Virtua Health is an academic health system that serves the people of South New Jersey. Since 2020, Virtua has grown its da Vinci surgery program from four da Vinci Xi surgical systems in three hospitals to nineteen da Vinci 5 surgical systems, four da Vinci Xi systems, and two da Vinci SP systems across all five of its hospitals, one ambulatory surgical center, and one hospital outpatient department.
Virtua Health was no stranger to da Vinci surgery when they became early adopters of the da Vinci 5 surgical system. With more than 27,000 da Vinci surgeries already performed, they were confident in the patient outcomes. But Virtua didn’t want to simply blend the new da Vinci 5 systems into their existing infrastructure. Instead, they wanted to assess how the new technology might help expand the robotic surgery program to reach more patients in the community.
That required a process, an organizational framework, and data. At the heart of that process was Virtua’s Robotic Surgery Strategic Task Force, made up of clinical, operational, and executive leaders, as well as representatives from Intuitive. The task force meets regularly to align on goals and draw on data to get a clear-eyed view of the program’s current status and determine future pathways for growth.
Before da Vinci 5 systems became available, the task force knew that demand for da Vinci surgery had outpaced supply. “With limited access, we had high utilization of our systems, and no capacity to grow our program,” said Jackie Wills, Virtua’s network robotics director.
During da Vinci 5’s limited introduction, Virtua was among the first hospital systems to acquire three da Vinci 5 systems. From the first installation, Virtua began collecting data to assess da Vinci 5’s value and determine if it could help meet their growth targets. Some of what they learned surprised them.
Virtua chose a thoracic, a bariatric, and a general surgeon to be the first to use the da Vinci 5 systems. Each was a high-volume surgeon who had performed hundreds of cases on the da Vinci Xi system. For the initial phase, the thoracic surgeon committed to using the new Force Feedback instruments and assessing the technology. The bariatric surgeon switched all sleeve gastrectomy surgeries from da Vinci Xi to da Vinci 5 to assess procedure times.
Dr. Craig Zaretsky, the general surgeon, used the da Vinci Xi at one hospital and the da Vinci 5 at another. Zaretsky, who also serves as vice president of operations for surgery, helped spearhead the process. “We started collecting data focused on outcomes, efficiency, and immersion,” he said. “We understood that there were gaps in our awareness, yet we were eager to explore the opportunity.”
Virtua saw a correlation to reduced hospital stays for lung wedge resections when Force Feedback instruments were used. Another discovery the team hoped for and saw was an 11-minute decrease in console time for sleeve gastrectomies using da Vinci 5.
The surprise came with Dr. Zaretsky’s data showing that switching between the da Vinci 5 and Xi drove up dV5 console time by 18 minutes compared to da Vinci Xi times. When Zaretsky began performing surgeries exclusively on the da Vinci 5, console time dropped by an average of eight minutes compared to da Vinci Xi times across all general surgery procedures, demonstrating the value of full immersion. Procedure times have fallen further since those early days. And those minutes add up, potentially allowing Virtua to add more surgeries to the schedule.
The unexpected discovery on immersion prompted the team to consider what would happen if they switched to da Vinci 5 for all inpatient surgeries.
To better understand the da Vinci surgery program’s operational, financial, and market impact and opportunity, the task force wanted a broader perspective. In addition to looking at Virtua’s internal data, the task force tapped into the resources available through Intuitive’s Market Access & Custom Analytics (MACA) consulting services. “Through a data sharing engagement, we were able to provide a current state of their program, what was working well, and the value da Vinci surgery was providing their patients,” said Jim Assenmacher, MACA’s director for the Eastern U.S. region. “Early on, we saw great value. We saw great outcomes. Financially, it was a very healthy, profitable program. But it was small, and there was opportunity for growth.”
According to Jackie Wills, the data showed “our robotics programs were not only delivering superior outcomes and operational efficiencies, but da Vinci surgeries were, in fact, the highest contribution margin service line in the healthcare system. Understanding this really paved the way forward for us to increase the access and streamline our minimally invasive surgical strategy under a unified approach.”
