Healthcare // Clinical Information Systems
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11/15/2013
08:00 AM
David F Carr
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Surgical Robots: Look Who's Coming To The OR

Intuitive Surgical's da Vinci system dominates the field, but it doesn't have a lock on innovation. Take a look at present and future surgical robots.
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The surgical artist
Robotic surgery today is virtually synonymous with the da Vinci system from Intuitive Surgical, which allows a surgeon to control a four-armed machine that can be used to perform minimally invasive surgery. Three of the arms are designed to wield surgical tools while the fourth probes the surgical site with a high-definition camera that sends a 3D image to the surgeon's console.

Although robots play other roles at hospitals, such as sorting and delivering medication, none of those applications has captured the public's imagination as much as the idea of robots performing surgery with inhuman precision. The da Vinci system is the most flexible example in production, capable of performing multiple operations. The next-most-significant surgical robots in use today are probably those from Mako Surgical, which are specialized machines for performing knee and hip replacement surgery.

Intuitive says it chose to name its product after Leonardo da Vinci because he designed the first "robot", a sort of animated suit of armor, plans for which were found in one of his sketchbooks. Intuitive's armor has been its patent portfolio. Competitors also face the steep challenge of designing a complex medical device and getting it approved for use.

Hospitals are looking for alternatives because of the cost of the da Vinci robot and its questionable impact on clinical outcomes. However, according to The Advisory Board Company, a healthcare technology advisory firm, the alternatives are years away from commercial availability. While those products are in development, Intuitive also has the opportunity to continue improving its own products.

"Competitors are going to have to come to market with something that is significantly cheaper or that demonstrates an outsize clinical benefit," said Rachel Klein, a research and insights consultant at The Advisory Board Company.

Competitors might be able to find a market opening, because the da Vinci system costs almost $2 million and comprises several large pieces of equipment that use up a lot of space in a hospital, Klein said. A couple of years ago, hospitals looking to showcase their cutting-edge technology were talking about adding a second robot. Today, they're more likely to be thinking about how to maximize the effectiveness of the equipment they already have.

With some studies questioning the assumption that robotic surgery really delivers superior clinical results, hospital leaders are also taking a second look at whether the da Vinci robot is being used effectively at their facilities and when its use is necessary, according to Klein. There seem to be a few procedures for which the da Vinci legitimately delivers superior results, she says. In other cases where other techniques for laparoscopic surgery are available, bringing a robot into the operating room could add to the cost and complexity of a procedure unnecessarily.

All that's needed to change the cost-benefit equation is the demonstration of greater benefits, ideally combined with lower cost and smaller units. But the upstarts will find Intuitive to be a formidable competitor.

Photo: Intuitive Surgical

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anon9719738726
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anon9719738726,
User Rank: Apprentice
11/23/2013 | 3:15:28 PM
Re: Is it just me?
If a car hits another car we sue the driver not the car. Surgical "Robots"are being "Driven" by a Doctor, that is who should be sued. (In My Humble Opinion.)
anon9719738726
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anon9719738726,
User Rank: Apprentice
11/23/2013 | 3:00:10 PM
Terminology...
Science fiction writers in the mid 20th century gave us names for much of the high tech equipment that are built and in use in the present. One was Robot, as an autonomous machine styled after a humanoid and performed with high precision the tasks as needed done, Like a "Generalist" they were very good at many tasks with no continous human control. The Robots in manufacturing plants doing welding and painting at high repeatable accuracy are examples in use. However another similar technology which appears to be a robot but is not autonomous but instead under the constand detailed control of a trained operator was named a "Waldo" not a Robot. Because the operating room surgical machine is in constant control by the Doctor, it is in fact a "Waldo" and not a robot. By making this point clear, to the patient, that the Doctor, and not a computer controlled mechanism, was performing the operation. Perhaps using the proper terminology, "Waldo" NOT "Robot", the patients would be better served, and less concerned. Proper vocabulary promotes understanding, but, misused terminology confuses and concerns users, who then misinterpret the operating proncipals and procedudes, with any technically complex systems. 
tkeller852
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tkeller852,
User Rank: Apprentice
11/21/2013 | 2:07:56 PM
Scary?
When they roll you into the operating room and move you onto the small,narrow platform under a big four armed monster it does look very intimidating.  I have an engineering background so I probably was not so intimidated as someone that less understands the machine.  You kind of wonder at that point but when you wake up with no pain and pretty much just four band aids you have to be impressed.  I was walking down the hall the afternoon of the same day.  The biggiest incision was not for the robot but was to get my prostate out.  Good, well done modern technology is truly wonderful.  It's worth a lot more than a new facebook.  Cheer it on!
Alison Diana
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Alison Diana,
User Rank: Moderator
11/19/2013 | 10:02:49 AM
Re: Is it just me?
There have been quite a few issues with da Vinci robots, including some lawsuits. Now, there are a lot more lawsuits associated with human surgeons, of course, but I think people get a bit leery of robotic operators. Anything new, especially in the surgical suite, will lead to increased scrutiny. With Watson, IBM has been very careful to underscore the big role doctors continue to play. Eventually, though, I'd imagine the tech will become more proactive and equipped to physically do more in an OR, ER, ICU, and other healthcare facilities.
David F. Carr
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David F. Carr,
User Rank: Author
11/18/2013 | 10:27:48 AM
Surgical robots not autonomous AI, so far
From everything I learned, no one is in any rush to give surgical robots autonomous capabilities. They're meant to be carefully controlled by a surgeon, albeit operating remotely. That doesn't mean there aren't clever algorithms in the mix, but typically for things like damping out the vibration of the surgeon's hands so the movement of a robotic arm can be precise.
Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
11/18/2013 | 10:04:46 AM
Re: AI in HC
I'd love to see how Watson would perform in the OR. Right now he's useful for mining extremely large data sets to improve education and outcomes, but I'm interested to see if he'll enter the OR and provide clinical decision support anytime soon. 
Lorna Garey
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Lorna Garey,
User Rank: Author
11/15/2013 | 9:58:05 AM
AI in HC
David, I've been reading a lot about use of artificial intelligence in HC. I think I would be OK with Watson helping with my surgery.
David F. Carr
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David F. Carr,
User Rank: Author
11/15/2013 | 9:45:57 AM
Is it just me?
Is it just me, or do these surgical robots look scary? They remind me of an Imperial torture device from Star Wars.

I guess a human surgeon with a knife in his hand looks a little scary, too.
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