For the last 15 years, Orlando has been the location surgical robotics companies choose when introducing new technology to the U.S. market, and for good reason. With approximately 610 surgeons at 59 hospitals, the seven-county Orlando region presents a huge market opportunity. That’s not to mention the presence of a dedicated space for surgical robotics training.
The 54,000-square-foot Nicholson Center at AdventHealth’s Celebration campus houses a surgical training lab with 50 surgical and clinical skills stations, team training operating rooms, advanced robotic and laparoscopic simulation labs and a 500-seat medical conference center. Situated 20 miles from Orlando International Airport, the facility sees roughly 15,000 surgeons from all over the country pass through its doors each year.
“About 20 years ago we built the Celebration campus — a unique design project in cooperation with Disney with a resort feel — to be a living laboratory for new ideas,” says Dr. Roger Smith, chief technology officer at AdventHealth Nicholson Center. “Most hospitals build a facility and implant existing processes. The Celebration campus was designed specifically to try out new ideas.”
One of those new ideas was to establish a continuing education center for practicing clinicians, nurses, surgeons, and technologists. Dubbed the “Institute for Surgical Advancement,” the precursor to the Nicholson Center, the modest lab began teaching courses inside its main hospital building.
Despite the lab being carved out of the old mail room and the staff working out of old doctors’ offices, the program took off, attracting Intuitive Surgical to start teaching da Vinci robot skills. The da Vinci surgical robot is now one of the most widely used minimally invasive surgical options available.
“They needed space and access to surgeons. We had both,” Dr. Smith says. “They very quickly became our biggest customer.”
One of the hospital’s surgeons later performed surgery using the da Vinci on a patient who was so impressed by the technology and the surgeon’s skills that he decided to donate to the advancement of surgical robotics at the hospital. That patient was Tony Nicholson and his donation served as the catalyst to create a surgical epicenter specifically designed for training.
“The Nicholson Center was a forethought. We knew this was what we wanted to do,” Dr. Smith says. “We built the space specifically for training.”
Today the Center trains several hundred surgeons each day in more than 50 specialties. Courses range from small group hands-on-surgery to large-hall didactic sessions, which include lecture, video and observational elements. Once a year, several hundred surgeons train in a variety of hands-on procedures conference-style over the course of a week.
To continue practicing, surgeons need to earn a certain amount of continuing medical education (CME) credit hours each year. Continuing education for surgeons and clinicians who are already licensed and practicing typically comes in two forms. The most common are industry-sponsored, led by device manufacturers who provide the curriculum, equipment and staff. The other is more traditional, like what’s offered at university hospitals, where the expertise and knowledge is not associated with any specific device company. Surgeons take both types of courses, but it’s the courses independent from industry that count toward CME credits and the Nicholson Center is one location for acquiring them.
“You get great knowledge in both,” Dr. Smith says. “But the difference is we’re teaching robotics courses now with our own experts, not the device manufacturers, creating the curriculum and deciding what needs to be taught.”
The similarities between the Nicholson Center and what’s offered at a university hospital don’t end there. In fact, it’s affiliated with AdventHealth University (AHU), a private medical school that’s been part of the hospital system for 25 years with its main campus located next to AdventHealth Orlando. It also has a relationship with the STAN Institute at the University of Lorraine, France’s equivalent of the Nicholson Center.
“We sell out our basic robotics courses every month, bringing in surgeons from all over the world,” Dr. Smith says. “Most of them already have the robots in their facilities and come here to grow and maintain their skills. We don’t teach them how to perform surgery – they learn that in their residencies and practices – we teach them the technical aspects and user interface – how to use the robot for procedures that they already understand.”
Currently, there are close to a dozen robots that are operating in surgery, six of which held their training at the Nicholson Center, including devices by MAKO Surgical Corp. (now Stryker), Mazor Robotics (now Medtronic) and TransEnterix Surgical. But the industry is about to explode. More than 50 surgical robotics companies will be coming to market in the next few years, with specialties including hip or knee replacement, spine surgery, abdominal procedures and transoral procedures. There are even devices focused on operations inside the skull that enter the brain, find a tumor and biopsy it.
“As all those companies are lined up with different release dates,” Dr. Smith says. “Our goal is to work with each as they come to market and find which are a fit here. Many of them are offering some really exciting capabilities and we’re looking forward to working with them.”
One of these newcomers is the Versius robot from CMR Surgical out of Cambridge, U.K., which is smaller and more lightweight than the da Vinci and allows surgeons to move its parts more freely. The Nicholson Center worked with the company on its pre-FDA study in the summer of 2018 and plans to use the facility as its entry point to the U.S. market.
“We’re the first in the United States to have the robot and that’s a great story for Orlando,” Dr. Smith says. “Usually a robotics company sends their people to conduct training. But CMR is using our people which creates a more objective perspective.”
AdventHealth is growing as well. An all-new wing is under construction at its Celebration campus. With room to grow inside its walls, the Nicholson Center is undergoing small-scale growth with the development of a new lab space on its second floor.
“Eventually, the facilities development arm will swing back to us and we’ll double in size,” Dr. Smith says.
Given Orlando’s current trajectory, that shouldn’t be long.