Unifying the strategy to use the da Vinci 5 for all minimally invasive surgeries offered additional advantages. “We can reduce the investments in laparoscopic equipment,” said Wills. “Not only the equipment expenditure, but the service contracts that are associated with them.” That’s projected to save Virtua $400,000 a year and could potentially cut up to $3 million in spending on lap equipment over the next three to five years.
And because da Vinci 5 connects all components needed to perform surgery into a single system— including an external monitor, insufflator, and handheld camera—the shift to da Vinci 5 reduced the amount of equipment needed in the OR.
The smaller OR footprint and reduced need for lap towers created a ripple effect that impacted other areas of the organization. “From an infrastructure perspective, having the da Vinci 5 allows us to use some of our older buildings that have very small rooms for da Vinci surgeries, which we would not have been able to do in the past,” said Meg Coley, Virtua’s vice president for surgical service operations.
Wills added, “We were able to partner with one of our campus leadership teams to forgo the need for additional construction to reinforce a beam in the ceiling that was meant to house a hydraulic tower boom that held laparoscopic equipment. So, by eliminating the need for that additional construction and opening that room up six months sooner, we were able to avoid $1.6 million in costs.”
Mark Nessel, senior VP and president of Virtua Voorhees and Marlton hospitals, adds another perspective. “What we were seeing over time was that we were able to increase the number of surgeries and we were able to bring down the amount of time people spend in the hospital, which is really important. Facilities are so expensive. So, we want to do as much as we can with what we have. If we can decrease our procedure time, and we can decrease length of stay, it really makes our buildings bigger.”
Beyond the fleet swap to da Vinci 5, the task force has pursued other strategies to get the most out of Virtua’s infrastructure and investments. Initiatives include:
The thread that connects all da Vinci 5 strategies is patient care. John Matsinger, executive vice president and chief operating officer for Virtua, put it this way: “You have to start from the patient's perspective. What does the patient need? What does the surgeon need? The thing that inspired the most enthusiasm was when surgeons came to me and said, ‘This makes me a better surgeon.’ That's when we knew it was time.”
But sustaining a healthcare network requires practical thinking as well. “Data plays a role in everything,” Matsinger continued. “We're seeing key process indicators—whether they be clinical quality indicators or financial indicators—all going in the right direction. And that's critical, because, at the end of the day, we're stewards for the healthcare of the community, but also of the finances.”
Important safety information
For risks, contraindications, cautions, and warnings and full prescribing information, refer to the associated da Vinci 5 Surgical System user manual(s), or visit https://manuals.intuitivesurgical.com/market.
Da Vinci 5 system
Indications for Use / Intended Use
The Intuitive Surgical Endoscopic Instrument Control System (da Vinci 5 Surgical System) shall assist in the accurate control of Intuitive Surgical Endoscopic Instruments including rigid endoscopes, blunt and sharp endoscopic dissectors, scissors, scalpels, forceps/pick-ups, needle holders, endoscopic retractors, electrocautery and accessories for endoscopic manipulation of tissue, including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, and delivery and placement of microwave and cryogenic ablation probes and accessories, during urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures and general thoracoscopic surgical procedures. The system is indicated for adult use.
It is intended to be used by trained physicians in an operating room environment in accordance with the representative, specific procedures set forth in the Professional Instructions for Use.
Contraindication
Use of the force feedback needle driver is contraindicated in hysterectomy and myomectomy due to the risk of vaginal bleeding requiring hospital readmission and/or the need for additional procedures. The use of non-force feedback needle drivers is recommended for suturing in these procedures.
Precaution for Representative Uses
The demonstration of safety and effectiveness for the representative-specific procedures was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease or condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.
For risks, cautions, and warnings and full prescribing information, refer to the associated user manual(s).