As a surgeon for 30 years, making a difference in patients’ lives has always been an immensely powerful motivator. I see that same motivation in the healthcare leaders working to achieve health equity. There has been an inspiring surge of smart, passionate people at every level of healthcare applying their knowledge and skills to equity solutions, especially since the quadruple aim became quintuple in 2022 with the addition of the “imperative to advance health equity.”
Achieving health equity is particularly challenging, but I believe robotic-assisted surgery (RAS) offers strong opportunities to address it.
Aggregated study data across a wide variety of procedure types show that broader access to RAS equals fewer conversions to open procedures, fewer complications and shorter length of hospital stays which can contribute to better clinical and economic outcomes. Despite this evidence, barriers to minimally invasive surgery (MIS) continue to exist, including lack of provider MIS access or adoption, inconsistent availability of advanced technology as well as health literacy challenges (i.e., the inability to find, understand and use information to inform health-related decisions and actions). It doesn’t need to be this way. There are significant opportunities to help hospitals reach their health equity goals by reducing these barriers.
Bringing RAS to More Patients
As hospitals focus on quality improvement through increased volumes of minimally invasive surgery, executives and clinicians can make high-quality minimally invasive surgery more reproducible, accessible and equitable across patient populations with RAS. One strategy is to bring RAS to geographic areas with low MIS penetration. Where several rural hospitals implement RAS, they are seeing lower surgical site infection rates, shorter hospital stays and fewer ICU admissions, while eliminating the economic burdens of traveling to a larger city for care.
MIS technology partners can facilitate RAS adoption through structured and measured training pathways for physicians and care teams that help increase the number of RAS-trained surgeons and staff. In parallel, community outreach and education can help build awareness about RAS and the benefits of local access to the modality.
We also must address another barrier: the lack of quality MIS available in the emergency room. When patients present through the emergency room, there are fewer options for MIS. During these emergent, often-complex cases, patients are more likely to have open surgery or be converted to open surgery (primarily due to the limitations of laparoscopic surgery) compared to a patient who has elective surgery during regular working hours. This puts ER patients automatically at a disadvantage merely based on when they present, unable to reap the benefits and best level of care that MIS, specifically RAS, can offer. Hospitals should be able to offer all methods to deliver consistent patient outcomes regardless of when and where care is delivered.
Looking Toward the Future
Surgeons and hospitals are making noteworthy progress to advance health equity in their communities and part of that is leveraging RAS to increase access to minimally invasive surgery. RAS can help extend the reach of high-quality MIS and equalize outcomes, so that no matter where patients are located or what time they require care, they receive the same level of care electively, urgently or emergently. In this manner, MIS can become a true mechanism for change, reaching a broad circle of families and turning the idea of health equity into a tangible reality.
Myriam J. Curet, MD, FACS, is executive vice president/CMO, Intuitive.
A Premier Corporate Partner of ACHE, Intuitive was founded to create innovative, robotic-assisted systems that help empower physicians and hospitals to make surgery less invasive. For more information, go to ache.org/Intuitive.