Thoracic surgeon Johannes Kratz, MD, has been selected as UCSF’s first medical director of robotic surgery. He served as co-director of UCSF Health’s robotic executive committee from 2018 to 2022, becoming its sole director in 2022. Under his stewardship, the program has grown year over year, with UCSF surgeons performing robotically assisted thoracic, gastrointestinal, colorectal, urologic, gynecologic, cardiac, otolaryngological, head and neck, and bariatric surgeries. In this interview, Kratz discusses tracking volumes and outcomes, adding new service lines, developing credentialing processes and enabling innovation at UCSF.
Johannes Kratz, MD
Q: Why is this centralized medical director role so important to the robotic surgery program?
A: Our primary goal is to deliver the best possible patient care in the context of this new surgical technology. Robotic surgical equipment is one of the biggest investments a medical center can make. It’s a unique resource that’s shared across multiple service lines, divisions and departments, so it requires a fair bit of coordination. We need to make sure that access to this shared resource is distributed equally and fairly and that it’s being utilized maximally. Our other mission is to educate the next generation of surgeons on the use of the technology.
Q: What types of thoracic surgical cases are particularly appropriate for robotic-assisted procedures?
A: Those that are more complex than traditional minimally invasive cases, but not so complex that they require open surgery, are the cases in which robotic-assisted procedures really have their niche. A great example is a lobectomy, which is fairly complex and can be done minimally invasively. But I can do a finer dissection and a better job of getting all the lymph nodes out using a robotic-assisted approach because I have better visualization and manual dexterity.
Another example is a thymectomy. In the past, many of these cases required a sternotomy. Robotic technology now enables thymectomies to be done minimally invasively. This transformed a procedure that once required a lot of perioperative care into one in which only a few small incisions are needed.
Q: How are robotic surgical volumes and outcomes tracked at UCSF?
A: This was manually curated early on, but over the past year, we’ve worked hard to create a Tableau dashboard to report these numbers automatically. It tracks volumes and the services, surgeons and departments using the robotic surgical equipment and the ORs in which they’re used. It even calculates the utilization percentage by day, so we know which ORs are utilized most and where there are opportunities.
The outcomes tab on the dashboard tracks data like length of stay, ICU admissions, blood transfusion requirements, readmissions, surgical mortalities and operating time. It can also compare outcomes to similar non-robotic operations.
Q: How is the UCSF Robotic Surgery Program unique?
A: UCSF is always trying to be on the forefront of cutting-edge health care. There’s a tradition at our institution of research and innovation, and we push the frontier to incorporate technologies, techniques, procedures and the latest advances in medicine to better the care of our patients.
We were one of the first institutions in the western United States to do robotic surgery, and we stay very up to date and are always incorporating the latest robotic technologies, including the new single-port robots and robotic bronchoscopes.
We continue to innovate with the kinds of procedures that can be done at UCSF, such as robotic mitral valve surgeries, Whipple procedures and single-port colorectal operations. We just performed our first robotically assisted donor nephrectomy for transplant.
Q: Are there plans to grow the program?
A: We expect to keep expanding our indications for robotic procedures and the number of service lines performing them. The next two areas of expansion are orthopedic surgery, specifically robotic hip and knee replacement, and neurosurgery – using robotic technology to guide spine procedures.
Q: What is the process for integrating robotic surgery capabilities into a service line?
A: One of the charges of the robotic executive committee is to organize and formalize a process of how that happens. We now have pathways for credentialing, new procedures and new technologies. There are a number of different phenotypes a surgeon might fit into, such as a credentialed surgeon who’s never done a robotic procedure that’s being done by other UCSF surgeons. That’s the most straightforward credentialing pathway. It covers how to get trained and work with other surgeons in the department, and the approval and proctoring processes.
If a surgeon wants to use a piece of equipment for a procedure that's never been done at UCSF, the new procedure pathway involves creating a proposal that incorporates the value to patients, first and foremost, as well as economic and strategic implications. Next steps are sign-off from department leaders and bringing the proposal to different committees, including the robotic executive committee and the health and safety committee. Then integrating all the feedback, resubmitting the final proposal, creating the new robotic procedure and getting credentialed to perform it.
We’ve also created a pathway for a new robotic surgeon who wants to do a new procedure on robotic equipment that’s not yet in place at UCSF. This is the most extensive process requiring the highest levels of sign-off.
The creation of my new position is an example of how thoughtful UCSF has been about implementing robotic procedures the right way – very directed and regulated. At the same time, we never want to prevent anyone from doing something new. Our objective is to enable innovation. That means making sure everyone involved is on same page and excited about the vision.
Q: Do you publish outcomes data?
A: There’s academic rigor behind what we’re doing, so we also participate in the publication of our research around robotic surgery outcomes. We disseminate our information so that others can learn from it. We’re always interested in bettering patient outcomes.
To learn more
UCSF Thoracic Surgery and Oncology Clinic
Phone: (415) 885-3882 | Fax: (415) 353-7151
