Dr. Thomas Payne, National Medical Director for Robotics at HCA Healthcare, uses his experience as an international leader in robot-assisted surgery to drive innovation in the medical field. Since 2004, after the FDA approved the first-of-its-kind robotic platform, Dr. Payne has utilized technological advances to perform thousands of robot-assisted surgical procedures, improving patient outcomes and reducing recovery times. I did.
Although Dr. Payne has found great joy in providing direct care to patients, he wants to expand his impact on medicine by sharing his expertise with fellow surgeons to shape the future of robot-assisted surgery. I also realized my passion. Dr. Payne currently coaches physicians across HCA Healthcare and writes industry papers, textbook chapters, and magazine articles. He also shares his knowledge as an international keynote speaker, panelist, and faculty member.
Below, Dr. Payne shares his perspective on how the medical industry will continue to evolve with robot-assisted surgery and why continued development will help transform the care delivery experience for surgeons and their teams. Masu.
Q: Please tell us about your role at HCA Healthcare and how your career as a surgeon has evolved so far.
I have had the privilege of working at HCA Healthcare for the past 13 years. I currently serve as the National Medical Director for Robotics for HCA Healthcare and lead the Texas Robotic Surgery Research at St. David's Healthcare, headquartered in Austin, Texas and part of the Midwest Texas division of HCA Healthcare. I am the deputy director of the office.
I originally pursued this career to help patients heal through surgery. My personal journey as a surgeon in the field of gynecology has evolved from wide-open incision surgery to laparoscopic-assisted surgery in the 1990s and early 2000s to robot-assisted surgery since 2004.
I went from being a surgeon with a very busy, patient-centered gynecological practice to taking on the role of a mentor and educator to positively impact more patients. My current focus is on advancing robotic-assisted surgery through program building, surgeon and staff education, and future innovations. That's the exciting space I live in every day.
Q: Could you briefly explain the field of robotic surgery?
With any surgery, we want to deliver the most precise results possible so that our patients get better quickly. Good surgeons have lower complication rates, better outcomes, and faster recovery times. Robotic-assisted surgery offers surgeons benefits that support all of these objectives.
The easiest way to understand why we are investing in and promoting robot-assisted surgery is to explain the benefits for patients and surgeons.
Patient benefits:
As a patient, you want to have small incisions, or “minimally invasive surgery” (MIS), whenever possible. The optimal outcome of MIS is a low incidence of intraoperative and postoperative complications such as wound infection, blood loss, and blood transfusion, as well as shorter hospital stays, fewer readmissions, and faster recovery times. Robotic-assisted surgery often allows surgeons to have more reproducible MIS success rates and less chance of large incisions and associated complications.
Advantages for surgeons:
The physician's sole focus is to provide optimal results for every patient undergoing surgery. Surgeons recognize that MIS often has several advantages over open surgery, and employ the latest technologies and techniques to help avoid open surgery when appropriate on a case-by-case basis. I am thinking of doing so. Therefore, we promote and support robot-assisted surgery when it makes sense for patients. Robotic technology offers several surgical advantages to surgeons.
MIS Improves success rates Clear, high-resolution 3D views in the surgical field Advanced equipment that enables successful completion of complex surgeries Injectable dyes that outline important anatomical structures to avoid damage Improve techniques data and case feedback for
Finally, the introduction of robot-assisted surgery has the potential to extend a physician's career as the physical ergonomics of the surgeon are improved. The patient can sit comfortably and use their hands and wrists to see through the console as if they were inside the patient. Instead of standing next to the patient, you can perform minimally invasive surgery while sitting and operating in a more natural way.
Q: How has the field of robotics evolved? What are some medical fields in which robot-assisted surgery is used?
As health care providers, we hope to be involved in what we call a “paradigm shift” in care during our careers – major changes in how patients are cared for. For example, the 1900s brought new ways to treat patients: antibiotics, radiation therapy, and chemotherapy. In the early 2000s, another paradigm shift occurred in the surgical field, with the introduction of robot-assisted surgery.
In the early 2000s, the national open surgery rate reached 65%. Due to the early introduction of robotic technology, the domestic open rate was around 40% around 2014. Currently, HCA Healthcare has open rates as low as 8% for some facilities. Again, robot-assisted surgery is not suitable for all cases, but when it is, patients are likely to be discharged from the hospital sooner, have fewer complications, and have better outcomes. there is.
When we first started focusing on robotics, we focused on the soft tissue specialty. These are surgeries performed from the neck to the pelvis that do not involve bone structures. These specialties include urology, gynecology, general surgery, bariatrics, colorectal medicine, oncology, otolaryngology, pediatric surgery, and thoracic surgery.
