In a recent study, the Endo Stitch automated suturing device from Covidien was shown to lower mean hospital costs and operating room (OR) time during total laparoscopic hysterectomies treating benign conditions. In the study, the device reduced overall hospitalization costs by approximately $1800 and cut OR time by roughly 40 minutes, on average, when compared to those same procedures performed with robotic assistance.
To get some perspective on the automated suturing device for laparoscopic surgery, Medgadget spoke with Stuart Hart, MD, FACOG, FACS, co-director of the University of South Florida Center for the Advancement of Minimally Invasive Pelvic Surgery, who has used the device for years and helped present the study results at the American Association of Gynecologic Laparoscopists 40th Global Congress of Minimally Invasive Gynecology in late November 2011.
Medgadget: How did the device make such dramatic time savings possible in this study? Also, could you explain what the device is like in terms of usability?
Hart: Laparoscopic suturing is a very difficult skill to obtain. This is partly because it is almost like you are operating with stilts. In open surgery, we are used to having a needle driver and we are holding the needle very closely with the needle driver close to where our hands are. Whereas in laparoscopic surgery, we have these long instruments. One of the big challenges is driving needles through tissue from the longer distance.
The other big issue is, in traditional laparoscopic surgery, the surgeon is looking at a two-dimensional screen while operating in three dimensions.
Basically, the [Endo Stitch] device automates the process of suturing. Instead of having to go through this steep learning curve of learning laparoscopic suturing, this extremely simple device allows you to suture with very little skill needed and there is little training involved. It’s not much more involved than any laparoscopic instrument we typically use.
Just the ease of use of the device makes such impressive time savings possible. It allows you to very easily drive sutures through tissue without having to learn those advanced skills. […] When you automate the process, suddenly, that time goes down significantly. It just simplifies the whole process by automating it through the device. And it really adds significant time savings.
Medgadget: A somewhat related question: Doctors these days are forced to do more with less: thanks to a shortage of MDs and growing pressure to control costs in medicine. How do you think the Endo Stitch addresses these trends?
Hart: I think it is a really interesting question because cost containment is becoming one of the biggest issues [in medicine]. In this study, we looked at two things: we compared [the Endo Stitch] to robotic surgery and to traditional laparoscopic hysterectomies.
One of the challenges, as a physician who teaches courses in laparoscopic hysterectomies, is that the majority of hysterectomies, approximately 60–65% of them, are still being done through big open incisions. This is amazing because we have been doing them that way for more than 100 years and you would think that we would advance to a newer technology. But partly the reason that it is still being done open is the challenge of developing the laparoscopic skills.
What the da Vinci robot has done is they have come in with a very nice instrument that happens to be very expensive. It enables the physicians to suture much more naturally because [it gives them] that seven degrees of freedom on your wrist. Basically, you suture with the da Vinci robot almost identically to how you suture with an open surgery.
One of the biggest issues with the da Vinci robot, even though it is a very elegant and sophisticated piece of equipment that works very well, is the cost. Do we really need a $2 million robot to perform the majority of our hysterectomies? And getting back to the rate-limiting factor of performing laparoscopic hysterectomies, it is the suturing. So suddenly if you had an enabling technology like the EndoStitch that would enable you to suture very easily, quickly, and efficiently, it would take away the need for the very expensive robot because you could do it with a much-less expensive piece of equipment. And so that is why we compared it to the robot. And that is why we saw all of the time savings in the OR and obviously the significant cost savings. There have been other studies that looked at robotic versus traditional laparoscopic surgery for hysterectomy and also showed a cost savings.
Medgadget: Besides its ability to speed surgical procedures and to save costs, what else is noteworthy about the Endo Stitch?
Hart: It is a very straightforward instrument. It is very simple to train physicians to use it.
The best thing to compare it to is the $2-million piece of equipment: the da Vinci robots. You have to get additional training, robotic training, to use it. And not every hospital can afford to buy a robot. On top of that, even if they can afford to buy a robot, they usually can’t afford to buy more than one or two. So you are very limited in the ability to even use it.
The Endo Stitch is obviously pretty inexpensive compared to the robot. It is no more than a typical laparoscopic instrument that we use. It really requires pretty minimal training. It allows the doctor to perform straightforward laparoscopic hysterectomies with significant—not only cost benefits, but benefits to the patient in terms of blood loss, decreased pain, quick return to normal activity, better quality of life, decreased risk of hernia formation. Those are your typical benefits of laparoscopic surgery. And to do it quicker than the robot, with less cost, and hassle, with trying to find time or the hospital that has the robot. And it is disposable. So you can throw it away at the end. It is a nice instrument. I’ve been using it for years and, as they come out with new iterations to it, I continue to expand my use of it.