Before a packed audience of physical therapists and other medical professionals, Billings Clinic Dr. Galen Mills showed just how much Powell Valley Healthcare’s Mako robot can do to assist in knee replacement surgeries. 

"You don't have to have a Ph.D. in math to know that the growth with the Mako robot has been quite substantial over the last 20 years, so it's either due to really good marketing by Stryker or the fact that it's actually really working,” said Mills, who practices in the Big Horn Basin. “Personally, I think it’s probably some of both.”

Having the Mako has been a boon for Powell Valley Healthcare, as it’s the only one in the region; Mills prefers doing knee surgeries in Powell to be able to utilize the robot.

“The power of this robot really comes out for me when you get more complex patients,” he said at the September event. “So I feel like I'm rolling in the giant DeWalt tool chest.”

Mills said the power of the device makes doing even complicated aspects of procedures with knee replacements “insanely easy” compared to manual instrumentation. 

Robots are becoming so important to healthcare that Powell Medical Foundation head Amy Wells says it's become an important part of bringing in new doctors, as many are training on the machines.

Powell Valley Healthcare CEO Todd Sandberg said the organization sees a need to purchase a different robot, the da Vinci Surgical System.

“We are finding if we truly want a general surgeon [or] an OB/GYN that’s earlier in their career, this is something that they’re going to need for practicing,” Sandberg told the PVHC board at its September meeting.

The hospital is seeking a replacement for longtime OB/GYN Dr. Jenkins Clarkson, who retired in September; Sandberg said the organization has two OB/GYN prospects they’re talking to who said they would only come if the hospital acquires a da Vinci robot. 

While the Mako excels in knee surgeries, the da Vinci focuses more on surgeries in the torso area. It’s priced around $2 million, plus ongoing support costs, and Sandberg said the board is going to start talking about steps needed to acquire the machine. Wells said the foundation has been looking at using its upcoming fundraising campaigns to help acquire a new robot, among other needs.

Regional competition

Cody Regional Health acquired a da Vinci in 2023, thanks in large part to funds raised by the West Park Hospital Foundation. 

“The da Vinci Surgical System is a game-changer for surgeons. Its precision and minimally invasive capabilities will enhance our ability to perform complex procedures with greater accuracy,” general surgeon Dr. Rebecca Deal said in a 2023 release, shortly before she came on staff at the Cody hospital. “This advanced technology not only benefits our patients by reducing surgery time and promoting quicker recovery but also empowers our surgical team to provide the best possible care.”

North Big Horn Hospital in Lovell also has a da Vinci and Sandberg told the Tribune he’s found more hospitals in the region have one than don’t.

“I came from a similar sized critical access hospital … and we had a da Vinci, and we definitely saw an increase in those patients staying close to home,” he said. “We did see an increase and improvement in the outcomes of those patients, and it allowed us to compete in the region versus sending out all of our patients for certain types of procedures.

Additionally, Sandberg said one of the surprising benefits was that two surgeons in their late 60s, early 70s “extended their career for another five years” as a result of the robot.

Sandberg said the da Vinci can help with a wide variety of procedures, especially in gynecology, urology and general surgery, and would lead to more patients being able to stay in Powell. Especially with elderly patients, he said it’s important the hospital do what it can to keep them from having too many long trips.

“Based on the volumes that we anticipate, that are being sent out to go north to Billings or maybe to another location, we feel like those are patients that we can safely take care of here in the community with the same kinds of results because of the robot technology,” Sandberg said.

“At the end of the day,” he added, “the robot’s not doing the surgery. It’s just an extension of the fingers and the brain and the head of the surgeon, and it’s helping just be more accurate and more precise.”

Mako

Mills has high praise for the Mako, especially when dealing with more complex cases. At Powell Valley Healthcare the machine is used for more precise knee replacements, but it’s also capable of total hip replacements. 

The Mako uses a CT scan obtained before surgery that allows Mills to figure out a variety of important facts about the knee before surgery. 

“We get a CT scan, we upload that scan into the software as a Mako computer, and it’s going to help generate a digital anatomic model for us to basically play with, create our plan, and then we're going to execute the plan,” he said. 

Like the da Vinci, the Mako has become an expectation for many younger doctors who deal with knee and hip replacements. 

“The truth is, the majority of orthopedic surgeons that are graduating from their residency program, they graduate with being used to this product as a part of their training, and so as we go to hire new providers, new surgeons, they too come with this expertise,” said Martine Grant, PVHC executive assistant and an organizer of the Mako event. “That’s how they learned, and so they go looking for places where that's an option.”

Looking ahead

Sandberg said it’s become the standard of training in universities and medical schools across the country, so “if you want to recruit those individuals to come to your community and serve a population, the only way to make that happen is to have the tools that they're trained on and used to.”

As more information comes out on these new technologies, he said it only confirms the importance of these robots. With the precision they are able to achieve, it can make for less blood loss and shorter recovery periods, as Mills noted in his presentation on the Mako. 

Sandberg said over the next couple of months, he anticipates coming to a decision in regards to a da Vinci robot, which he said can be purchased outright or, more likely, financed.

“Over the next couple board meetings, we anticipate making a decision,” he said.