perform robotic-assisted procedures. They mentioned another who may take the training.
One of the local physicians most experienced in the use of surgical robots is general surgeon Dr. Arkam M. Hassanyeh, who has been operating with the da Vinci devices here since August 2011. After receiving his initial training in robotic-assisted surgery in Florida, Hassanyeh took advantage of more advanced training, provided at East Georgia Regional Medical Center by the company that supplied the robot. The kinds of surgeries that Hassanyeh performs with this equipment include incisional hernia repair, inguinal hernia repair, colon resection and kidney removal.
The surgical robot is “user friendly” and offers “less physical stress on the surgeon, better optics, and a smaller incision for faster healing time for the patient,” Hassanyeh replied to some questions emailed by the reporter and forwarded by Spillman.
Not for all cases
But while some physicians prefer to use robotic-assisted surgery when possible, others choose not to, and it is obviously used more often for certain kinds of procedures.
“You won’t see it on every case because the setup and everything for a case is longer, because you’ve got just more equipment,” Theriot said. “So a doctor may not. If he doesn’t need that higher level of precision, then it’s not necessary.”
At this point, robotic-assisted surgeries do not constitute a majority of surgeries performed at EGRMC.
“I wouldn’t say it’s half,” Theriot said. “It’s growing. They’re definitely developing more affinity of using the robot for certain cases, so we’ll see that number go up.”
New name: STU
While da Vinci Xi is the manufacturer’s trademark, the particular surgical robot at East Georgia Regional Medical Center now has a name of its own, “STU.” The hospital held a “Name Our Robot” contest, open to public school, private school and homeschooled students from kindergarten through 12th grade that drew more than 100 entries.
Joshua Hollis, a Southeast Bulloch High School student, suggested naming the robot ASTUTE, an acronym for “Advanced Surgical Tool of Unrivaled Technological Exactness,” and calling it STU for short. The surgical team chose that name.
So Joshua won $100 for himself and another $100 for his school and is being invited to tour the operating room where STU works.
Al Hackle may be reached at (912) 489-9458