As HCA Healthcare’s National Medical Director of Robotics, Dr. Thomas Payne uses his experience as an international leader in robotic-assisted surgery to drive innovation in healthcare. Since 2004, following FDA approval of a first-of-its-kind robotic platform, Dr. Payne utilized advancements in technology to perform thousands of robotic-assisted surgical procedures – providing patients with improved outcomes and faster recovery times.
While Dr. Payne found great joy in providing direct patient care, he discovered a passion for expanding his impact on healthcare by sharing his expertise with fellow surgeons to help them shape the future of robotic-assisted surgery. Dr. Payne now mentors physicians across HCA Healthcare and writes industry papers, textbook chapters and journal articles. He also shares his knowledge as an international keynote speaker, panelist and faculty member.
Below, Dr. Payne shares his perspective on how the healthcare industry will continue to evolve with robotic-assisted surgery, and why continued developments can help transform the care delivery experience for surgeons and their teams.
Q: Can you tell us about your role at HCA Healthcare, and how your career as a surgeon has evolved to this point?
I have enjoyed the privilege of being with HCA Healthcare for the past 13 years. I currently serve as HCA Healthcare’s National Medical Director of Robotics and as the Vice President of St. David’s HealthCare’s Texas Institute for Robotic Surgery, headquartered in Austin, Texas and part of HCA Healthcare’s Central West Texas division.
I originally pursued this work to help heal my patients through surgery. My personal journey as a surgeon in the field of gynecology evolved from performing surgery with large, open incisions to laparoscopic-assisted surgery in the 1990s and early 2000s, and then on to robotic-assisted surgery beginning in 2004.
I’ve gone from being a very busy, patient-focused surgeon practicing gynecology to serving in a leadership and educator role, to impact more patients in a positive way. I’m now focused on advancing robotic-assisted surgery via program building, surgeon and staff education and future innovations — that is the exciting space I get to live in each day.
Q: Can you briefly describe the field of robotics surgery?
With any surgery, we want to yield the best possible precision outcomes, so patients get well quickly. The best surgeons have low complication rates, good outcomes and quick recovery times. Robotic-assisted surgery provides advantages to surgeons to support all of these objectives.
The easiest way to understand why we invest in and promote robotic-assisted surgery is by describing its benefits to patients and surgeons.
Patient benefits:
Whenever possible, as a patient, you want to have a small-incision or “minimally invasive surgery (MIS).” The optimal outcomes with MIS are lower rates of intra and post-operative complications, including wound infections, blood loss and transfusions, as well as shorter hospital length of stay, less readmissions to the hospital and shorter recovery time. Robotic-assisted surgery in many cases allows your surgeon to have a more reproducible, higher rate of success in performing MIS, thus lowering your chances of a large, open incision and its potential complications.
Surgeon benefits:
For physicians, their sole focus is to provide the most optimal outcome for each and every patient that undergoes surgery. Surgeons are aware that MIS often has several benefits compared to open surgery, and they want to adopt the newest technology and techniques that help them avoid open surgery when it is appropriate on a case-by-case basis. Thus, we promote and help them perform robotic-assisted surgery when it makes sense for a patient. Robotic technology offers several operative advantages to our surgeons:
- A higher rate of MIS success
- Clear, high-definition 3D views in the surgical field
- Advanced instrumentation allowing for success in complex surgery
- Injectable dye that outlines critical anatomy to avoid injury
- Data and case feedback to improve techniques
Lastly, with improved physical ergonomics for surgeons, adopting robotic-assisted surgery can be a career extender for physicians. They can comfortably sit and look through a console, using their hands and wrists as if directly inside the patient. Instead of standing beside the patient, they can sit and operate in a more natural way while performing minimally invasive surgery.
Q: How has the field of robotics evolved, and what are some of the areas of healthcare in which we are using robotic-assisted surgery?
As a medical provider, one hopes to be involved in something that becomes a treatment “paradigm shift” during your career — a significant change in how we take care of patients. For example, in the 1900s it was antibiotics or radiation and chemotherapy that ushered in a new way of treating patients. For the early 2000s, another paradigm shift occurred in the surgical space and began with the adoption of robotic-assisted surgery.
In the early 2000s, the national rate of open-incision surgery was as high as 65%. Around 2014, with early adoption of robotics, the open rate in the nation was about 40%. Now, at HCA Healthcare, our open rate is as low as 8% in several of our facilities. Again, robotic-assisted surgery is not appropriate in all cases, but when it is it can translate into patients getting out of the hospital more quickly, fewer complications and better outcomes.
When we first started concentrating on robotics, we focused on the soft tissue specialties. These are surgeries performed from the neck to the pelvis not involving bone structures. These specialties include urology, gynecology, general surgery, bariatrics, colorectal, oncology, ENT, pediatric and thoracic surgery.
