Davinci- what a scam

Discussion in 'Intuitive Surgical Patient Discussions' started by Anonymous, Jun 22, 2012 at 7:09 PM.

Tags: Add Tags
  1. Anonymous

    Anonymous Guest

    one of these guys is definitely RW from OR. what a douche!
     

  2. Anonymous

    Anonymous Guest

    Wow, this is quite a negative thread. Basically, tele-robotic surgery is in its infancy. It creates some competition for companies that supply instruments and equipment for alternative approaches, and there is currently just one company that provides a robotic system for soft tissue surgical procedures, so as a result there are bound to be people who are a bit bent out of shape about the competition or the lack of leverage during purchasing negotiations.

    An alternative way to view this is as a potential way of improving the options and conditions for patients and surgeons and being constructive about trying to figure out where it can be used most effectively, as well as where it may not be appropriate. Operative times are just one of many factors that you can read about in many clinical studies. One cannot come to any conclusions based on a single study with just tens or even hundreds of patients. Look for studies that cover multiple institutions where the metrics measured consider the broad spectrum of costs and benefits.

    Another way to view this technology, if you are a proud American, is that several American companies have designed and manufacture pioneering products in this field right here in the US and are part of trying to figure out if/how robotics can improve surgery for patients and surgeons. Some of these include Intuitive Surgical, Mako Surgical, Hansen, Accuray, Restoration Robotics. Not all of their products will pan out and some good ideas will run out of steam because they are trying to make it in a challenging environment. If you have constructive inputs for these and future companies, then this might be a good forum to contribute those thoughts.
     
  3. Anonymous

    Anonymous Guest

    Have you read the majority of the posts in this forum? Most of them are negative, not just this one.

    Also, it may help you to know is that there is no clinical benefit with the robot and a benign hysterectomy.
     
  4. Anonymous

    Anonymous Guest

    This post is on spot, to an extent. Yes, this is amazing, revolutionary technology. Yes, there are many "traditional" surgical devices being displaced by robotic surgery, and this is bound to stir up the haters. Where the legitimate criticism comes in is the discussion of clinical benefit, cost/value analysis and overall necessity for this technology in fairly routine procedures.

    In my area, I would estimate that 60 to 70% of the surgeries performed with daVinci have a clinically proven, cost effective, minimally invasive alternative. If you take prostates out of that analysis, the "need" for a robot is very low. That said, it's here to stay and market forces will ultimately take hold, especially once a competitor enters the race.

    The next few years will be interesting. All of my hospitals are starting to pay attention to the literature on clinical outcomes and trying to figure out how to operate a robotic program in the black. The single-site platform will extend the craze for a while, but I think the days of robotic oophrectomy or lap chole are numbered.
     
  5. Anonymous

    Anonymous Guest

    UNLESS you consider it a clinical benefit that 35% of the surgeons once doing open benign hyst are now offering a minimally invasive approach with the robot that is reproducible for them. Since the introduction of of robotics to benign hyst, vag hyst has remained steady, lap hyst has increased slightly and open hyst has been cut in half. It baffles me that this is never considered or discussed. To me, eliminating open surgery is a clinical benefit.
     
  6. Anonymous

    Anonymous Guest

    What is wrong with Stephanie Hayes. Interviewed with this person and saw a blank uninterested stare back. Appeared to not understand the job, and only touted how great she and her team are? Interviewed with another manager and this person is bringing me back for another round. AM very concerned if I have to work for SH, especially the thread from her old company.
    Any advise? Maybe just a bad day?
     
  7. Anonymous

    Anonymous Guest

    No question that laparoscopic hyst, whether performed with sticks or robotically assisted, is much better than a TAH. This begs the question of why surgeons in the 35% weren't already doing traditional LAVH on benign cases? I don't think that benign lap hyst would rank very high in terms of complexity, and the tools for safe and effective LAVH have been perfected for years, so the argument that robotic hyst is more "reproducible" doesn't really hold water.
     
