It really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.
The Centers of Excellence framework served as a way to report and compile patient outcomes within a national registry to assess and verify risks and benefits.
Using longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.
The green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.
Centers of Excellence provided a means to identify bariatric surgery programs that provide comprehensive and standardized care and long-term follow-up.
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 38 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 38 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 38 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 38 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 38 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 38 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 38 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 38 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 38 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 38 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 38 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 38 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 38 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 38 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 38 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 38 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 38 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 38 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 38 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 38 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 38 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 38 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 38 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 38 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 38 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 38 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 38 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 38 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 38 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 38 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 38 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Marc's statements about Esophageal Atresia33 statements
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 70 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 70 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 70 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 70 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 70 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 70 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 70 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 70 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 70 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 70 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 70 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 70 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 70 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 70 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 70 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 70 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 70 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 70 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 70 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 70 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 70 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 70 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 70 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 70 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 70 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 70 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 70 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 70 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 70 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 70 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 70 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Marc Michalsky, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 20 · 2:24
clinicalIn 2004-2005, ASMBS developed a Centers of Excellence framework in response to public and professional concerns related to patient safety in bariatric surgery.↗
▶Ep 20 · 2:48
clinicalKen Champion and Walter Porre led a consensus conference in 2004 that addressed bariatric surgery safety issues and published a treatise in 2005.↗
▶Ep 20 · 3:06
clinicalCenters of Excellence provided a means to identify bariatric surgery programs that provide comprehensive and standardized care and long-term follow-up.↗
▶Ep 20 · 3:24
clinicalThe Centers of Excellence framework served as a way to report and compile patient outcomes within a national registry to assess and verify risks and benefits.↗
▶Ep 20 · 4:18
epidemiologicalBetween 2005 and 2012, major payers declared that authorization for bariatric surgical care needed to be done in accredited centers, in part due to reduction in mortality attributable to national accreditation.↗
▶Ep 20 · 4:42
clinicalIn 2012, ASMBS and ACS combined forces to merge their two separate accreditation programs.↗
▶Ep 20 · 4:54
clinicalRobin Blackstone led the merging of the two accreditation programs and championed incorporating pediatrics, stating it was the right thing to do.↗
▶Ep 20 · 5:18
clinicalMBSAQIP was released in 2014 and has undergone a number of iterations over subsequent years.↗
▶Ep 20 · 5:30
guidelineThe MBSAQIP framework and ASMBS best practice guidelines informed the recent American Academy of Pediatrics policy statement and clinical practice guidelines on pediatric bariatric surgery.↗
▶Ep 20 · 6:36
epidemiologicalThere are currently 958 MBSAQIP accredited programs throughout the United States.↗
▶Ep 20 · 6:48
epidemiological109 programs are adult care centers with adolescent designation, representing 11% of all accredited centers.↗
▶Ep 20 · 7:00
epidemiological7 freestanding children's hospitals have MBSAQIP accreditation for adolescent bariatric surgery, representing about 1% of total accredited centers.↗
▶Ep 20 · 7:12
epidemiologicalPediatric bariatric surgery volume in the MBSAQIP registry appears to be increasing, approaching 500 cases in 2023 based on extrapolation.↗
▶Ep 20 · 7:36
epidemiologicalA significant number of high-quality, high-volume pediatric bariatric surgery centers are not part of MBSAQIP.↗
▶Ep 20 · 8:06
clinicalMBSAQIP accreditation translates into institutional commitment to providing the resources and equipment required to provide safe and timely care.↗
▶Ep 20 · 8:24
clinicalThe centralized MBSAQIP database allows for generation of risk-adjusted institutional-specific data analysis on a bi-quarterly basis.↗
▶Ep 20 · 8:42
clinicalRisk-adjusted outcome reports inform required quality improvement projects using standard PDSA or QI framework.↗
▶Ep 20 · 9:00
clinicalERAS implementation at Nationwide Children's Hospital showed reduced hospital length of stay and reduced opioid use.↗
▶Ep 20 · 9:18
epidemiologicalAge less than 18 is cited as the most common reason for bariatric surgery insurance denials.↗
▶Ep 20 · 9:36
clinicalMajor payers require MBSAQIP accreditation for adult bariatric surgery programs.↗
▶Ep 20 · 9:48
opinionIt is uncertain whether major payers will require MBSAQIP accreditation for pediatric bariatric surgery centers in the future.↗
▶Ep 20 · 10:06
