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Medical Pioneer

Dr. Daniel Robie aims to be among the first adopters

BIG MACHINES, LITTLE SCARS: Daniel K. Robie, M.D. is Kapiolani Medical Center's director of pediatric, minimally invasive surgery.Photo: Ronen Zilberman

There's an old adage in medicine that you don't want to be the first or the last to adopt something new. Daniel K. Robie, M.D., is a business-minded doctor, who tries to be in the top 5 percent of those who master new techniques. He is also a champion of advanced, minimally invasive surgery in Hawaii and the director of pediatric, minimally invasive surgery at Kapiolani Medical Center for Women and Children.

Robie entered private practice and started the program at Kapiolani in 2001, after finishing his commitment to the U.S. government at Tripler Army Medical Center. He says, "When I started, there was essentially no minimally invasive surgery here at Kapiolani. I know it's hard to believe - even appendectomies were being done by open incision and not laparascopically."

However, Robie, with his entrepreneurial bent, had a plan. He says, "Obviously, in any medical organization these days, you need a business plan. We worked very closely with our [operating room] director, who then formulated the business plan, presented it to the board and that's how it got accepted." The plan included a $750,000 investment by Kapiolani's parent company, Hawaii Pacific Health, into capital improvements that included retrofitting one operating room and putting in a totally new, minimally invasive surgery suite. The plan also outlined a clear return on investment.

According to Robie, minimally invasive surgery has a number of advantages - improved efficiency, the potential need for fewer nurses, better ergonomic movement for surgeons, improved safety for patients and better surgical outcomes, with more rapid recoveries.

The advanced operating suites at Kapiolani, which opened in April, were the first such rooms in Hawaii. They are also equipped with teleconference and telesurgery capabilities. The new gadgetry is such that a surgeon watching from a remote location could draw a line on his monitor that would tell a surgeon in one of the new operating rooms exactly where to perform an incision.

Minimally invasive surgery is not just for kids. Robie says that a surgeon who will be creating an adult minimally invasive surgery program will begin practicing there soon. The focus of his work will be combating morbid obesity through bariatric surgery, something that has gotten a lot of national media attention lately, with celebrities, such as Al Roker and Carnie Wilson, going under the knife.

Robie says, "Where we see ourselves is the Hawaii Center of Excellence for Minimally Invasive Surgery. To be that requires more than just building an OR suite. It means you have to create an environment that will attract surgeons and their patients. … I see us as continuing to lead the pack and be the model for where other people want to be. Now, the next big move for us is robotic surgery."

According to Robie, robotic surgery gives doctors freedom of hand motion, which they currently lack in most laparascopic procedures. A robot can also reduce inherent hand tremors by a factor of four. He is already in talks with representatives from Intuitive Surgical (NASDAQ: ISRG) about their Da Vinci surgical robot system. That system costs about $1.4 million, with an additional $120,000 a year in maintenance and upgrades.

He says Hawaii could be a training center for robotic surgery that would attract clients from Asia. Says Robie: "My goal, without question for Hawaii, is to make it so no patient has to leave Hawaii to get state-of-the-art, quality medical care."

Sounds like the good doctor is hard at work on the next business plan.

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