Innovation rarely fails because the technology falls short. More often, it fails because organizations underestimate what it takes to adopt it.
Michael Gallizzi, MD, a robotic and endoscopic spine surgeon at The Steadman Clinic in Vail, Colo., has spent years evaluating emerging technologies as a surgeon, researcher, educator and one of the nation’s leading trainers in robotic and endoscopic spine surgery. What he has learned is that success depends less on the technology itself than on the commitment behind it.
“The biggest thing I’ve noticed throughout my career is there are dabblers and there are doers,” Dr. Gallizzi told Becker’s.
As robotic and endoscopic spine surgery continue gaining momentum, health systems across the country are investing heavily in technologies they hope will improve outcomes, attract surgeons and position them for the future. Hospitals spend millions of dollars every year chasing the next breakthrough in spine surgery, a new robot, a new platform, a new minimally invasive technique, a new promise of better outcomes.
But according to Dr. Gallizzi, the equipment is rarely the deciding factor. The distinction between success and failure has little to do with talent or access to technology. It has everything to do with commitment.
The ROI hospitals may be measuring incorrectly
Few technologies have generated more enthusiasm in spine surgery than robotics, yet many hospitals continue struggling to justify the multimillion-dollar investments required to build robotic programs. Part of the problem, Dr. Gallizzi said, is that organizations often evaluate robotics through the lens of a single procedure instead of the entire episode of care.
When viewed more broadly, the benefits become easier to see. Research Dr. Gallizzi reviewed demonstrated improvements in pedicle screw accuracy, reductions in adjacent-level facet violations and lower complication rates in several spinal procedures. Robotic-assisted cases have also been associated with shorter hospital stays, in some studies reducing length of stay by more than 24 hours.
But Dr. Gallizzi believes the most significant value may still be ahead.
“When you’re looking at these single-level degenerative cases, where robotics becomes a game changer is reducing hospital costs and allowing more procedures to be done safely in outpatient settings,” he said.
As spine surgery continues migrating out of hospitals and into ASCs, technologies that make procedures less invasive and more reproducible may play an increasingly important role. The real savings, he argues, may not come from the operating room. They may come from keeping patients out of hospital beds altogether.
Why some robotics programs never work
Hospitals often assume that buying a robot is the hard part.
Dr. Gallizzi sees it differently.
“The robot always screws up,” one surgeon recently told him after describing a program that used the technology only for particularly difficult cases.
Dr. Gallizzi’s response was simple. Does it? Or is the problem that nobody uses it often enough?
“Any time you have a new technology, there’s an increased need for specialized teams,” he said. Robotic surgery does not simply require a trained surgeon. It requires scrub technicians, nurses, sterile processing teams and device representatives who understand the workflow as well.
When a hospital performs robotic cases every week, that expertise compounds. Teams become efficient. Problems become predictable. Processes become standardized. When a hospital performs one robotic case a month, every case becomes a new learning curve.
“The people who really realize the value are the high-volume centers,” Dr. Gallizzi said. In other words, successful robotic programs are built long before the first incision.
The learning curve most organizations underestimate
The same principle applies to surgeons themselves. Healthcare leaders often talk about innovation as if adoption is simply a matter of purchasing equipment. Dr. Gallizzi believes that view dramatically understates the challenge.
Robotic and endoscopic spine surgery both require learning curves that can span 20 to 50 cases before surgeons become consistently efficient. That process happens largely outside the operating room. It means attending cadaver labs. Traveling to training courses. Studying new techniques. Listening to podcasts. Practicing on weekends.
It requires time that competes with family obligations, clinical schedules and administrative responsibilities.
“Someone who’s truly dedicated to beating the curve and getting over the hump has to invest a tremendous amount of effort away from their clinical practice,” he said. That is where the difference between dabblers and doers emerges.
A surgeon who experiments occasionally may never gain enough experience to realize the technology’s full value. A surgeon who commits fully can fundamentally transform a practice.
“If I’m going to do something, I’m all in on it,” Dr. Gallizzi said. Hospitals that fail to recognize that reality often end up with an expensive lesson.
“They do this big capital expenditure, and then it becomes a dust-collecting item in the back of their facility,” he said.
Why endoscopic surgery may be the bigger disruption
While robotics attracts much of the attention, Dr. Gallizzi believes endoscopic spine surgery may ultimately have the stronger economic case. Unlike robotics, endoscopy requires relatively little capital investment. Much of the necessary equipment already exists in ASCs.
The clinical benefits are increasingly difficult to ignore. Research has demonstrated lower muscle damage, shorter hospital stays, reduced opioid utilization and faster returns to work compared with more traditional approaches.
“People are able to return to work faster,” Dr. Gallizzi said. “Their opioid usage and pain management requirements have significantly decreased.”
Those outcomes matter in a healthcare environment increasingly focused on value. The question is no longer simply whether surgery works. It is how quickly patients recover afterward.
What innovation looks like when it works
Dr. Gallizzi sees the future of spine surgery not as a choice between robotics and endoscopy, but as a combination of both. Many of his most complex revision cases now involve robotic navigation working alongside endoscopic techniques to solve problems that previously required large open operations.
He described one patient with a prior multilevel fusion who required additional surgery above the fused segments. Traditional revision surgery would have involved extensive dissection and recovery. Instead, robotic guidance allowed precise instrumentation while endoscopic decompression addressed multiple nerve roots through minimally invasive approaches.
Without those technologies, he said, the operation would have been “a brutal surgery.”
Today, that patient is back hiking, biking, fishing and skiing. For Dr. Gallizzi, that outcome represents the real purpose of innovation. Not the technology itself. What it allows patients to do afterward.
The challenge hospitals aren’t talking about
Near the end of the conversation, Dr. Gallizzi shifted away from technology entirely. His concern was people.
As more spine procedures move into ASCs and healthcare consolidation accelerates, he worries that many organizations have begun treating physicians as interchangeable.
“Hospitals have to be thoughtful and flexible about surgeon engagement and partnering with their surgeons in the ASC space,” he said. Too often, he argues, health systems view physicians as replaceable parts within a larger machine.
“The attitude that we can just take this surgeon and replace him or her with another surgeon is flawed,” he said. That mindset becomes especially dangerous when organizations are trying to build highly specialized programs around advanced technology.
Because robots do not create successful spine programs. Teams do. Surgeons do. Champions do.
“At the end of the day,” Dr. Gallizzi said, “no revenue is generated without a doctor starting the process.”
For healthcare leaders investing in the future of spine surgery, that may be the most important lesson of all.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
