Surgical Robots: Look Who's Coming To The OR - InformationWeek

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11/15/2013
08:00 AM
David F Carr
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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David F. Carr
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David F. Carr,
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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,
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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,
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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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