Introduction
Over the past few decades, we have been working with a constant discrepancy of opinions and their likely threat to humans, especially in the work environment. However, evidence indicates that in countries where robots participate in the productive sector, there is a decrease in unemployment and that advances in artificial intelligence help to improve multiple tasks in specialized sectors1.
Some of the most prominent examples, such as the use of artificial intelligence in landmine clearance occupations and the application of robots in health, education, and care for the elderly2, illustrate the multiple benefits of using technological advances in each of the areas mentioned above.
When we talk about artificial intelligence in medicine, the first thing that usually comes to mind is robotic surgery, such as that which has been performed worldwide for several years3–6, particularly with the Da Vinci robot from Intuitive Surgical Inc.®7–9, whose development at ABC Medical Center since 2017 has been highly relevant, mainly due to the inclusion of mechanisms such as amplified 3D vision, reduced size of instruments, and synchronous handling of up to four devices, all directed by the surgeon from a console.
The robotic surgery program at ABC Medical Center was promoted by the management of the medical staff, together with a group of doctors who are experts in robot-assisted surgery10. The creation of the Robotic Surgery Committee11 was fundamental to monitor and maintain the quality of each of the program’s procedures and thus guarantee the best results and continue with the high standards that distinguish ABC Medical Center.
The Surgery Service Line with the Robotic Surgery program and the grouping of professional services guarantees high quality, efficiency, safety, and ease of patient care, without forgetting the importance of integrated and personalized care.
The unexpected emergence of situations such as the SARS-CoV-2 pandemic has confirmed that streamlining the incorporation and transfer of new technologies helps strengthen their applications and concretely their benefits12,13.
The ABC Medical Center accelerated the previously planned adaptations, so priority was given to the wise decision to migrate the entire robotic surgery program from the Observatory Campus to the Santa Fe Campus, where the appropriate measures were taken for the relocation of the Intuitive Surgical Inc.® Da Vinci surgical system, together with the changing epidemiological adaptations during the pandemic14–17.
Objective
The objective of this study was to analyze the behavior and acceptance of the Intuitive Surgical Inc.® Da Vinci surgical system with the change to Campus Santa Fe during the SARS-CoV-2 pandemic, as well as the participation of the specialties involved in the robotic surgery program at ABC Medical Center.
Materials and methods
The robotic surgery committee reviewed and approved all procedures before being performed. In addition, all robotic-assisted procedures and the specialties and number of surgeons certified within the robotic surgery program were examined.
Within the worldwide literature, various protocols for safe surgery during the pandemic are described18–20. The robust structure of a strict but adaptable protocol to changing needs during the pandemic helped ABC Medical Center ensure safe surgical procedures for the patient and all health-care personnel involved.
At the beginning of the pandemic, making use of current regulations and available certifications21–23, with the help of ABC Medical Center epidemiological surveillance unit, considered the performance of reverse transcription polymerase chain reaction and computerized axial tomo-graphy fundamental to a protocol that ensured patient and healthcare personnel safety; as the pandemic and its natural history evolved, protocols and safety measures were also adopted.
Results
From the start of the robotic surgery program in January 2017 to June 2022, 1064 procedures were performed, of which 501 surgeries were performed in the first 3 years 10. Since the change of location of the Da Vinci surgical system to the Santa Fe campus, from May 5, 2020 to the end of the first half of 2022, 563 robotic-assisted surgeries have been performed (Graph 1); the campus transfer of the Robotic Surgery program was decided with the course of the SARS-CoV-2 pandemic, where physician acceptance, campus staff participation, and patient willingness increased the volume of surgeries with this type of approach.
Graph 1. Total procedures carried out from 2017 to June 2022.
One of the reasons for the increase in procedures from 2020 onward was the enthusiastic participation of physicians certified in robotic surgery, of whom 40% currently belong to the urology specialty, 24% to general surgery, 18% to gynecology, 9% to oncological surgery, 4% to pediatric surgery, 2% to thoracic surgery, and 2% to the ENT specialty.
Grouping surgical procedures by specialty, from the start of the program to the end of the first half of 2022, the urology specialty had the highest number of cases with 676 procedures, followed by general surgery with 229, gynecology with 120, and thoracic surgery with 26 and oncological surgery with 13 procedures.
Taking for analysis the three specialties with the highest number of interventions since the creation of the program: in the specialty of urology, during the stay of the Da Vinci console at the Santa Fe campus, there was a reduction of 22 cases at the end of the first semester of 2022, the specialty of general surgery had an increase of 129 events attended and with respect to gynecology, we note a decrease of 30 surgeries compared to the period when the robotic surgery program was at the Observatory Campus (Graph 2).
