Surgical system uses ‘bits and bytes’ to reduce trauma

Medical Center Board OKs 2004 budget, seeks BOV approval

Photo courtesy of Intuitive Surgical

Board members watched a video of a surgery being performed (such as the one above) using the da Vinci surgical system, which the University has just purchased. Using the system, a doctor operates a console (left) that directs robotic arms (center, inserted inside the patient) to perform the necessary tasks. This type of surgery gives a surgeon greater range of motion and depth perception, and causes less trauma to tissues and organs, minimal pain and blood loss and greater precision. At U.Va., the da Vinci System will initially be used for prostate and heart patients and for gynecology.

By Fariss Samarrai

Members of the Medical Center Operating Board got a neat glimpse of some cutting-edge medicine at their May 8 meeting.

Dr. William Steers, chairman of Urology, showed a three-dimensional movie of prostate surgery as a way to show off a new $1.3 million surgical robot that will be arriving soon at U.Va.

“Surgery is becoming less about blood and guts and more about bits and bytes,” Steers said as board members donned their 3-D glasses. They watched as a prostate gland was removed by a physician who was operating from a console on a patient several feet away.

The robot, called the da Vinci Surgical System, allows a surgeon to operate on a patient remotely by using laparoscopic surgery and operating hand and foot controls at a console. The robot’s “arms,” which have been inserted into the patient’s abdomen, include a camera that sends to the surgeon a magnified 3-D view of the operating area inside the body. The surgeon manipulates instruments at the console that are mimicked by the arms in the patient. The doctor is able to cut tissue with great precision, and to cauterize the bleeding areas and sew the incisions.

Steers said this type of surgery will become commonplace in coming years. It offers a surgeon greater range of motion and depth perception, and eliminates the “tremor” of ordinary hands working in detail in tight places. The surgery causes less trauma to tissues and organs, minimal pain and blood loss and greater precision.

The Paul Mellon Prostate Cancer Research Institute paid for the da Vinci Surgical System. The Wards Buchanan Fund is providing $1.2 million for related expenses, such as training, additional equipment and operating room renovations.

The system will initially be used for prostate and heart patients, for gynecology, and could eventually be used for other surgeries. Steers said surgeons will be able to operate on patients miles away using the advanced systems of the future.

The board also was given a report on the Medical Center operating budget by Larry Fitzgerald, chief financial officer. Fitzgerald said the Medical Center is projected to produce an operating income of $31.6 million for fiscal year 2003, which ends June 30.

Operating expenses for the year are projected to be $601.1 million, $11.8 million more than the $589.3 million budgeted. But a projected net operating revenue of $632.7 million exceeds the $610.3 million budgeted, resulting in the projected $31.6 million operating income net. This is a 5 percent operating income margin.

These numbers are based on operating income against operating expenses. An additional $9.9 million is projected for interest income, resulting in a projected net income for the year of $41.5 million.

The operating income, however — $31.6 million — is considered the better measure of Medical Center operational efficiency because it measures only the profitability of services rendered and not investment income.

Fitzgerald originally budgeted for a 3.4 percent margin. The projected 5 percent margin is good news for the Medical Center at a time of rising operational expenses here and nationwide.

Fitzgerald also reported that the Medical Center is budgeting for a 4.3 percent operating income margin for fiscal year 2003-04 and a net income (margin plus interest) of 5.4 percent. While this provides needed wiggle room for running the Medical Center budget, it falls short of the longer-term 5 percent annual operating margin goal set by the Board of Visitors.

Fitzgerald emphasized that the Medical Center is in the business of treating patients, not making profits. The Medical Center, however, in order to function with a safe margin must diligently pursue strategies that accomplish both needs.

All income from the center is used for buying new equipment, maintaining equipment, renovations of facilities, and for paying various debts. The center generally operates with only 90 days of cash reserves.

The Medical Center will need to increase inpatient admissions and hold down expenses to meet its goals, Fitzgerald said. The center is adding nine beds to the hospital this year and increasing its operating room capacity 10.5 percent, with two new operating rooms opening July 15. To accommodate additional inpatients, the center also will need to hire additional surgeons. Fitzgerald expects 27,809 inpatient admissions for fiscal year 2004. This is 883 more than this fiscal year. He said the trend is upward for hospital admissions and that there is a current backlog of surgeries to perform.

The Medical Center also is modernizing, using new technologies to reduce costs. The da Vinci system is one example. Fitzgerald said the center also is introducing new drug eluting stents, devices that improve patient care. Fitzgerald said industry experts project that drug eluting stents could decrease the clinical need of heart surgery by as much as 30 percent.

The Medical Center is increasing its outpatient medical imaging capacity, opening a new Imaging Center in the new Medical Office Building 2 at Fontaine Research Park.

The Medical Center Operating Board accepted the 2004 budget and will recommend approval by the Board of Visitors.