Jonathan Sorger on November 8th at 11:45 AM
>
> Robotic-Assisted Surgery
>
> Jonathan Sorger is Director of Medical Research at Intuitive Surgical,
> 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 introduced in
> 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 bioengineering
> Ph.D. program at Stanford University before moving to Varian Medical
> Systems, where he was responsible for Varian's integration of molecular
> medicine into radiation therapy. At Intuitive Surgical, he helps
> interpret clinical needs regarding the development of next-generation
> surgical robotic platforms.
>
> Jonathan will give an overview of the history of MIS, describe current
> 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 assistance.

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.

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 disposable parts.