  8. Anonymous

    Anonymous Guest

    "The single-site platform will extend the craze for a while, but I think the days of robotic oophrectomy or lap chole are numbered."

    I am sure there will be alot of people from Intuitive bashing me and throwing in their 2 cents when I say this, but as a mid-level hospital administrator who sits in on these meetings at least twice a month, I can assure you most of our general surgeons think the single-site route is overkill, especially when you factor in OR time. Forget the whole argument about how it takes a surgeon a bunch of cases to get acclimated to using the robot. How are surgeons are saying they don't see any clinical benefit to going single site for a lap chole. Plain & simple. I have to see ANY do it even NEAR what a general surgeon takes to do one (20-25 min tops).

    In regards to the statement about trying to operate robotic cases in the black, this is true as well. Unfortunately for most of my OR staff, it is coming down from the C level suite and our dr's are only "giving it a shot" to appease the suits. The bottom line is that there are se indications where it works GREAT, but the Intuitive reps and all their "specialists" don't bring me much value and from the conversations I have had, we don't see how the robot is going to change how general/laparoscopic surgery gets done.
     
  9. Anonymous

    Anonymous Guest

    Don't forget the lawyers who are chomping at the bit for any complications from a procedure(lap chole) that has been pretty much perfected as a straight lap procedure over the last twenty years.
     
  10. Anonymous

    Anonymous Guest

    Sorry to hear that your rep and his specialists do not bring value to your facility. Currently, the facility I am at has 3 robots, operating cost is + or - 100 dollars vs. most lap cases - when you consider up front AND back end costs. Our performa was set to recover initial expenditures at 1 year - came in right under plan. Our general surgeons compete to be the most efficient single site (not fast... efficient). Most efficient to date is 12 minutes console time and 29 minutes skin-to-skin. Surgeons and administrators need to be committed in order to make the line work (Yes... treat it as a service line). Our O.R. teams compete for turnover records (currently 15-20 minutes). I would encourage you to demand these results by partnering with your rep. At the very least, make them earn their money. If you do not receive value, direct and set expectations toward goals that align with your L.E.M.'s. It is a two way street. Our facility may be the exception rather than the rule. Good luck.
     
  11. Anonymous

    Anonymous Guest

    Whatever dude. Set up and turnover on the robot is a joke. What's up with the recall? The robot stalls, then suddenly gets unstuck and drives its hand thru the patients vena cava? Sign me up for that.
     
  12. Anonymous

    Anonymous Guest

    That is impressive. How do you keep the costs within $100 of traditional lap? My facility pays over $1000 for the arm and camera drapes alone. We use at least two arms for each case, which works out to $300 to $500 per case, plus a lot of our surgeons are using the vessel sealer. Add to that the (seemingly) inflated price of the cannula covers, and other accessories, and we see around $3000 in extra cost. This does not take the capital outlay or on-going service fees into account. I'd love to know how you are achieving such improved economic effeciancy.
     
  13. Anonymous

    Anonymous Guest

    Please expand on what you mean by "up front and back end costs...."
     
  14. Anonymous

    Anonymous Guest

    Without getting off on a tangent, we are a smaller hospital (360 beds) w/ 1 robot. Currently it is being utilized by 65% GYN's, 25% Uro & the remaining are general surgeons trying to find a use for this thing. Our TRUE operating costs (arms, covers, trocars & vessel sealers) are operating at a net loss of approximately $500-800 per case. Forget about the "back end costs."

    As for your statement about making our Turnover Team operate more efficiently, good luck w/ that. We have anywhere from 4-5 of them cleaning rooms at any given time & they are relatively good at their job. The only problems that ever arise are when 2 cases end within 10 minutes of each other & it's a scramble to get the room turned over. For employees that make $35-40k/yr, outside of paying them $90-100k/yr (which will never happen), I do not believe there is anything that will speed up their turnover time between cases.

