Management goals expenditure would support

capital purchase, costing more than $5,000, which your company could benefit from.

Background of the technology

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The Da Vinci robot is one of the most recent innovations that I think would be extremely helpful for my organization.

The robot, created only a few decades ago and invented in 1985 with the PUMA 560 for helping surgeons conduct neurosurgical biopsies, has all the signs of an instrument straight out from some science fiction novel. There is one that acts as doctor, rolls over the patient, asks questions, observes symptoms, and even uses a stethoscope. Other robots provide lunch and even assist in surgeries. UCLA uses a state-of the art robot called Vespa that wanders the halls of nearly 600 hospitals worldwide.

In 1988, doctors had the PROBOT, which was designed for prostate work. The ROBODOC helped doctors with hip replacements, whiles the late 1990s led to telesurgery that enabled surgeons to speak to patients on remote military zones. DaVinci was also introduced (and is still being worked on). In 1998, the Adaptive Prosthesis helped patients achieve a more natural walking stance and better adjust to prosthetic limbs, whilst the C-Leg debuted in 1997 and helped with leg-flexing. (The History of Medical Robots)

Da Vinci

One such useful robot is called Da Vinci. DaVinci is used for surgery and helps surgeons and nurses assisting surgeons in procedures that include prostate surgery, cardiac surgery and gynecologic surgery. Although hugely expensive, it has been found to help surgeons in reducing their hand tremors and in enhancing the capability of the average surgeon. As regards nurses, it makes their lives easier in that it reduces the stress of their profession whilst participating in a surgery and helps them and the physician make fewer errors.

History of Da Vinci

Approximately 20 years ago, surgeons began practicing minimally invasive surgery (MIS) where miniscule cameras, called endoscopes or laparoscopes, were inserted in the patient’s body through small ports. Although useful in that it reduced patient trauma, the cameras and their process of inserting them made the surgical procedure that much more complicated and distracted the surgeon’s attention resulting in potential accidents, further delay, sometimes more pain, and a 2D image instead of the conventional 3D image that distorted results.

In the late 1990s, Intuitive Surgical introduced the da Vinci ® Surgical System to obviate some of these concerns. These instruments have ergonomic comfort, can twist and turn in seven degrees of freedom, and have 3-dimentisoanl intuitive vision. Da Vinci provides minimal invasion with accurate photographs and many other advantages for both organization and patient in numerous ways that span economic to managerial advantages. Da Vinci’s contributions — as see Table 1 — expend to numerous health conditions allowing the surgeon and nurse to perform complex procedures that otherwise would have taken more time and cost to achieve (Advance surgery. Minimally Invasive Surgery)

The management goals that expenditure would support.

Da Vinci has been found to help surgeons in reducing their hand tremors and in enhancing the capability of the average surgeon. As regards nurses, it makes their lives easier in that it reduces the stress of their profession whilst participating in a surgery and helps them and the physician make fewer errors.

DaVinci has been programmed to do other things that include importing data from imaging devices and others devices in the operating room for information augmentation, and reducing the danger of occupational environmental hazards for both nurses and doctors, for instance, by removing the doctor from radiation exposure or other bio hazards that the doctor may encounter by sitting too close to the patient. Although most of this regards the surgeon, the nurse is freed in that she is able to relax some of her huge responsibly and focus on the tasks that are most important for her to accomplish.

The producers of da Vinci note that:

The da Vinci Surgical System is the only commercially available technology that can provide the surgeon with the precision, dexterity and control of traditional open surgery, while only requiring 1-2 cm incisions. (Da Vinci Surgery. Features.)

Crafted in a way so that the patient sits comfortably whilst operating the controls and giving him extreme ergonomic design, the robot reduces much of the discomfort of the surgeon who operates for lengthy hours on his feet. The operation demands the extreme concentration of the surgeon, particularly since many of these procedures are complex and can be tiring on the eyes. Da Vinci is wonderful, therefore, in that it mitigates and prevents a great deal of this fatigue; it directs the surgeon’s hands and provides him with another pair of eyes and by so doing cuts down on errors.

Cutting down on surgical errors is also of immense help to the hospital since it boosts their reputation and vastly reduces the chance of costly litigations.

Da Vinci also produces more motivated nurses since burnout is partially caused by harassed surgeons who practice short-short on nurses. Produce more contented surgeons who accomplish more successful, less stress-filled operations and you have a cadre of more motivated nurses.

• How the item could enhance the economic environment of the organization.

The expenditure could save the organization billions of dollars in expense. These are just some of the advantages it affords:

Shorter hospital stay (Poston et al., 2008)

Less pain and scarring (NIH)

Less risk of infection (ibid.)