Graph 2. Number of procedures in the three specialties with the highest intervention from 2017 to 2019 and from 2020 to the end of the first half of 2022.
Worldwide, the use of robotic-assisted surgery for the specialty of urology has been a fundamental part. Its increase is notable at a global level and at ABC Medical Center24–26.
As for the behavior of the specialties involved in the robotic surgery program, during the first 3 years of the robotic surgery program, before the pandemic, the urology specialty performed 70% of the procedures, gynecology 15% of the total, and general surgery 10% of those mentioned, the rest of the specialties participated with 5% of the procedures. However, from 2020 to the end of the first half of 2022 (during the pandemic), 58% of the robot-assisted procedures corresponded to the urology specialty, and general surgery had a notable increase with 32% of them, gynecology 8% in this period and specialties such as oncological surgery and thoracic surgery closed with 2% of the total performed.
Regarding the increase in the number of cases in the general surgery specialty, the procedures that have been performed the most since the start of the program are inginolplasty (unilateral and bilateral), Nissen-type fundoplication, and cholecystectomy, following some of the worldwide demand guidelines27–30.
To keep elective surgery safe, ABC Medical Center implemented different admission and scheduling protocols for surgical procedures, including a sufficient supply of supplies, diagnostic tests for SARS-CoV-2, and adequately trained staff to continue the quality care that characterizes ABC Medical Center.
During the pandemic, there was only one incidence of SARS-CoV-2, keeping the number of SARS-CoV-2 events at an all-time low. Nevertheless, this event was very useful in restructuring and strengthening the changing protocols during the pandemic to safeguard the safety of patients and collaborators at ABC Medical Center.
Much of the increase in the volume of procedures resulted from negotiations with insurance companies, achieving more excellent coverage, reflected in the patient benefit that this treatment modality entails. The relationship between ABC Medical Center and the insurance companies has always been of great importance, without ceasing to be a challenge to increase coverage with the use of this technology and to offer a competitive alternative in the market, quality assurance by the doctors involved and the staff included in the program.
As we saw during the pandemic, more and more surgeons are benefiting from the technological advantages, giving a positive impact derived from the pandemic, and reflecting the collaborative and integrated work of all the staff working within ABC Medical Center.
Discussion
As has been seen in specific surgical centers in other parts of the world, the indications for minimally invasive surgery, with adequate safety measures for the patient and professionals, were not a reason for its interruption during the pandemic26, since the use of the Da Vinci Si console from Intuitive Surgical Inc.® console during surgery is allowing increasingly complex operations, impossible with other approaches, to be performed with fewer complications and greater precision. However, the options offered by this approach still have much more room for exploration, taking advantage of digital improvements, strengthening comprehensive, personalized, data- and evidence-based care, and ensuring more stable quality and improved efficiency31.
As in other parts of the world, professional training and adopting practical projects that improve quality are another critical issue to be addressed when forced changes such as the pandemic lead to retrofitting programs such as robotic surgery31–33.
Conclusion
The success of Robotic Surgery within ABC Medical Center lies in fulfilling four fundamental pillars: safety of the patient and the healthcare personnel involved, affordability, efficiency, and effectiveness to exceed the expected results.
ABC Medical Center has always been a benchmark for the safety of patient care. This has been one of the strengths maintained since its inception, ratified with each national and international recertification due to the excellence that permeates each of its collaborators.
The notable increase in the number of cases treated by the Robotic Surgery program is primarily due to the negotiations that have taken place with the insurance companies and the coverage of the same, something that has strengthened the relationship with the insurance companies, strengthening the trust placed in ABC Medical Center.
As additional ingredients to obtain the results of the program, we must take into account the efforts of the hospital staff, the prompt response by the robotic surgery committee for the evaluation of patients, the orientation directed to patients without third-party payer to achieve adequate care, the energetic enthusiasm of the doctors, the willingness of the staff, the change of campus, and the reduction of surgical time, are part of the efficient processes that have made us reach the goals of the program.
Funding
The authors declare that they have not received funding for this study.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical disclosures
Protection of humans and animals. The authors declare that no experiments on humans or animals have been performed for this research.
Confidentiality of data. The authors declare that no patient data appear in this article.
Right to privacy and informed consent. The authors declare that no patient data appear in this article.
Use of artificial intelligence to generate texts. The authors declare that they have not used any type of generative artificial intelligence in the writing of this manuscript or for the creation of figures, graphs, tables, or their corresponding captions or legends.