    The bottom line is, Intuitive has obviously done a good(maybe even great) job marketing this 1,000 lb paperweight to our C Level suite & surgeons. Our hospitals gameplan is to continue to serve our dr's and patients at an affordable cost. We have been informed of some studies that are currently ongoing both inside and outside of our hospital that are looking at ALL the costs associated w/ operating the robot and will form a more conclusive answer once more long term data is available.......until then, we are telling our surgeons to do what is best for their patients.
     
  15. Anonymous

    Anonymous Guest

    Thanks for the response. The question of why the "other" 35% weren't doing LAVH is a good one. It is my thought that they were not comfortable. Otherwise it's logical to assume that they would have been doing it. We all agree that LAVH would have been much better for the patient than TLH. As for the comparison of lap to robotic, I think there IS a difference. I would argue that the only similarity between lap and robotic is the size of the incisions. Robotic dissection is more like an open technique. When the surgeon looks in the console, the robot works out the "backwards" movements for them (i.e. right is right and left is left.) Many say that suturing is easier. I agree that LAVH has been advanced and refined over the years but the fact remains that the adoption was still low among GYN's. The TAH rate has drastically dropped since the introduction of the robot to benign GYN. That's a fact. The market share for robotics in benign GYN is, coincidentally, very close that % decline in open hyst. More MIS to more patients. I think that's a benefit.
     
  16. Anonymous

    Anonymous Guest

    And before that, it was perfected as an open procedure. When lap rolled around, the lawyers were chomping at the bit as well. Lawyers chase money. Not saying robotics is ideal for chole, but there is a sweet spot for it in general surgery. As we learned when open went to lap, advancement is good for the patient. But for a person that makes their living selling, it may suck if you're on the wrong side.
     
  17. Anonymous

    Anonymous Guest

    Just what patients want/need: a bunch of surgeons who already have huge ego's now racing to see who can have the fastest "skin to skin" time. Reminds me of the cock heads at Penn in the ortho dept. They boast about "skin to skin" time. PA"s open and Surgeon rolls in, throws implant in and heads to the next room letting the PA close.

    How about focusing on patient care and getting great outcomes. Not racing and acting like a fucking neanderthal.
     
  18. Anonymous

    Anonymous Guest

    What about the extended anesthesia time? 5 years in with the company and I still don't see the value in benign gyn procedures.

    You can't sell me on it and I work for the company. When we give our bullshit cost numbers we give the layout of a surgeon who has done 300 robotic cases. You are trying to tell me that a surgeon that does 30 cases a year uses the same instruments as the experienced surgeon? Not a chance...

    It costs much more, takes nearly twice the time and the overall clinical value is not proven.

    and yes the culture here is horrible. It is embarrassing to deliver the messages we are told to deliver to our customers. We manufactured hundred's of phantom cases to boost our stock. If you have been here for five plus years you know it is true.
     
  19. Anonymous

    Anonymous Guest

    I HAVE been here over five years. I really question whether you have based on some of the things you say. If in fact you have been here 5+ years and feel the way you do, YOU'RE AN IDIOT. We have been selling GYN for 5+ years. If you have such strong disagreement with what you sell then don't you have a moral obligation to yourself to seek out other employment? You must hate yourself for being nothing more than a lemming and selling what you so passionately disagree with for all these years.

    As for your comparison of a surgeon doing 300 cases vs. 30 cases - of course there will be a time/skill difference, as there would be when doing lap, vaginal or open. There will always be differences in the skill sets of surgeons.

    So here is my hypothetical scenario for you. Let's crown you King or Queen of the world. Your first action is to do away with robotics for benign GYN. After you have done that, what's the case mix look like between open, lap and vaginal? Are more or less women getting a minimally invasive hysterectomy? Is that better for patient? I know the answer and so do you, no matter who you work for. The only question left is will you be honest with the answer you post on here or will you just continue to whine about your job that you are "forced" to do.
     
  20. Anonymous

    Anonymous Guest


    I hate both of you. Please get syphilis and go away.