Jonathan Sorger on November 8th at
> Robotic-Assisted Surgery
> Jonathan Sorger is Director of Medical Research at Intuitive
> a Sunnyvale based medical device company that develops and markets
> robotic-assisted minimally invasive surgical (MIS) systems. The
> company's market leading/ da Vinci/ ® Surgical System was
> 1999 and is now found in over 1450 hospitals worldwide.
> Jonathan earned a B.S. in bioengineering from the University of
> California, San Diego, and Ph.D. and MBA degrees from Johns Hopkins
> University. He helped develop and teach the first-year
> Ph.D. program at Stanford University before moving to Varian
> Systems, where he was responsible for Varian's integration of
> medicine into radiation therapy. At Intuitive Surgical, he helps
> interpret clinical needs regarding the development of
> surgical robotic platforms.
> Jonathan will give an overview of the history of MIS, describe
> technologies and applications, and hint at what we might see in the
> next-generation of systems.
Dr. Sorger began by explaining that
Intuitive Surgical, the company that manufactures the robot, is a
Sunnyvale company that was founded in 1995 and currently has about 1800
employees, including a local manufacturing staff. There are at least
2000 of their systems out there doing surgery on a regular basis.
The original basis for robotic tools of
many kinds was Robert A. Heinlein's short story about a boy named
Waldo, whose body was so weak that he couldn't use it until he invented
"remote manipulators". The idea has since become widely used,
particularly in areas where extreme conditions make it impossible for
people to go. Inside nuclear reactors, out in space and deep under the
sea are just a few of the more famous examples.
The founders of Intuitive were inspired
by technology developed at SRI with DARPA funding - robotics for
improving battlefield medicine. They started with a prototype system
developed by SRI. Sorger showed us a video they had made to get DARPA
funding. It started with a "man down" on a battlefield. This robotic
ambulance picked him up. Inside a tank like hull was an operating table
with just enough space around it for robotic tools manipulated by a
surgeon miles away in a safe place to stablize the patient for
transport to a hospital. After much trial and error Intuitive figured
out that laparoscopic surgery could be improved through robotic
Laparoscopic surgery was first
introduced in the 1980s, with the idea that making a smaller hole in
the patient would lead to faster healing times. The problem was that
accurate work is difficult with limited room to manuver. Robotic tools
get around this by puting a small camera and remote manipulators at the
end of the probe inside the patient that fits through a small
hole. By scaling response so that the doctor manipulating the
"waldoes" can use gestures of a size that are easy to make, the much
smaller tools inside the patient do exactly what is needed, making the
situation better than could be done manually.
The DaVinci robot has two parts, the
part that interfaces the surgeon and the part that probes the patient.
The surgeon interface looks like a big viewing console over an area
where the surgeon moves his hands in master manipulators. There are
foot pedals to change what the hand switches control as well as what
the display screen shows. The patient side robot resembles a
squid with a few tentacles, each ending in a different tool. One is a
stereo CCD camera, another a knife, etc. The other end of the patient
probe has motors connected to the remonte manipulators by tungsten
wires to control the action inside the patient and computer equipment
to decode the commands. Sorger explained that each tool arm has a wrist
and elbow to give the surgeon flexibility required to do his job.
Applications where machine assisted
laparoscopic surgery have been successful include prostate cancer,
hysterectomies, and throat cancer. The surgery can take longer than
with an open procedure, but because the patient leaves the operating
table with much smaller holes they heal faster and are less likely to
get infected. Some surgeries work out so much better when done this way
that every year a greater percentage of such operations are done with
MIS robots. For prostate surgery its already reached the point where
most such surgeries are done this way.
Lots of development work is being done
in fluorescence imaging. The idea is that a florescent tumor is easier
to remove, and a florescent nerve is easy to miss during surgery.
Development work is also going into getting more control through
smaller holes in the patient.
During Q&A the following points came up:
MIS is successful because the smaller
wounds mean less blood loss, less time in the hospital and less
infection. Standardization of procedures also reduces complications.
Usually this means savingabout $700 per surgery.
The main competition is conventional
"open the patient" surgery. Also, China claims to be developing a very
similar machine for their domestic marketplace. The Canadians have a
company that is working in the area, and that machine will probably be
on the market soon. Intuitive is working to develop the best machine in
the market at the best price.
Each DaVinci robot machine costs about
$1,500,000. In addition, each operation uses about $1800 worth of
<>Other interesting information about specific surgeries can be found