Currently, we perform robot-assisted surgery in areas other than soft tissue specialties such as orthopedics, spine surgery, neurosurgery, and pulmonary surgery. Essentially, almost every surgical field has computer-assisted robots that can optimize the ability to perform surgeries with greater precision and smaller incisions.
Q: How does our robotics work tie into the larger HCA healthcare strategy in terms of supporting physicians and expanding best practices?
As one of the nation's leading health care providers, we take pride in extending best practices in all areas of health care throughout our system. We purposely and systematically support surgeons to develop into robotic leaders. No other health system has trained surgeons on the scale that we have. Over the past decade, we have developed robust program structures in the robotics field.
HCA Healthcare's current robotic footprint consists of 169 hospitals and 32 ambulatory surgery centers, and the company has invested in nearly 900 state-of-the-art robotic surgical platforms utilized in multiple surgical specialties. Ta. HCA Healthcare performs more robot-assisted surgeries than any other health system, with more than 1 million cases and growing. Our surgeons have also led several robotic “firsts” in the world over the past decade. Additionally, we have developed one of the largest databases on robotic surgery. Our continued research in technology, caseloads and data allows us to deliver the most technologically advanced robotic-assisted surgical outcomes in medicine.
As a learning healthcare system, we constantly strive for scalable high performance from all of HCA Healthcare's robotic programs. This creates a culture of continuous improvement where local knowledge is translated into company-wide value.
Q: How are you training the next generation of doctors to lead robotic surgery?
HCA Healthcare is a national leader in graduate medical education (GME), working with new physicians to develop the next generation of robotic surgeons. By 2025, we expect up to 850 general surgeons, urologists, and gynecologic surgeons to be trained in robot-assisted surgery.
The HCA Healthcare Robotics team works closely with the HFEGME program to support junior-level residents who want to improve their robotics knowledge and skills. So upon graduation, residents can receive robot training, certification, and begin their medical careers. Many of these residents will continue to seek employment at hospitals that offer robotic surgery.
After all, robot-assisted surgery is a tool. The steps you learn in training are the same steps you learned 30 years ago. This technique is similar to open or laparoscopic surgery, but is more accurate and reproducible. In fact, what they are learning is how to use a new tool: robots. With training and experience, this becomes a second habit.
So, not only are we looking to elevate practicing graduate surgeons into industry leaders in robotics, but we're also moving back upstream to ensure that in-training residents graduate with an advanced skill set in robot-assisted surgery. I'm trying to pull it up.
Q: At HCA Healthcare, physician voices are essential to determining best practices. How have our physicians used their voices to lead the field of robotics?
HCA Healthcare is collaborating with robotic surgeons to add value to patients treated at our facilities. We work with companies across the industry to introduce new innovations to surgeons, and their feedback often shapes the future of robotic technology. We also believe in developing surgeons into national and global leaders with expertise in their respective robotic specialties. These experts share their experience with other surgeons in a variety of ways.
We have supervising surgeons who help other surgeons learn new techniques on our home hospital robotic platform. We have case observation surgeons who invite surgeons from all over the world to observe surgeries at our HCA Healthcare hospitals. Top-level physicians teach 10 to 20 surgeons at a time best-in-class surgical techniques using a robotic platform.
In fact, approximately 25% of all soft tissue surgery case observation and education sites for robot-assisted surgery in the United States are located within HCA Healthcare hospitals.
That's no coincidence. It's about how we reach out to physicians, be good partners, and help them achieve what they want to do: become experts and international leaders in their fields and provide the highest standards of care for their patients. Ask if you can help.
Q: What is likely to happen in the field of robotics to help transform care?
This year brings new platforms built to work in the fields of artificial intelligence (AI) and machine learning. So, the future is here and it will move quickly. These new robotic-assisted platforms have the ability to leverage this computing power to optimize surgeon and team performance to provide superior patient care.
With the accumulation of data collected securely and anonymously from hundreds of thousands of surgical cases, AI can help inform and optimize the education and skills of future surgeons. Over time, this AI data can help reduce variability, improve patient outcomes, and reduce the skill gap between new and experienced surgeons using robotic surgical techniques.
All these advances place the human element at the center of surgical treatment. Patients should know that their doctors are always in control of their surgical decisions and actions.
The era of robot-assisted surgery has definitely arrived and will continue to expand. Surgeons and patients alike should expect the future to change rapidly and the continued use of robotics, AI, and machine learning to further optimize surgical care.