Less blood loss and need for blood transfusions (Poston et al., 2008)

Faster recovery (ibid.)

Quicker return to normal activities (ibid.)

Consider too that the robot makes surgery more precise and stress-free thereby preventing many of the errors that usually accrue from a fatigued and overwhelmed surgeon who has to concentrate, sometimes for hours on end, on complex situation. Errors — and there are many from such circumstances — result in costly litigation. Da Vinci, therefore, although expensive in the short-run certainly produces its value in money in the long run. There is no doubt but that the hospital profits.

Da Vinci too can save the hospital money in the HR Management area, since turnover of nurses often results from demanding, stressful conditions. With more complacent, satisfied surgeons, you have a better atmosphere in the hospital which results in greater stability of staff workforce. This also saves the hospital money.

Finally, although not exclusively, Da Vinci provides surgeons with many instruments that normally the hospital would have to procure; likely at lesser quality. These precisely controlled EndoWrist instruments help the hospital’s surgeon perform specialized surgical tasks with precision and control.

The forceps are one instance. Da Vinci comes equipped with master controls that work like forceps. At the same time, it replaces the conventional laparoscopic instruments with a highly magnified 3D image of the body’s interior.

• The organizational goals the expenditure would support.

The da Vinci Surgical System is used in procedures that treat a range of conditions. The Da Vinci, therefore, makes numerous contributions to the organization. The way that this can be best illustrated is via the following Table

Conditions that Da Vinci treats

Contributions

Bladder Cancer

Significantly less pain (Smith et al., 2009)

Less blood loss (ibid.)

Less occurrence of major complications (Kauffman et al., 2009)

Shorter hospital stay (ibid.)

Quicker recovery of bowel function (Smith et al., 2009)

Coronary Artery Disease

Shorter hospital stay (Poston et al., 2008)

Less pain and scarring (NIH)

Less risk of infection (ibid.)

Less blood loss and need for blood transfusions (Poston et al., 2008)

Faster recovery (ibid.)

Quicker return to normal activities ibid.)

Gynecologic Cancer

Treatment generally reduces pain and consequents in shorter hospital stay but outcome varies according to individual (http://www.davincisurgery.com/da-vinci-gynecology/conditions/cancer/)

Kidney Disorders

Shorter operation (Smith et al., 2009)

Less blood loss & transfusions (Kauffman et al., 2009)

Less pain (ibid.)

Shorter hospital stay (ibid.)

Kidney Cancer

Excellent clinical outcomes and cancer control (Benway et al., 2008)

Short hospital stay (Rogers et al., 2008)

Low blood loss (Benway et al., 2008)

Precise tumor removal and kidney reconstruction (Rogers et al., 2008)

Excellent chance of preserving the kidney, in certain operations (ibid.)

Low rate of operative complications (ibid.)

Obesity

Low rate of complications

Low rate of wound infection

Low conversion rate to open surgery

Short hospital stay (Snyder et al., 2009)

Throat Cancer

Excellent cancer control (Weinstein et al., 2009)

Low rate of complications

No visible scarring or disfigurement

Low blood loss (Rogers et al., 2008)

Minimal need for tracheotomy (breathing tube) (Snyder et al., 2009)

Minimal need for chemoradiation therapy (Weinstein et al., 2009)

Ability to swallow (Snyder et al., 2009)

Short hospital stay (ibid.)

• How the expenditure would relate to the needs of the organization.

The robot used for surgery that is called daVinci helps surgeons and nurses assisting surgeons in procedures that include prostate surgery, cardiac surgery and gynecologic surgery. Although hugely expensive, it has been found to help surgeons in reducing their hand tremors and in enhancing the capability of the average surgeon. As regards nurses, it makes their lives easier in that it reduces the stress of their profession whilst participating in a surgery and helps them and the physician make fewer errors.

DaVinci has been programmed to do other things that include importing data from imaging devices and others devices in the operating room for information augmentation, and reducing the danger of occupational environmental hazards for both nurses and doctors, for instance, by removing the doctor from radiation exposure or other bio hazards that the doctor may encounter by sitting too close to the patient. Although most of this regards the surgeon, the nurse is freed in that she is able to relax some of her huge responsibly and focus on the tasks that are most important for her to accomplish.

The robots have their disadvantages. There are, firstly, hugely expensive with some hospital claiming that the step amount of expense invested in acquiring them and maintaining them does not give any returns. Nurses, too, have to get used to their presence and they require time for training and overcoming of reluctance to using them. They also require substantial personnel experience. On the other hand, many health-care institutions who know how to use them and do so claim them to reduce errors as well as to lighten the tasks of staff including doctors and nurses.

