Oswego Health has joined the list of hospitals offering robotic surgeries. It has performed about 300 surgeries since the program was launched last year
By Stefan Yablonski
Some hospitals have been doing robotic procedures for quite some time; others for about one year.
Crouse surgeons affiliated with the da Vinci program perform an average of 2,500 robotic surgeries annually and more than 20,000 da Vinci cases have been completed to date.
Oswego Hospital has done around 300 robotic surgeries since last summer.
“Yes, we acquired our robot in July 2024. The da Vinci xi, the fourth generation of the robot, and started our program from there,” said Ryan Walker the specialty care physician lead at Oswego Health and chairman of Oswego Health’s robotics committee. “We are now up to seven surgeons using the robot. We started with three, the most experienced surgeons. So it was myself, a general surgeon and two bariatric surgeons for the first few months. Along the way we’ve added two more general surgeons, another bariatric surgeon and a urologist. Seven surgeons across three specialties.”
For the general surgeons they are doing all of their gall bladder surgery and hernias of every variety, he said. They will occasionally do an appendectomy, some bowel surgery and a bit of colon surgery as well.
“It is getting a lot of use,” Walker said. “For the hospital, we are approaching our 300th case — our volume is growing rapidly. Personally, I am approaching my 500th case coming up soon. I have been using the robot at other hospitals for the last five or six years in Upstate New York. The idea was to get the program up and running, then get the others trained and comfortable with the robot.
“While it certainly is a high-tech piece of equipment, we feel it is the best tool at our disposal — especially for general surgeons.”
“The learning curve is actually much shorter. It’s much easier to learn new cases or to start doing procedures that you have done laparoscopically or open,” he added. “It’s actually much easier to learn on the robot. The controls are intuitive, so it’s like how you would normally use your hands. It’s very easy to get up to speed.”
Game changer
Robotic is far more common these days.
“But I wouldn’t say that it is industry standard. It’s becoming more and more common as the years go on,” Walker said. “The big change came in 2016 when this robot was introduced and that was really the game-changer. This robotic platform is by far the easiest to use. It’s easier on the staff and easier on the surgeon.
“More of these are coming to the smaller hospital where I feel they serve an even greater role. It allows us to do more complex or complicated surgery — with a higher degree of accuracy, better outcomes, better patient experience. The results are greatly improved with the platform. We are able to accomplish surgery successful through these smaller incisions. For those reasons I think it serves a greater purpose in these smaller hospitals.”
For the patients, he said, it means smaller incisions, less pain and quicker recovery time.
“At some point I would love for that to happen [adding another robot]. That would be a few years off. We are ramping up and getting to the point where you could make that argument” he said. “From an industry perspective, if you are utilizing your robot and doing 500 cases a year — that is our target now that we are going to be fully up to speed — that’s what we want to accomplish in our second year. Most hospitals don’t get to that point. Once you hit 500 then you should start thinking about potentially expanding to ease the access and make it easier for everyone to utilize it when they need it.
“I think we could accomplish 600 to even 800 cases per year when we are really up to speed. You are the elite of the elite when you are doing that many cases on one robot. That is what we want to get to in the next few years and then once we get there I think we can have the conversation to see if we’re lucky enough to get a second robot. First we got to get there.”
Oswego Health opened access to the robot to urgent and emergent cases, so there’s now technically 24/7 access to the robot, if needed, he said.
“Our goal all along after 12 months of this program, we want to expand our access and allow the robot to be utilized 24 hours a day, seven days a week. We strongly believe it is the best instrument at our disposal and we want to be able to use it all the time; to offer the best intervention to the patient no matter the time of day,” he said. “Our goal was to do that in 12 months; the program’s been very successful and everyone is very comfortable with the robotic platform. We actually rolled out the true 24/7 access on April 1. We started a few months early based on the program. It is available across all specialties 24 hours a day seven days a week, every single day of the year. If we need to use it, we can use it.
“We have the enviable problem of fighting for time, which is that’s how you want it. Every once in a while we are competing for time a little bit. Obviously, only one person at a time can use the robot at any given time. We do have to sort of negotiate from time to time to make sure we are getting the time that we need.”
