How to Start a Sustainable RAS Revolution in Your Hospital

Building and managing a robotic-assisted surgery program in 3 steps

Medtronic Robotics System Utilisation Manager, Berta Ortiga, a former hospital operations manager and deputy hospital CEO, joins us to share her experience and perspective on the best way for hospitals to approach investing in robot-assisted surgery technology and building a successful robotics program.

To start, we’ll first let Berta answer the big question: Why should a hospital entertain the idea of a robotic-assisted surgery program? “Adding or expanding robotics in a hospital’s portfolio aligns with goals to deliver better care by broadening the adoption of MIS procedures. Not only can that attract patients, but also talent – the surgeons of the future will be using robotics more and more.”

But, as Berta points out, there really is a lot more to it than just being a forward-thinking healthcare provider. 

“Buying a robot is the easy part. After that, how do you make sure that the technology really makes an impact on how professionals work? And, how does it impact the patients?”

–Berta Ortiga, Medtronic Robotics System Utilisation Manager, a former hospital operations manager and deputy hospital CEO

This is where Berta’s expertise comes in

“The strategic management of the robotics program is equally as important as developing the most effective perioperative process. It’s a matter of balancing these two,” she says. 

As a former hospital manager, Berta knows how important it is to have strong collaboration through the program development process. “When you are looking at managing a robotic program, you may not have the background to know if you are on the right path or not. That’s why you need a collaborative relationship with a company who can share best practices— not just sell you a robotic system.”

Berta recommends a simple, efficient way to partner with hospitals as they begin or expand their robotics program.  The “3 Rules of Engagement” plan for building a robotic-assisted surgery program should include phases for preparation, initiation, and expansion. 

#1: Prepare for a successful RAS program

Preparation is everything leading up to the first surgery, it's the kickoff of the robotic-assisted surgery program in the hospital. “The hospital needs to go deep into analysing their needs and goals,” Berta explains. “There are strategic decisions to be made. It’s important to establish proper governance, and the right program management. Someone needs to be responsible for the use of this technology and represent the surgeons and nurses who will be using it. Even the installation process requires some assurance that in the facility everything and everyone is going to be ready to receive the robot” she adds.

She suggests beginning with some high-level questions to help define program objectives, such as:

  • Which surgeons should be participating in a robotic program?
  • How many procedures should the hospital be doing with the robot?
  • How many procedures per surgeon are is appropriate?
  • How should we be allocating robotic time among teams?
  • How should we allocate robotic time among the different specialties?
  • How are we going to decide which procedures should be performed robotically?
  • How do we establish the order of training?

The analysis process involves a combination of clinicians, nurses, and administration. It requires alignment to ensure a smooth implementation of the technology on a short and long-term basis.

The second part is preparing for the first surgery. The hospital needs to train the right surgeons, as well as nurses and OR staff to cover all the procedures. This technology cannot be left to untrained professionals. It's like an orchestra in the OR and everything needs to be aligned and coordinated to ensure a safe and smooth surgery. Additionally, all items needed for an agile RAS will be checked to ensure a safe and successful first procedure such as preference cards, and sterilisation. It’s also important before the first surgery to perform a dry run with the entire clinical team.

#2: Initiate the first cases

After the first clinical team has been trained and the hospital has done all the rehearsals or ‘dry runs,’ it’s time for the first surgery with a patient. The first 15-20 surgeries are probably the hardest part of the learning curve and should be performed during the first 7-9 weeks after the first surgery. In this phase, the utilisation team needs to be very present to guide the clinical staff, surgeons, and nurses to ensure a good experience with our technology, and the focus is patient safety and quality. Everyone wants to be sure early procedures and the overall adoption process go smoothly, so that clinicians are committed to the benefits robotic technology can bring to their professional lives, and that the results are what everyone expects.

#3: Expand to enhance utilisation

The next phase is the roll out for using a RAS system, among different surgical specialties and to perform diverse procedures. This phase should align with the hospital’s progress towards its robotic program objectives. The expansion phase is crucial to ensure high utilisation of the investment. In this phase it's critical to focus on efficiency to maximise access to the technology. Hospitals need to establish and track metrics on OR turnover times, instrument and supply standardisation, and operative times in order to work towards an improved surgical robotic program.

“This is a fundamental part of our perioperative process on how to improve the use of the technology, minimise waste of resources - whether these resources are material or human: time, consumables, and more.”

By following the "3 Rules of Engagement", hospitals can establish and expand their surgical robotics programs, and ensure that their investment in capital equipment is strategically monitored to meet both short and long-term goals.

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Refer to the Instructions for Use for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions and potential adverse events. Refer to the Instructions for Use for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions and potential adverse events. In Australia and New Zealand, Hugo™ Robotic Assisted Surgery System is currently indicated for certain urologic surgical procedures, gynaecologic laparoscopic surgical procedures, and general laparoscopic surgical procedures. (Please refer to Hugo Users Guide for a full list of specified procedures).