clinicalThe American Academy of Pediatrics has made bariatric surgery a widely disseminated therapeutic paradigm through education.↗
▶Ep 20 · 10:24
clinicalMajor payers have been asked to pay attention to the AAP guidelines on pediatric bariatric surgery.↗
▶Ep 20 · 12:18
quotethe biggest unknown and the biggest question mark here is what are payers going to do↗
▶Ep 20 · 12:30
quoteI can tell you from personal experiences having been. You know, leading an accredited center for, you know, for many, many years now, we have gotten patients from other centers that have been denied by their payer because the, the, you know, the institution that they went to was not ASM was, was not MBSA QIP accredited↗
▶Ep 20 · 12:30
clinicalPatients have been denied bariatric surgery coverage by payers because the institution was not MBSAQIP accredited, even for pediatric cases.↗
▶Ep 20 · 13:06
quotemy assumption is that at some point, um, payers are going to get wise, uh, to what's going on here, and they're going to turn around and, um, and, and probably apply the same sort of approach that they've widely applied, you know, in the adult world↗
▶Ep 20 · 13:18
opinionSome children's hospitals do not freely provide the resources required to set up a safe bariatric surgery service.↗
▶Ep 20 · 13:42
clinicalMBSAQIP accreditation requires hospitals to commit to making all required equipment and resources available, which costs money.↗
▶Ep 20 · 14:25
clinicalThe MBSAQIP application price is high, but active discussions are underway to accommodate pediatric programs and reduce the cost.↗
▶Ep 20 · 14:25
quoteThe price is high, um, but you know, we, we are involved in active discussions on how to accommodate for pediatric programs. So stay tuned. I think the price is gonna wind up coming down.↗
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
clinicalDr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 3 · 7:56
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 3 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 3 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 3 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 3 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 3 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 3 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 3 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 3 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 3 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 3 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 3 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 3 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 3 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 3 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 3 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 3 · 39:10
clinicalTeen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
▶Ep 3 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 3 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 3 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 3 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 3 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 3 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 3 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 3 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 3 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 3 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 3 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 3 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 3 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 3 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 3 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 3 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Marc's statements about Pediatric Robotic Surgery68 statements
clinicalDr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 5 · 7:56
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 5 · 7:56
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 5 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 5 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 5 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 5 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 5 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 5 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 5 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 5 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 5 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 5 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 5 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 5 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 5 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 5 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 5 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 5 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 5 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 5 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 5 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 5 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 5 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 5 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 5 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 5 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 5 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 5 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 5 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 5 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 5 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 5 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 5 · 39:10
clinicalTeen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
▶Ep 5 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 5 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 5 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 5 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 5 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 5 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 5 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 5 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 5 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 5 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 5 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 5 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 5 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 5 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 5 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 5 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 5 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 5 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 5 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 5 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 5 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 5 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 5 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 5 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 5 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 5 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 5 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 5 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 5 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 5 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 5 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