Now we have robotic-assisted surgery outside of the soft tissue specialties including orthopedic, spine, neurosurgery and pulmonary. Essentially, for almost every surgical specialty there is a computer-assisted robot that can optimize our ability to operate more precisely and with smaller incisions.
Q: How does our robotics agenda tie into our larger HCA Healthcare strategy, in terms of supporting physicians and scaling best practices?
As one of the leading healthcare providers in the U.S., we take pride in our ability to scale best practices in all areas of healthcare across our system. We intentionally and systematically support the development of our surgeons into robotic leaders. No other health system has developed their surgeons in this way at the scale we have achieved. Over the last decade, we have developed a robust programmatic structure in the robotic space.
HCA Healthcare’s current robotic footprint comprises 169 hospitals and 32 ambulatory surgery centers, where we have invested in nearly 900 of the most advanced robotic surgical platforms utilized in multiple surgical specialties. HCA Healthcare does more robotic-assisted surgery than any other healthcare system — with more than 1 million cases and growing — and our surgeons have led with several robotics “firsts” in the world over the last decade. In addition, we have developed one of the largest databases on robotics surgery. Our investment in technology, number of cases and constant study of our data helps us deliver some of the most technologically advanced robotic-assisted surgical outcomes in healthcare.
As a learning health system, we constantly look for scalable high performance from across all of HCA Healthcare’s robotic programs. This creates a culture of continuous improvement where local knowledge is transformed into enterprise-wide value.
Q: How are we training the next generation of physicians to lead in robotics surgery?
HCA Healthcare is a national leader in graduate medical education (GME), and we collaborate with new physicians to develop the next generation of robotic surgeons. By 2025, we expect to have up to 850 general surgeons, urologists and gynecology surgeons being trained in robotic-assisted surgery.
HCA Healthcare’s Robotics team partners closely with our HFEGME program to support junior level residents who wish to advance their robotic knowledge and skill, so when they graduate they are can be both robotically trained and certified as they begin their medical careers. Many of these residents go on to seek out jobs in hospitals that offer robotic surgery.
Ultimately, robotic-assisted surgery is a tool. The procedures you learn in residency are the same procedures that were learned 30 years ago. The techniques are almost identical to open or laparoscopic surgery, but with more precision and better reproducibility. In truth, what they are learning is how to use a new tool — the robot. With training and experience this becomes second nature.
So altogether, we’re elevating our post-graduate practicing surgeons to be industry leaders in robotics, and we’re also looking back upstream to elevate our residents-in-training to graduate with a highly competent skill set in robotic-assisted surgery.
Q: At HCA Healthcare, physician voice is vital to help us determine best practices. In what ways have our physicians used their voices to lead in the robotics field?
HCA Healthcare works alongside robotic surgeons to add value to the patients who receive care in our facilities. We collaborate with companies across the industry to introduce our surgeons to new innovations and often their feedback shapes the future of robotic technologies. We also think it’s important to develop our surgeons into national and world leaders with expertise in their respective robotic specialties. These experts then share their experience with other surgeons in a number of ways:
- We have proctoring surgeons who help other surgeons learn new techniques on the robotic platforms in their home hospitals.
- We have case observation surgeons who invite surgeons from all over the world to watch them operate in our HCA Healthcare hospitals.
- We have expert surgeon educators at the highest level who teach 10 to 20 surgeons at a time on best-in-class surgical techniques utilizing robotic platforms.
In fact, approximately 25% of all soft tissue surgery case observations and educational sites in the U.S. for robotic-assisted surgery are inside of HCA Healthcare hospitals.
That’s not by accident. That’s us reaching out to our physicians, being good partners and asking how we can help them achieve what they want to do — which is to become experts and international leaders in their fields and to provide the highest standard of care for their patients.
Q: What is on the horizon for the field of robotics that will help drive care transformation?
This year, we have new platforms that are built to operate in the Artificial Intelligence (AI) and machine learning space. Thus, the future is here and will be moving fast. These new robotic-assisted platforms will have the ability to leverage this computational power to optimize a surgeon and team’s ability to provide excellent patient care.
With the accumulation of data securely and anonymously mined from hundreds of thousands of surgical cases, AI will help inform and optimize future surgeon education and skill. Over time, this AI data can help decrease variability, improve patient outcomes, and reduce the skill gap between new and highly experienced surgeons using robotic surgical technologies.
All of these advances maintain the human element at the center of surgical care. Patients need to know that their doctors are always in control of the decisions and actions taken in surgery.
The age of robotic-assisted surgery is here to stay and will expand. Surgeons and patients alike should expect the future to move rapidly, and surgical care to be optimized further with continued utilization of robots, AI and machine learning.