Robotic surgery debuts at the Atlanta VA Healthcare System

 Jackson Slappy, Ankit Patel, Jonathan Pollock

July 2021

The years-long process of obtaining approval for instituting robotic surgery at the Atlanta VA Healthcare System culminated in mid-April 2021 with the installation of the hospital's first da Vinci robotic surgical platform. Shortly thereafter, Jackson Slappy, MD, Associate Chief of Surgery at the VA, performed the first robotic procedure to be done at the facility, a cholecystectomy.

"This was a two-pronged milestone," says Dr. Slappy. "Not only are we finally able to offer the advantages of robotic surgery to our veterans, we can also serve as an additional source of robotics training for our residents. The growing commonality of surgical robotics in our profession makes having this training asset available pretty imperative."

The campaign to acquire a robot for the VA began in 2013 when urologist Christopher Filson, MD, and general surgeon Ankit Patel, MD, both staunch robotics practitioners and advocates, began assembling a narrative and proposal for initiating a robotics program for prostate surgery at the hospital. They presented the material to Atef Salam, MD, the Atlanta VA's Chief of Surgery at the time, who was impressed by the advantages patients could experience due to the precision and accuracy of the robots, including less pain, shortened recovery time, and the option of having a minimally invasive procedure instead of traditional open surgery.

"Given the priorities of the Atlanta VA then, the effort stalled," says Dr. Slappy. "Meanwhile, my colleagues and I were having to refer more and more of our patients who were interested in robotic options to other hospitals in the Emory system, which was frustrating. Then Ann Brown arrived as the new Director of the VA in 2019, and we were back in business."

After Ms. Brown gave the go-ahead to revive the effort, Dr. Slappy, who had become Acting Chief of Surgery at the Atlanta VA, dusted off Dr. Filson and Dr. Patel's original business plan and updated it. Ms. Brown signed off on the proposal, and Dr. Slappy began working the initiative through the VA's National Surgery Office, Central Office, and purchasing and acquisition bureaucracy.

"One major disincentive for leaders was the cost of the robots, which can be as much as $2.2 million," he says. "When I stressed that the expense would be absorbed fairly quickly by the sheer volume of common cases that could be done robotically, and that the robotic versions of many of those procedures were also becoming the best options, people began to be convinced at all levels of the chain."

With the understanding that it was finally only a matter of time before a robot would actually be in place at the VA, he established a working group with fellow general surgeon Jon Pollock, MD, Acting Chief of General Surgery at the VA, to determine what types of instruments, supplies, and additional adjustments would be needed to accommodate the technology.

"After managing the Emory general surgery residency rotation at Soddo Hospital in Ethiopia from 2011-2016, I had returned to Atlanta," says Dr. Pollock. "I gradually came around to the benefits of having robotic surgery available at the VA, and by 2020 I was all in. I was particularly inspired by Dr. Slappy's tireless leadership as he worked the robot initiative through the VA approval process.”

Dr. Patel, who had successfully integrated robotics training into Emory's residency curriculum during the intervening years, helped to train and advise Dr. Slappy and Dr. Pollock so that they could become credentialed in robotic surgery. In addition to their onsite training with Dr. Patel, Drs. Slappy and Pollock worked with robotic simulators at Emory and enrolled in training sessions sponsored by Intuitive, manufacturer of the da Vinci system. For the final step in their credentialing process, Dr. Patel observed them perform their first robotic procedures.

As of July 2021, the two surgeons have performed approximately 40 robotic surgery cases at the Atlanta VA. Other physicians at the facility, particularly from the urology and thoracic surgery sections, are working to obtain VA robotic surgery privileges as well.

"Robotic surgery offers incredible benefits for our veterans, the most significant being equal or better results compared to older surgical methods. It's extremely gratifying to be able to make its benefits available to them," says Dr. Slappy.