Hospitals embrace robotic surgery, despite cost questions

Sherry Boultinghouse took off four weeks of work for her hysterectomy at Shawnee Mission Medical Center last year, and her husband planned to be home taking care of her for a full week.

But after surgeons performed the procedure with a da Vinci Surgical System robot, Boultinghouse was feeling fine so quickly that her husband went back to work after just two days and she went back a week early.

“I had never had a major surgery before so I didn’t know what to expect, but overall I was really surprised at how well I got along,” said Boultinghouse, 57, of Girard, Kan. “I was up walking the halls a few hours later that evening and went home the next day.”

Shawnee Mission Medical Center became the first hospital in the region to install a da Vinci system in 2002. At the time the machine was a novelty — robotic arms that surgeons could use to manipulate small instruments through small incisions. It had been approved by the U.S. Food and Drug Administration just two years earlier.

Now the machines have become almost ubiquitous in Kansas City hospitals. The University of Kansas Health System, St. Luke’s Health System, Menorah Medical Center, Providence Medical Center, Research Medical Center, Overland Park Regional Medical Center, Liberty Hospital, Centerpoint Medical Center and North Kansas City Hospital all use some version of the da Vinci system.

Overland Park Regional began using it for pediatric surgeries last year, and Shawnee Mission Medical just marked its 4,000th surgery using the device.

“In certain fields, it’s revolutionized our practice,” said Brenda Shoup, a Shawnee Mission Health gynecological oncology surgeon who has used the da Vinci system for about 10 years.

That revolution comes with some costs.

Jason Wright, a surgeon at Columbia University Medical Center in New York who went to medical school at the University of Missouri-Kansas City, said that compared to open surgery, robot-assisted procedures are clearly super.

But a 2013 study he co-authored found that compared to laparoscopic hysterectomies, another minimally invasive procedure, robot-assisted surgery produced similar outcomes but cost about $2,000 more.

“I think that’s probably the main limitation of robotic surgery is that it is expensive,” Wright said.

Wright said certain procedures can be done in a minimally invasive way only with a robotic system. But after investing $1 million to $2 million in a system, the temptation might be to overuse it, because cost is not usually a factor for the surgeon — or the patient.

“I think for hysterectomy and for most procedures there’s lots of different options out there and they probably need to weigh those options with their surgeon,” Wright said.

Shoup said she’s heard the cost-benefit arguments but thinks the da Vinci system provides advantages over even laparoscopic procedures. It gives the surgeon a three-dimensional image to look at versus the two-dimensional television screen of a laparoscopy; it holds the tissues more stable at the insertion sites to minimize trauma; and it cuts down her time in the operating room.

“We can do hysterectomy and lymph node dissections with a laparoscopy, but it’s much more difficult and it requires two trained surgeons to do,” Shoup said.

Boultinghouse, a speech-language pathologist, said she did research about hysterectomies online after her primary care doctor referred her to Shawnee Mission Medical Center for the procedure and was happy with the decision to use the da Vinci.

“My overall experience surpassed what I had hoped for,” Boultinghouse said.

This story was originally published July 17, 2017 at 3:47 PM with the headline "Hospitals embrace robotic surgery, despite cost questions."