Program at Crouse is home to 11 robots
Over the past 16 years, the Crouse Institute for Robotic Surgery has become the largest multi-specialty robotic surgery program in Central New York, thanks to an experienced team of regionally and nationally recognized physicians and a commitment to using the most advanced, minimally invasive technology available.
Crouse Health began offering robot-assisted surgery using the da Vinci surgical system in 2008. Since then, their robotics team has set the standard for robot-assisted surgery in the region.
Today, the program is home to 11 robots, including nine da Vinci Surgical Systems used in gynecology, urology, colorectal, cardiothoracic, bariatrics and general surgery.
Having more robots, very simply, means Crouse completes more robotic surgeries than other healthcare organizations in the region, said general surgeon Ben Sadowitz.
And volume directly correlates with improved outcomes.
“High-volume programs consistently have better outcomes,” he added. “That’s not just about the surgeon’s skill, but the collective experience of the entire operating team.”
St. Joseph’s using robots for cardiac surgeries
St. Joseph’s Health welcomed physician Amine Hila as chief medical officer, acute care, in January.
He has used the robot “many, many years.”
“I am relatively new to St. Joe’s; I’ve been here six months. The first robotic program was in the mid-2000s. So 20 plus years,” he said. “There are specific uses of the robot. We use them for a variety of specialties — for example we use some of our robots for cardiac surgery, which is extremely unusual. We’ve done about 150 cardiac surgeries, mainly coronary bypass this past year with a robot. Most hospitals don’t use them at all for cardiac.”
They are currently engaging with a company to help educate surgeons in other areas, cardiac surgeons, how to use the robot.
Currently, the hospital has five robots.
“That’s a high number when you think about the fact that we have 15 operating rooms,” Hila said.
He used to be at UHS in Binghamton (United Health Services Hospitals) before coming to St. Joe’s.
“We had one robot and we had 14 operating rooms,” he said. “So it is very dependant on the interest of the surgeon. But also surgeons who were trained in the last 20 years, somewhat younger surgeons, they use them a lot more because they were trained on that as opposed to maybe people who were trained in the ’80s and ’90s when it didn’t exist.
“We are also getting a sixth robot. It’s already here; we just haven’t used it yet. Our first case [was] Friday [June 13]. It is called a single port robot. Everything is done through one hole as opposed to two or three. It is not a da Vinci but it is an intuitive robot. Da Vinci is the classic robot. Depending on the surgery it could be two or three holes. This is just one.”
It is approved for prostates as well as lower colon surgery. It is going through the process to be approved for other surgeries as well.
It’s one incision, faster healing, less pain for the patient and less risk of infection, he explained.
St Joseph’s is part of Trinity Health that has 95 or 96 hospitals.
“We are the only hospital in all of Trinity Health that does cardiac robotic surgeries. Our cardiac surgery program here at St. Joes is not just one of the best in New York; it is one of the best in the whole country. Our post surgery mortality is in the top 10 hospitals in the whole country. I think number 7,” he said. “I would say that 30% of our cases in general are robotic.”
There is a training program that the company puts together where surgeons can go and get acquainted with the machine and then after that training is fulfilled they come and get precepted by an experienced physician until they feel their skills are adapted to the robot.
Learning curve
“It’s dependant on whether they were trained on it or not. Years ago there was a steep curve because a lot of surgeons may not have had experience with robots,” Hila said. “Nowadays, more people are used to [robots]; the curve is not very steep.
“How many surgeons are using the robot? That’s a great question. I have to think about that actually. It’s over 20, but I don’t know the exact number.
When you use a robot the surgeon is actually sitting at a console and looking through kind of goggles and using a ‘joy stick.’ An assistant is at the patient’s side.”
Is robotic surgery becoming more commonplace?
“Yes it is expanding,” Hila said. “I think the push by Medicare and private insurance companies is to send the patient home quickly. They don’t want them to stay in the hospital. There is a financial reason, but there is also a risk reason. The longer someone is in the hospital, the higher the risk is of complications. And that is one of the reasons why robotic surgery is becoming very important.”
