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Hospitals smarten up surgeries

As local hospitals bring in more "ultra high-tech" surgical equipment, experts debate whether the result is better health care or unnecessary expense.

LISA GREENE
Published September 26, 2003

TAMPA - Inside the woman's body, Dr. Alexander Rosemurgy was clamping, snipping and suturing with tiny instruments, just a few millimeters thick.

Outside, all that showed was four slender tubes protruding from her stomach.

Except, of course, for the video screens.

Rosemurgy stared at one as he worked, tracking his instruments as they skimmed across glistening organs.

In a conference room downstairs at Tampa General Hospital, a handful of medical personnel watched on another monitor.

"Move right," Rosemurgy commanded. A pointer on the computer screen slid obligingly. "Stop." And it stopped.

"Where the pointer is, that's the back of the stomach," Rosemurgy told the group.

This is the world of surgery that Tampa General describes as not just high-tech, but "ultra hi-tech." The hospital has spent upwards of $440,000 apiece on two new operating rooms with digital cameras, video monitors mounted from the ceiling, and a camera, operating table and light switches that obey voice commands.

Across the bay, Morton Plant Hospital in Clearwater was the first to put in a pair of the "Endosuite" operating rooms two months ago, spending $500,000 to $600,000 on each one. Bayfront Medical Center plans on such changes as it renovates over the next two years. All Children's Hospital has a voice-activated robot that holds instruments and other similar equipment.

But spending so much to make a table move up and down by itself? Is such new equipment improving patient care, or is it a pricey toy that makes surgeons happy while driving up medical costs?

It's a real debate in medical care today. Policy experts are concerned that hospitals, warring to attract patients and doctors, sometimes engage in a "medical arms race" that drives up cost while doing little for patient care.

"Doctors want access to the latest technologies for their patients, and patients, who are increasingly informed consumers, want the latest technologies," said Gerald Kominski, associate director of the UCLA Center for Health Policy Research. "It raises the greater question of how are we going to continue to pay for it.

"I'd like to have lights that go on and off in my office, but I still have to get out of my chair," Kominski said of the new operating rooms. "It sounds indulgent."

But not so fast. Rosemurgy and local hospital officials have plenty of reasons why their high-tech devices are more than playthings - and even Kominski said their arguments are pretty convincing. Judging the worth of a new medical innovation can be a complex equation, he said.

"This, in fact, sounds to me like a small amount of money for a large amount of productivity gained," Kominski said.

Using the new equipment, Rosemurgy finished Thursday's operation - removing the patient's gallbladder and rearranging her stomach and esophagus to treat acid reflux - in an hour, 30 minutes faster than before. When operating room time costs $1,000 an hour, that's $500 in savings.

Less time under anesthesia is also better for the patient.

Rosemurgy, surgical director of Tampa General's digestive disorders center, views the new operating rooms as an invaluable teaching tool. The new equipment, made by Stryker Endoscopy, can transmit live images to students at the University of South Florida - or to surgical conferences on the other side of the country.

"In days gone by, surgeons learned from books with line drawings," he said. "They were cartoons."

The cameras also transmit images back, allowing students to ask questions. Or a surgeon could contact a colleague at another hospital, transmit images of the surgery to her, and listen as she offered advice.

Rosemurgy and Hal Ziecheck, chief operating officer at Morton Plant, say the new technology will help make minimally invasive surgery, such as laparoscopic procedures, more popular. With sharper digital images, surgeons will be able to do more complicated surgeries. With surgeries easier to record and share, surgeons who use traditional techniques will find it easier to learn laparoscopic ones, or operations performed with instruments inserted through several small incisions.

That's a plus for patients, because the tiny incisions mean shorter hospital stays.

"This is really breakthrough technology," Ziecheck said. "It's going to change our process of doing surgery. Patients will recover quicker, and they'll have better outcomes."

Morton Plant already is budgeting for two more Endosuites, and other hospitals in the Baycare Health System plan to add them as well, Ziecheck said.

Dr. Michael Albrink, chairman of surgery at Tampa General, hopes the equipment will cut down on medical errors. For example, one of the most common mistakes in gallbladder surgery is when a surgeon nicks a bile duct. Sharper digital images lessen the chance that a surgeon might misperceive what he's seeing on the screen, Albrink said.

"This might seem extravagant, and perhaps it is," he said. "But I'd rather our patients have the finest equipment there is."

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