Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
With Dr. Dr. Marc Michalsky · hosted by Dr. Dr. Marques (Marky)
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What the experts said
The da Vinci SI-to-XI transition was transformational due to enhanced range of motion and flexibility.
Computer Motion developed 5 mm robotic instruments, which Intuitive sunsetted after acquisition.
Nationwide's robotic volume grew from ~70 cases in 2014 to 130–140 cases/year by 2020, with general surgery matching or exceeding urology.
A children's hospital received a donated robot that sat unused for 18 months (~$25k/month maintenance) due to lack of planning.
Maintenance of certification requires 10 cases over a 2-year cycle plus quarterly digital simulation.
Nationwide created a block-time overlay system with 14-day release to eliminate robot-availability conflicts.
Using long (bariatric) instruments reduces external arm collision in smaller patients.
Approximately 12% of Nationwide's robotic cases are in patients <15 kg, driven primarily by urology.
No difference in operative time, complications, or readmissions for sleeve gastrectomy in patients with BMI >50 vs. <50.
Starting with a familiar operation (e.g., sleeve gastrectomy) and double-scrubbing accelerates safe adoption.
Robotic sleeve gastrectomy learning curve dropped from 132 minutes (SI) to 36 minutes (XI); shortest case 21 minutes.
Acute cholecystitis cases showed no difference in time or complications compared to elective cholecystectomy.
Robotic experience improves laparoscopic skills, particularly intracorporeal knot-tying.
Emerging platforms (Medtronic Hugo, Stryker/CMR Versius) promise modular designs and 5 mm instruments.
Hopkins demonstrated a fully autonomous robotic cholecystectomy in a pig cadaver model with no human input.
Intuitive employs 4 pediatric surgeons (including James Wall) and is working with FDA to shift from case-specific to category-based clearance.
Robotic cases carry a facility charge of level 5 (~$4000/15 min) vs. level 3 (~$2200/15 min) for standard laparoscopy.
No insurance denials or patient surcharges attributed to robotic surgery at Nationwide over the entire program history.
Fellows must bedside-assist 10 cases and perform 20 console cases as primary surgeon for credentialing letter.
Digital overlay systems integrating axial imaging (e.g., J&J–Google partnership) are in development to superimpose CT anatomy onto robotic view.