At the end of 2018, Intuitive Surgical released the da Vinci SP robot, the first single-port surgical robot to reach the market and as yet the only one of its kind in clinical use. The concept entails miniaturizing the robotic arms used in robotic surgery to allow them to enter through a single channel rather than requiring a port and separate robotic arm for each instrument to enter the abdomen, chest, or other body cavity. The natural question for a surgeon before investing in learning to use this new robot or as a hospital before investing in this new and expensive technology is whether or not this is a significant leap forward.
The answer, as with many things in healthcare, is that it is complicated. For some types of surgery, the SP robot is definitely a game changer because it allows access into the body through natural orifices and can work in tight spaces. So for trans-oral surgery for throat cancers, for example, or for transanal surgery for rectal cancers, for example, a patient will literally have no incision after their tumors have been resected as opposed to an often morbid alternative like splitting the jaw to access the tumor or a large abdominal incision. Operations that previously would have required several days of hospitalization and weeks of recovery can be done on an outpatient basis or overnight stay.
On the other hand, many operations have been performed robotically for over a decade and at a very high level with excellent outcomes. Almost all prostate cancer and endometrial cancer surgery in the U.S. is already done robotically and for almost two decades with other common procedures like robotic hysterectomy, hernia repairs, and kidney surgery continuing to grow. Will replacing five smaller incisions for robotic instruments with one, approximately inch-long incision truly impact patient care?
This remains to be seen, but early outcomes in Urology (the SP robot is only FDA-approved so far for certain urologic and otolaryngologic procedures) suggest that using the SP robot with minor modifications to the tried and true robotic methods might decrease patient pain and allow earlier discharge.
At OhioHealth Dublin Methodist Hospital, outside of Columbus, Ohio, we were among the first 10 or so hospitals in the world to install a da Vinci SP robot and have been using it for over a year. We have reported our initial experience in 100 patients treated for prostate cancer, kidney cancer, and other urologic conditions with nearly 90 percent of these patients going home the same day as surgery. On average, we have seen a 15 percent reduction in pain, which will require larger numbers of patients to validate but most patients are managed with no narcotics postoperatively, which in the era of the opioid crisis is significant. In addition, as the longer-term implications of the COVID-19 crisis become more clear, it may be important to minimize hospital lengths of stay not only for cost reduction but to protect postoperative patients from potential exposure to infections now more than ever.
Certainly, for now, single-port robotic surgery is still cutting edge and won’t be for every surgeon or every hospital. As early adopters, we recognized a value in being progressive in our market and the opportunity to contribute to the future of robotic surgery given that we have an already very mature multidisciplinary program. But this will not be the case for all. Some hospitals will want more data and a better understanding of financial impact before investing, and some surgeons will need more time to be convinced that it is worth adopting. We are currently hosting urologists from around the country wanting to observe SP robotic surgery and “kick the tires” so to speak and anticipate a growing interest particularly over the next year and beyond as additional robotic systems hit the market, and surgeons and their hospitals have to decide how their robotic surgery programs will evolve.
So is single-port robotic surgery a game changer or just a little bit better?
The answer is that time will tell and that it probably depends less on just having a robot with the capability and more on what your team of surgeons across specialties can do with it.