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The beta1 and beta2 versions of the Italian Surgenius system.
Image credit: Surgica Robotica

Da Vinci hysterectomy under investigation

Since 2011, hysterectomy became the most common procedure of the da Vinci. There are approximately 600,000 cases a year in the US, and da Vinci hysterectomy (approved in 2005) has increased its penetration from 0.5% in 2007 to 9.5% in 2010. A recent study published in the Journal of the American Medical Association found no difference in the surgical outcome of dVH versus hand-held laparoscopy. (Even the editorial was analyzing these results: "rapid dissemination of robotic surgery in the United States may be linked to a number of converging factors, including better ergonomics for the surgeon, marketing campaigns, and the national fascination with technology and innovation...")

"Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the US from 2007 to 2010 found:

• the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR])
• patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR)
• transfusion requirements (1.4% vs 1.8%; RR) 
• rate of discharge to a nursing facility (0.2% vs 0.3%; RR) 

Total costs associated with robotically assisted hysterectomy were $2189 more per case than for laparoscopic hysterectomy. Median cost to the hospital of robotic procedure is $8,868, compared with $6,679 for laparoscopic hysterectomy."

You can read a more thorough analysis of the article here.

@100K

Today, SurgRob has passed 100K visits. Thank you all for visiting!

The "evil" robot surgery legal case

 

Since da Vinci surgery has become commodity, naturally, we have seen the rise of errors and malpractice. However, surgery is not a risk-free business, and since the nature of the robot (the master-slave teleoperation) does not allow autonomy in the control, so far, legal cases ruled in favor of Intuitive. Recently, we have seen a new wave in robotic-surgery legal cases, along with the rise of law offices specialized on this topic. (Apparently some not even knowing how a da Vinci looks like...)

 To be a little more objective, you can read a fair narrative here. Also, anyone can check ALL medical device related issues on FDA's MAUDE site. E.g., in January this year, there have been 18 cases of any kind reported with the da Vinci, and 280 in 2012, total, therefore the "thousands of victims" is a clear exaggeration. These issues reported are typically not even related to any malfunction of the robot. Hard not to see all this as the lawyers intention to tap into Intuitive's huge profit.  

Nevertheless, Intuitive is facing some challenges due to these news, investor speculations, and also, the rise of competitors.

Besides, the number of prostate surgeries have been declining, strengthening the position of hysterectomy as #1 (see figure below). "Q3 2012 US da Vinci Prostatectomy procedures were approximately 20% lower than Q3 2011. Year to date 2012 prostatectomy procedures were 14% below YTD 2011. The US prostatectomy decline appears to be driven by a combination of the US Preventive Service Task force recommendation against PSA testing and a change in treatment recommendations for low risk prostate cancer away from definitive treatment."(Intuitive Inc.) 

Image credit: Conflict Health blog

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Vintage finding: the first surgical robotic procedure from 1985 on photo. 

Dr. Kwoh with the PUMA robot. More images at Corbis Images.

Electromagnetic Tracking in the Operating Room

I was asked by Intuitive to give a seminar talk on the basics of electro-magnetic tracking. 

You can check the presentation here.

"In the past decades, many new trends appeared in interventional medicine. Electromagnetic Tracking (EMT) has been introduced to medical applications as an effective tool for navigation. However, magnetic fields can be severely distorted by ferromagnetic materials and electronic equipment, which is a major barrier towards their wider application. The focus of our research is to determine and compensate the inherent errors of different EMTs, in order to improve their accuracy. In the past decade, significant research work has already been invested into EMT performance analysis (Hummel, Wilson, Maier-Heim, etc.), yet there is still a need for a method providing objective, comparable results in different clinical environments.
Within an international consensus group, we aim to advance the state-of-the-art, to develop a standardized, simple and repeatable assessment protocol. This would lead to the ability to determine tracking errors with sub-millimeter accuracy, hence increasing the measurement precision and reliability. We aim to disseminate best practices, provide an easily reproducible calibration method, publishing the design templates of accuracy phantoms and supporting the process and evaluation of measurement data. This should allow the wider spread of the technique, and eventually lead to the repeatable and comparable assessment of EMT systems."

For more information, see our references! Learn about our joint EMT efforts here.

Report from the Valley

The fun fact of the week: according to Intuitive, there is a da Vinci robot in Budapest!

Whoever is hiding it, please email me! 

CIS news

• Stanmore's Sculptor Robotic Guidance Arm got FDA approval
• Report on Kaiser Permanente's health care robots day
• Augmented Reality for astronauts to perform surgery developed by ESA. See the prototype system in action.
• Hong Kong is an emerging robotic training center
• Intuitive is fighting short sellers, after a negative Citron report, yet Intuitive reports strong sales and the stock prices are higher than ever!
• New da Vinci simulator from MIMIC
• Needle insertion á la ROBOCAST
• Surgical robots at All on Robots
• Some updates on the Huatuo robot

• Aethon medical robot reports record revenues for 2012
• Xenon sterilizing robot is on the rise
• 10 medical robots that could change healthcare
• More on RP-VITA's approval

• Listen to Catharine Mohr's RI Seminar talk
• Browse through various IRCAD Student seminar talks on CIS
• Browse the SMIT2012 meeting's abstracts
• ICRA2013 Workshop on "Evaluating effectiveness and acceptance of robots in surgery"

• Hands-free control of surgical devices in the OR
• New craziness on YouTube: playing and failing with Surgeon Simulator 2013
• Ethical issues with electronic patient data

More medical robots entering the ring

• The eastern Iowa Mercy Medical Center hospital is the first in the US to install an I-V Station Onco robot for  mixing and administering chemotherapy drugs. The robot is produced by Health Robotics that has "80% of total IV robots market share in the world [including over 90% the Oncology Robots global market]. Health Robotics is the undisputed leading supplier of life-critical intravenous medication robots, providing over 300 hospital installations in 5 continents with the only fully-integrated robotics-based technology, IV Workflow, and manual compounding software automation solution. Health Robotics’ second generation solutions [i.v.STATION, i.v.SOFT, and i.v.STATION ONCO] have been found to greatly contribute to ease hospitals’ growing pressures to improve patient safety, increase throughput, and contain costs. The technology has no recorded medical errors within the organizations across Europe and elsewhere that already use it."

• GE Global Research is developing a robot that can sort, sterilize, and prep surgical tools automatically, minimizing mistakes and freeing skilled hospital personnel for other less-tedious jobs. GE researches are already using prototypes for hospital sterile processing . "Technologists at GE Global Research, working with the U.S. Veteran's Administration, are starting to build a robotic automation system to assist with handling, placement, accounting, and sterilization of surgical tools and kits. As part of the two-year $2.5 million project, the designers will evaluate the system at a VA hospital."

• Our ACMIT center has also created a prototype system for bin-picking tasks in the sterile environment.

Source: Txchnologist, Radio Iowa