Robotic Surgery Growth

We started our robotic surgery program at Newark Beth Israel Hospital on Dec. 13th, 2004.
Our 9 man group decided to let one person do all of the robotic surgery. Since I had the best combination of open and laparoscopic surgical skils, as well as strong cancer training from a 6 year residency at Indiana University, I had the fortune of being the person.
We did 2 cases in Dec, 2004 (both prostates). We did between 1 (Feb 05) and 7 cases per month from Jan to Sep 0f 2005 for a total of 42 operations (including 32 prostates).
We then jumped to 13 operations (10 prostates) in Oct 2005 and should do about that many in Nov and Dec of 2005.
I project I will do 200 operations (150 prostates) in 2006.
robotic volume Nov 2005.jpg

When we first started we had several hurdles.
Our practice is based in West Orange, about 1 mile from Saint Barnabas Medical Center. There was no robot there and no intention of getting one due to the cost. After visiting the AUA in May of 2004 and listening to my mentor from Indiana switch from open to robotics and listening to the advantages, I knew I had to get into it. I decided to go to Newark Beth Israel, also in the Saint Barnas Health Care System.
I met with the CEO of NBI and the rest is history. I did have a problem from bringing patients from the suburbs into the city.
The learning curve. The first 10 cases were scheduled as all day events. The times quickly went down from 10 hours, to 7 hours, to 5 hours. Given how far it was from our office in midday traffic and that we didn’t have enough equipment for 2 cases, we could only do 1 a day and usually didn’t schedule office hours afterwards. This was a major money loser.
The perceived learning curve. Amazingly to me, until we had done about 30 operations people still thought we hadn’t done enough and often went elsewhere.
What changed.
1) Currently, most people that need surgery understand we are the leaders in this and stay with us. We do the most difficult robotic surgery in the state including dvP in patients up to 300 pounds (I probably would go heavier, but my heaviest patient was 290 pounds.
2) I am getting referrals from PMDs that I did not know until I did surgery on one of their patients and now they know about me and send patients with blood in the urine or elevated PSAs.
3) I am getting many 2nd opinions for robotic surgery for patients with known problems.
4) I am getting referrals from the internet and from friends of friends that know what I am doing.
5) I am the only one in the state doing things such as robotic partial nephrectomies and robotic cystectomies. I think my complex robotic surgery ability ranks well nationally.
6) Some procedures that I once did laparoscopically I now do quicker and safer robotically. This includes pyeloplasties and nephrectomies. My last 2 of each went home the following day.
What do the hospitals think?
SBHCS- The system is delighted. They own both hospitals.
NBI- The robot collected dust except for a cardiac surgeon who used it about once a month and a pediatric urologist (The guy is world class- If your child needs urologic surgery, he is worth the trip) who used it 2-3 months.
Since my arrival, the general surgeons and gynecologists have come aboard.
There is strong talk of getting a 2nd robot for the hospital and 3 state of the art laparoscopic rooms are almost finished getting built.
SBMC- They have chosen not purchase a da Vinci at this time. If new procedures are done routinely with the robot, then I think they will reconsider. I think the next big procedure will be the robotic hysterectomy.