▶Ep 5 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Marc's statements about Tracheoesophageal Fistula33 statements
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 28 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 28 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 28 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 28 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 28 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 28 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 28 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 28 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 28 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 28 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 28 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 28 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 28 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 28 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 28 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 28 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 28 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 28 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 28 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 28 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 28 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 28 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 28 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 28 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 28 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 28 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 28 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 28 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 28 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 28 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 28 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Marc's statements about Tracheoesophageal Fistula33 statements
clinicalThe green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery.↗
▶Ep 22 · 8:05
quoteThis was an open surgical platform. This was not conceptualized as being part of minimally invasive surgery, which was really a surprise to me.↗
▶Ep 22 · 8:34
clinicalColonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies.↗
▶Ep 22 · 10:56
quoteHalf the time, ASOP could not understand you.↗
▶Ep 22 · 12:20
clinicalThe transition from da Vinci SI to XI was transformational, creating much more flexible range of motion.↗
▶Ep 22 · 13:09
clinicalComputer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications.↗
▶Ep 22 · 22:12
clinicalOne large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance.↗
▶Ep 22 · 23:14
clinicalNationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program.↗
▶Ep 22 · 28:50
quoteIt really should be someone who is going to do more than the occasional case. If you're only gonna do one or two cases with the robot, the robot's not for you.↗
▶Ep 22 · 29:06
quoteIf it's been a month since I've sat down on the robot, it takes me a minute to reacquaint myself with everything.↗
▶Ep 22 · 30:19
guidelineMaintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation.↗
▶Ep 22 · 32:20
clinicalBlock time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused.↗
▶Ep 22 · 34:36
quoteWhen content quality is poor — bad audio, corrupted video, inappropriate content — flag it rather than producing garbage metadata.↗
▶Ep 22 · 34:36
clinicalUsing longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children.↗
▶Ep 22 · 35:29
epidemiologicalIn Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology.↗
▶Ep 22 · 36:43
clinicalNo difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50.↗
▶Ep 22 · 41:07
clinicalRobotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier.↗
▶Ep 22 · 41:44
clinicalLearning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes.↗
▶Ep 22 · 43:51
clinicalNo difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy.↗
▶Ep 22 · 44:29
opinionRobotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying.↗
▶Ep 22 · 44:29
quoteI feel like robotic, my robotic surgery experience has made me a better laparoscopic surgeon.↗
▶Ep 22 · 52:46
quoteI think human integration will continue to be the foundation for any surgery, even robotic surgery. So not to worry, I think we all have job security.↗
▶Ep 22 · 55:30
clinicalHopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer.↗
▶Ep 22 · 58:25
clinicalIntuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections.↗
▶Ep 22 · 58:25
clinicalIntuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics.↗
▶Ep 22 · 59:07
clinicalCarl Storz platform has 5mm instrumentation and strong interest in pediatric applications.↗
▶Ep 22 · 59:17
opinionIntuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI.↗
▶Ep 22 · 59:17
quoteDo I think Intuitive is gonna build a pediatric robot? No. It's not part of their ROI to put the billion dollars that it would require.↗
▶Ep 22 · 1:00:27
clinicalRobotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes).↗
▶Ep 22 · 1:01:21
clinicalNationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use.↗
▶Ep 22 · 1:02:42
guidelineFellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion.↗
▶Ep 22 · 1:04:45
clinicalJ&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view.↗
Summaries Marc gave as host
· 11 summaries
Recaps of other experts' statements, not Marc's own clinical position.
Summaries Marc gave as host · Esophageal Atresia2 summaries
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
▶Ep 70 · 4:32
host summaryMarc Michalsky summarizing the discussion: Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 70 · 39:10
host summaryMarc Michalsky summarizing the discussion: Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
Summaries Marc gave as host · Esophageal Atresia2 summaries
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
▶Ep 38 · 4:32
host summaryMarc Michalsky summarizing the discussion: Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 38 · 39:10
host summaryMarc Michalsky summarizing the discussion: Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
Marc Michalsky, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 20 · 4:54
host summaryMarc Michalsky summarizing a resource: we're going to incorporate pediatrics, which I can tell you from personal experience being involved was not an easy thing to do because to Robin's point, it was the right thing to do↗
Summaries Marc gave as host · Pediatric Robotic Surgery2 summaries
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
▶Ep 5 · 4:32
host summaryMarc Michalsky summarizing the discussion: Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 5 · 39:10
host summaryMarc Michalsky summarizing the discussion: Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
Summaries Marc gave as host · Tracheoesophageal Fistula2 summaries
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
▶Ep 28 · 4:32
host summaryMarc Michalsky summarizing the discussion: Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 28 · 39:10
host summaryMarc Michalsky summarizing the discussion: Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
Summaries Marc gave as host · Tracheoesophageal Fistula2 summaries
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
▶Ep 22 · 4:32
host summaryMarc Michalsky summarizing the discussion: Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital.↗
▶Ep 22 · 39:10
host summaryMarc Michalsky summarizing the discussion: Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy.↗
