Monday, October 24, 2016

Surgical Robots – Current Status and Next Generation Solutions

By Alind Sahay

Vice President
Noxilizer, Incorporated

Today, robots are present in a variety of application areas in the healthcare space – in surgery, pharmacy, rehabilitation, hospital services and many new application areas.  With orders of magnitude improvements in processing power and maturing of sensor technologies, there is a global and societal trend toward increased use of robotics. Global spending in robotics, and correspondingly, in the surgical robotics areas is expected to more than double in the next 5 years. 

The surgical robotics field is over three decades old – the first robot-assisted surgical procedure occurred in 1985 when a neurological biopsy was carried out using a PUMA 560 robotic arm.  In this article we will take a look at areas where there has been significant adoption – laparoscopic and general surgery, orthopedic surgery, spine and neurology – and explore next generation solutions that are expected to drive further growth.

In the laparoscopic surgery area, in 2016, we expect more than 700,000 robotic procedures worldwide. Clinical adoption, to date has been driven by benefits from the reduction in hand tremors, the minimally-invasive nature of the system and improved visualization.  Along the way, there have been innovations such as improved image resolution, shortened set-up time and, recently, improved visualization to identify vasculature beneath the tissue surface.   A number of studies have shown that robotic assisted surgery leads to shorter hospital stays and faster recovery times.  However, there continues to be a debate regarding the clinical benefits of robot assisted surgery.

While more recent clinical data may demonstrate clinical benefits, next generation solutions have the potential to provide step-function improvements. These solutions include Laparo-Endoscopic Single Site Surgery (LESS), Natural Orifice Transluminal Endoscopic Surgery (NOTES) and further improvements in surgical field information that could be presented through a merged visualization display.   Surgical field information will include further improvements in 3D vision, in vasculature information, improved haptic feedback, as well as cellular level information. These next generation systems have the potential to further reduce overall cost as well as improve final outcomes.  One robotic system that provides NOTES capability recently became commercially available and we expect that more Single-Site Surgery systems will become commercially available over the next 2-3 years.

In the orthopedic space, adoption has been slower – in 2016 we expect approximately 100,000 worldwide robot-assisted procedures.   In this space, there are two types of available robots – active robotic systems where the bone machining is autonomous, and passive robotic system where the robot constraints the surgeon but the machine is under the surgeon’s guidance.  Recent clinical publications from all these systems have demonstrated that component positioning and alignment, using robot assisted surgery, is statistically superior to manual surgeries.  And in a recent 2-year follow-up study using an active robotic system, there is evidence that for robotic surgeries, there is less bone loss when compared to manual surgeries. 

A significant challenge faced by orthopedic robotic systems is that the robot is only responsible for bone machining, which is one half of the surgery – the other half is the design of the orthopedic prosthesis itself.  Therefore, by integrating the development of the robotic systems and prosthesis, there may be synergistic opportunities related to system design, clinical workflow and business processes.  For example, by using a robot, it is possible for orthopedic implant companies to eliminate a significant portion of the bone preparation hardware, thereby significantly reducing cost.  Synergistic possibilities in improving the design include further reduction in invasiveness and potentially reducing overall operating time through workflow improvements.   As more long-term data is available with more recent improved systems, orthopedic robots will also demonstrate an improved quality of surgery.  In the spine space, recent retrospective and prospective clinical studies have shown a significant reduction in complications and revisions for robot assisted surgeries.

Recent clinical data, from robot assisted surgical procedures, provides strong evidence of improved alignment and reduced bone loss (orthopedic robots), reduced recovery times (laparoscopic and general surgery robots) and reduced complications (spine robots).  Next generation solutions described earlier have the potential to significantly decrease invasiveness and improve clinical outcomes.  Because robot systems are computer controlled and have the capability to store surgical case data records, these systems will eventually incorporate Artificial Intelligence to augment the surgeon’s decision making process.   For these same reasons, these systems will be used more routinely for quality control purposes within a hospital system.  With further increases in procedure volumes and increased competition, we can reasonably expect that the cost of robotic surgeries will come down, while outcomes are being improved. 

Alind Sahay is a research and development business leader and innovator with over 20 years experience developing and launching innovative medical devices for global markets, which includes over 12 years leading product development for image based robotics at Integrated Surgical Systems and navigation systems at GE Healthcare. His business development experience encompasses defining and executing on technology-based opportunities, including licensing and collaborations. 

Currently, he is Vice President, Research and Development at Noxilizer. Previous positions include Program Director, Endo Health Solutions, where he was responsible for the complete research and development portfolio for the Healthronics product line and Director, Product Development at Terumo Cardiovascular Systems, where he managed new product development and line-extensions for cardiac pumping systems and associated disposables.

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