A Case for Higher Utilization of the Da Vinci System

At the request of my Urologist, I wrote the following as an open letter to the executive at Vancouver Coastal Health and the BC Minister of Health on June 19, 2013. The Surgical Robot, with a capital cost in the order of two million dollars, and equipment operating costs in the thousands per procedure being passed on to the patient, is currently substantially under utilized. I thought my perspective might be of interest to others.

I am a prostate cancer survivor, and in May 2008 I was the 50^th surgical patient to undergo radical prostatectomy performed with the Da Vinci robotic system by Dr. Larry Goldenberg at Vancouver General Hospital. I understand that at this time there are only two urologists and one cardiologist operating the system, and that it is effectively under utilized for a variety of reasons, including the direct cost to the patient that has been levied since the original funding from Jim Pattison and Jack Poole was depleted.

As a principal beneficiary of the functionality of this system, I believe I have first hand evidence of the benefits of its use and the economic justification for increasing its utilization. Recent publicity of the benefits of Robotic Laparoscopy (Financial Post, June 18, 2013) relieves me of having to cover much of the ground, but from a personal perspective I can state that the trauma reduction resulted in minimal time in acute care, and very rapid recovery to a state effectively unchanged from pre-surgery. In fact, having recently passed my fifth anniversary of the treatment, Dr. Goldenberg and I decided that I have no further need for his specialized care, and he has returned me to the care of my G.P. with only the caveat of annual PSA testing.

In light of my experience, and the substantial benefits that accrued to me, I urge you to allocate more resources to exploiting the technological and economic advantages that the Da Vinci system provides. It is an asset that has paid huge dividends for me personally and should be providing similar benefits for a much larger segment of the public.

Yours truly

Thomas Hasek

Ostrow, David [CORP] <David.Ostrow@vch.ca> August 9, 2013	8:57 AM (6 hours ago)
to me, hlth.minister, Clay

Thank you for your comments. Sorry for the delay in getting back to you. Robotic surgery for prostate disease is relatively new in the broad scheme of things, and VCH believes, while there are no well controlled studies that show that it is superior to other forms of minimally invasive surgery, that there is likely, as we become more expert in using the apparatus, to be only an upside to its use-which is why we support it in our organization. However, it is more costly to use(disposables), and takes up more operating room hours than traditional minimally invasive prostate surgery( less time available for other operations), with so far, no proven better outcomes and like all high tech devices needs to be replaced at a very high cost regularly. That is why we continue to use, improve our techniques and want to learn more about the best use of the device. I am pleased that you had a very good outcome for your surgery.

David Ostrow MD FRCPC
President & Chief Executive Officer
Vancouver Coastal Health
T:  604.875.4721