Surgical robots the future of North Big Horn Hospital

Erin Mullins

The purchase of surgical robotics was approved at a special board meeting of the North Big Horn Hospital District Board of Trustees.
On November 30, those in attendance voted unanimously to approve the purchase of the robotics.
North Big Horn Hospital surgeon Dr. Michael Hill said the robotics will lead to improved patient outcomes.
“All the data suggests that patients have improved outcomes when surgeries are done robotically. They have a shorter length of stay in the hospital. They take fewer prescription strength pain medications,” Hill said. “They are able to return to work at a faster time, and they are able to return to their activities of daily living faster. Then there’s some integrated technologies that are built into the robot that allow for some safer surgery.”
Indocyacaine green (ICG) is one technology that makes surgery safer, Hill said. ICG is a medical dye doctors use to find and help treat problems in the body. The camera in the surgical robot has a special lens in it that picks up ICG and will show different things about the patient’s anatomy.
For removal of the gallbladder, ICG will be taken an hour before surgery and be metabolized through the liver, Hill said. The ICG will highlight the anatomy of the biliary tract system and allow the surgeon to see the biliary tract system with precision.
There is a misconception about surgical robots that they are controlled from afar at the push of a button, like while a surgeon would be in the cafeteria getting coffee, he said. Instead, he is controlling the robot the whole time and watching carefully. Safety will only improve with robotics, he said.
Hill said the most common surgery he expects the robot to be used for is hernias, more specifically growing hernias, abdominal hernias and hiatal hernias. After that, he expects gallbladder removal to follow in popularity.
The robots are expected to be used roughly twice a week for surgery, Hill said.
“We’re hoping that we have roughly six cases a month on the robot,” he said. “It would be great if it were eight, but looking at my historic averages on the robot, we’re anticipating between six and eight cases a month.”
The hospital is financing the purchase of the robotics over a period of five years, Hill said. The hospital expects the volume of surgery and types of surgery will “more than pay for” the amount of money that the hospital is paying to finance the robots.
The robot that the hospital is purchasing is a Da Vinci Xi, which is made by the company Intuitive, said Eric Connell, North Big Horn Hospital District CEO. The robot will cost $1,925,000 in total. Additionally, the board approved the purchase of a $117,000 steam sterilizer, which is needed to clean the instruments.
Hill said he has been aware of robotic surgery for over a decade. He met his first surgical robot back in 2004 when he was interviewing for medical school at the University of Washington.
“I just fell in love with it. I mean, I just thought it was so beautiful. It was so elegant. It was so pristine,” he said. “Just the precision and everything that it could do. I was enamored by it. And so I, you know, through medical school, through residency, I had some exposure but not a tremendous amount of exposure.”
After joining Billings Clinic in 2014, he was the first official surgeon to get robotic training at the Billings Clinic in 2017. He did about 130 robotic cases when he was there. When he started to perform robotic surgeries, it was “thrilling,” he said. He is excited to once again have the opportunity to use robotics in surgery.
The idea to pursue robotics first came up when Hill moved to Lovell and asked if robotics had a potential future. Connell advised that the hospital was in a unique position for robotics due to how small the hospital is, how many surgeries they do and their large service area.
Hill contacted a former colleague who now works at a hospital in Colorado with a comparable size to Lovell to get an idea of what the feasibility would look like. Later, Connell researched relevant data and potential insurance options. After, the board got to demo the robots.
Subsequently, the proposal was presented more formally to the board, Hill said. Finally, after more precise research by Connell, the plan to purchase a robot was officially OK’d by the board.
From the time the robot is bought, it will not be a loss for the hospital but rather make money, he said. After it is paid off, the robot will make the hospital even more money, Hill said. The hospital should expand the surgical services that the hospital can offer, like urology and gynecology.