The da Vinci System could also potentially be used to perform truly remote operations; this is something that is still being worked on (Technology Review (MIT)

• Justify the expense to the organization. Relate the reasons to the hospital goals, including departmental and management goals, and how the acquisition would be beneficial.

The hospital’s goals include hiring and retaining top-notch surgeons, hiring and retaining skilled and motivated nurses, promoting a friendly, calm hospital environment, satisfying and relieving patients of their fears, reducing pain, preventing errors, preventing costs as much as possible, and building a reputation as a specialist hospital in one or more particular fields. Many hospitals choose a particular division of surgery to specialize in. Da Vinci can help the hospital achieve all these aims as elaborated in previous sections.

In conventional laparoscopy, the surgeon operates while standing using unwieldy instruments that lack wrists. The surgeon too is distracted form his instrument in order to see the image of the patient on the 2D camera aside from which the surgeon has to rely on his assistant to position the camera accurately. The da Vinci System’s ergonomic design on the other hand allows the surgeon to comfortably operate surgery from his console whilst keeping his hands on the instruments. All he has to do to reposition camera is simply to use his hand. The surgeon, in other words, is solely in control and much of the stress of the conventional surgery room — that impacts other workers — is gone.

The robot provides superior visualization, enhanced dexterity, and greater precision and ergonomic comfort. It is truly (as advertised) the Slave of the Master giving the organization and surgeon far more than either of them can do alone. The surgeon can perform minimally invasive procedures involving complex dissection or reconstruction and for the patient there is less pain, less blood loss and less need for blood transfusions. In this way, the hospital benefits by having more content patients, less expense in the long run, less stress-filled surgeons, and more motivated nurses leading to hospitals retaining their competent and hard-won staff. More content staff results in a friendlier environment. Da Vinci produces more accurate procedures, thereby avoiding litigation. The robot costs an enormous $1.3 million in addition to several hundred thousand dollars of annual maintenance fees and surgical procedures performed with this robot take longer than traditional ones, but many hospitals say that the expense and time is worth it.

As of January 2013, more than 2,000 units had been sold worldwide (intuitivesurgical.com). It is time that our hospital buys one.

Sources

Benway BM, Wang AJ, Cabello JC, & Bhayani SB (2008) Robotic Partial Nephrectomy with Sliding-Clip Renorrhaphy: Technique and Outcomes; European Association of Urology,

Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, & Fowler WC. (1994) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J. Obstet Gynecol. (4):360.e1-9.

Davinci surgery. Minimally Invasive Surgery

http://www.davincisurgery.com/da-vinci-gynecology/treatment-options/minimally-invasive-surgery/

Da Vinci Surgery. Features.

http://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system/features.php

DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, & Finkler NJ. (2008) Robotically assisted laparoscopic hysterectomy vs. total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecologic Oncology111:412-417.

Schimpf, S. (2012) Robotics can revolutionize the delivery of medical care http://www.kevinmd.com/blog/2012/01/robotics-revolutionize-delivery-medical-care.html

Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. (2009) Prospective Randomized Controlled Trial of Robotic vs. Open Radical Cystectomy for Bladder Cancer: Perioperative and Pathologic Results, Eur Urol, 10.024.

Snyder B, Wilson T, Scarborough T, Yu S, Wilson E. (2009) Lowering gastrointestinal leak rates: a comparative analysis of robotic and laparoscopic gastric bypass. J Robotic Surg.

Technology Review (MIT) The Slow Rise of the Robot Surgeon http://www.technologyreview.com/biomedicine/24850/

The History of Medical Robots!

http://neurochangers.com/2012/08/09/the-history-of-medical-robots/

intuitivesurgical.com. products http://www.intuitivesurgical.com/products/products_faq.html#18

Kauffman EC, Lee MM, Otto BJ, Portnoff A, Ehrlich JR, Schwartz MJ, Wang GJ, & Scherr DS. (2009)A Comparison of Postoperative Complications in Open vs. Robotic Cystectomy. Eur Urol

National Institutes of Health How is Coronary Artery Disease Treated? http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_Treatments.html

Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. (2008) Comparison of economic and patient outcomes with minimally invasive vs. traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 248(4):638-46.

Piquion-Joseph JM, Navar A, Ghazaryan A, Papanna R, Klimek W, & Laroia R. (2009) Robot-assisted gynecological surgery in a community setting. Journal of Robotic Surgery,:1-4.

Rogers CG, Menon M, & Weise ES, (2008) Robotic partial nephrectomy: a multi-institutional analysis; J. Robotic Surgery 2:141-143

Weinstein GS, O’Malley Jr. BS, Desai SC, & Quon H. (2009) Transoral robotic surgery: does the ends justify the means? Current Opinion in Otolaryngology & Head and Neck Surgery, 17:126 — 131.


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