Wanted: An Abdominal Robot For Same-Day Surgery

Intuitive Surgical's da Vinci robot, which sells for $1.5 to $2 million and costs about $300,000 a year to maintain, continues to dominate abdominal robotic surgery. Nimbler, lower-priced systems, in various stages of development (see "Da Vinci Alternatives" on page 56), have yet to gain much if any traction in the U.S. market. That's likely to change in the coming years — as will the cost of entry for abdominal robotics.

"Competitors are trying to keep their price points closer to $1 million. That's still pricey, but over time competing companies will lower their prices as they get into larger production runs," says Roger Smith, PhD, chief scientist at AdventHealth Nicholson Center in Celebration, Fla.

"Robots are certainly going to be more popular and numerous, and like anything with technology, they'll get cheaper, smaller, easier," adds Dmitry Oleynikov, MD, FACS, professor in the Department of Surgery at the University of Nebraska Medical Center College of Medicine in Omaha.

"Ultimately, this technology will let surgeons do more audacious and complex surgeries without big incisions."

Dr. Oleynikov says robots are being used for "just about every single abdominal operation you can think of" in inpatient settings. "For outpatient surgical cases," he says, "things like inguinal hernia, umbilical hernia, gallbladder — fairly straightforward, low-risk procedures — are being done with robots."

Yet a robot like the da Vinci is a difficult proposition for outpatient ORs, says Dr. Oleynikov, citing these factors.

• Size. "The robot is big, so it requires a pretty large OR," he says. "Most [same-day] ORs are smaller."
• Staff training. "Robots are complicated," he says. "They require docking, undocking, maneuvering and positioning."
• Reimbursement. The procedures in ASCs are reimbursed less than the same types of procedures in hospitals. "An expensive robot that may take additional time to perform an operation is going to severely erode the ASC's bottom line," he says. "Depending on the procedure, the additional cost of using the robot versus straight laparoscopy is anywhere between $1,500 to $3,000."

Are there less expensive, more functionally limited robots, or products that leverage robotics, that outpatient facilities can consider? Dr. Oleynikov says such products are emerging, like a handheld robotic needle driver that lets you bend at the wrist. "Some companies are looking to create fairly rudimentary robotic tools — kind of like a 'Robot Lite,'" he says. "But right now, there really isn't an easy-peasy, cheap hybrid robot on the market."

Dr. Oleynikov himself is working on a smaller, less expensive robot for abdominal surgeries with a company called Virtual Incision, where he's chief medical officer. "It's basically a throwaway robot," he says. "You get 10 to 15 uses out of it, then throw it away. It's designed for the outpatient/ASC environment because it's very easy to use, dock and clean, and it's designed for smaller ORs." He says the robot is still "more promise than fact" at this point, however.

"Others are interested in creating smaller single-incision robots that are easier to use and deploy, and cheaper to operate versus a multi-arm robot," he adds. "That future is coming, but it's going to take time. My guess is over the next 3 to 5 years, we'll see a lot more competitors on the market." OSM