Trials on UCLA’s Robotic Training Device Postponed

Meanwhile, Researchers at Work on Other Robotic Developments 


by John Otrompke

Work on one of several medical robots under design at the University of California at Los Angeles has reached the point of human trials, but the trials were delayed until the fall, according to an administrator at the Center for Advanced Surgical and Interventional Technology (CASiT).

“We’re just finishing up the final touches on optimization systems and network connections on one of our projects, called the Laprobot,” said Erik Dutson, MD, coordinator of CASiT. “This robot would not need to go to the FDA; it would train them to do laparoscopies and minimally invasive surgery, which is now required to become a general surgeon,” he said.

The current incarnation is actually the second iteration of the Laprobot, according to Dutson. “We made it from scratch. The first platform was not as robust, so we remachined a lot of parts so they function more consistently,” he said, adding that UCLA manufactured every piece of the device, except the motor.

Once the tests begin, Dutson and colleagues will begin experimenting with novices. “We’re going to run them through three  of five standardized tests, to see if can teach them at a faster rate with a robotic interface,” said Dutson. The researchers would   test the Laprobot on three groups of ten novices, and use the device to teach them to pass a plastic triangle from one hand to another without dropping it. to do a surgical knot, and thirdly, a  scissor cut, he explained.

Initially, the experiments were to be complete by the end of the summer, but they have now been postponed until October or November, according to an administrator, so that researchers could resolve network issues and not have a problem with video delays in the telesurgery project.

“The robot would have to have certified as validated training tool, so we would request their endorsement of the Society for American Gastrointestinal Endoscopic Surgeons (SAGES),” Dutson said. If successful, he would hope to market the device for about $100,000 apiece, he added.

Other Research, Including Novel Robot for Eye Surgery

However, the Laprobot is only one of several project under way at the institution. A second one is a modular system under design for adding tactile feedback to surgical robots, while the other is a novel robot designed for eye surgery, Dutson said.

“We have patented a system which registers tactile feedback to the da Vinci, which allows us to mount silicon balloon pads that cause pressure indentations on the fingertips.

The system is modular, according to Dutson, which means that it could be remodulated for any other potential surgical robot, should another large manufacturer decide to produce one.

“One of issues with the system is whether it’s too expensive, or whether the water-proofing is cost effective,” said Dutson, noting that each instrument for a da Vinci costs around $2,500 and may last for ten uses. Adding the tactile feedback system may add another $500 or $1,000 per instrument, according to Dutson, who added that marketing is probably at least two years in the future.

A more novel product under design is a robot for opthalmalogic surgery. 

“The platform for this is fundamentally different from any former surgical robot,” said Dutson. “The da Vinci has a series of arms for a modular platform that rolls over the patient, while the platform for  our opthalmologic robot is a halo which is secured to the patient’s bed over their head, allowing it to operate relative to the bony structures in the skull,” he added.

Having co-authored an early paper on robotic ocular surgery (“Robotic Ocular Surgery,” by Tsirbas, Dutson, and Mango, in the British Journal of Opthalmology,  January of 2007), Dutson and fellow researchers Tsu-Chin Tsao, PhD, professor in the department of mechanical and aerospace engineering, and Jean-Pierre Hubschman, MD, an assistant professor in Jules Stein Eye Institute, have made a smaller robot for retinal surgery.

Adept’s Purchase of Mobile Robots Expected to Result in Price Decrease for Swisslog’s Hospital Robots

by John Otrompke

Consolidation among the manufacturers of two recently-marketed hospital robots currently sold in the U.S. may result in a price decrease over the course of the next year.

The acquisition of Mobile Robots by Pleasanton, California-based Adept Technology took place last summer. The two companies had manufactured components of two hospital robots, the Robocourier and the Speciminder, sold by Swisslog, a European company with operations in Denver, Colorado. Formerly, Mobile Robots made the base, but now Adept will make both parts of the robot, the base and the top.

While the robots have been 15 years in development, marketing has been taking place in earnest for just over a year, according to Jeff Barber, product manager for Swisslog. 

Currently, about a dozen robots operate in various hospitals, such as Inova Fairfax Hospital (a part of Inova Health Hospital System), where two robots operate in the hospital, and two in the central laboratory, Barber said.

“Seventy percent of people in the hospital have lab tests done,” said Barber, who noted that the Robocourier is equipped for sensitive tasks with a proximity badge reader, an interface for the elevator, and auxiliary devices such as a wireless door interface and an arrival indicator, which can also serve as a call button.

“The domain for the Robocourier is anywhere in the hospital. Perhaps I don’t want it to open the door, but to have something delivered outside, or has an open-topped payload bin and is designed to operate in controlled spaces in the hospital or the lab.

The two robots range in price between $75,000 and $100,000, depending on the services and options that come with it, Barber said, but prices would likely come down over the next year, due to the manufacturer consolidation, as well as increased volume. No robots have yet been sold in Canada, Barber added.

The robots are part of of an array of robotic devices Swisslog sells to hospitals, including a pill picking machine designed to service an entire large hospital, and the MedRover, part of a cart pushed by a nurse. “The robot presents only the medication that’s supposed to be administered, and it reduces the chance of an error compared to if the nurse goes to the medicine cabinet,” Barber said.

Robotic Surgery: Where it’s Been and Where it’s Going

Commercially-Sponsored Supplement

The use of robotic instruments in surgery was first documented in 1985. Over the years, surgeons have found that the technology offers greater precision in their work, and frequently benefits patients with shortened recovery times and reduced risk of infection because they can be used in a less invasive manner. The science behind these instruments has evolved considerably. Here’s a look at how far robotic surgery has come, and some thoughts about robotic surgery in the future.

AESOP and the da Vinci Surgery System

In 1990, the AESOP surgical system became the first approved by the FDA to be allowed in an endoscopic procedure. The robotic arm was controlled by voice commands to help maneuver a camera. Robotics took another big step in 2000, when the FDA approved the da Vinci Surgery System for use in general laparoscopic surgery. The prototype was designed by the United States military, which hoped surgeons would be able to operate on wounded soldiers without being placed in harm’s way, themselves. However, because the da Vinci system wasn’t very portable, this original goal was abandoned. 

A private company later purchased the technology and adapted it to suit robotic surgery as we know it today. da Vinci surgical system procedures were different. The robot’s smaller surgical arms and “Endo-wrist” feature gave the surgeon greater dexterity, improved accuracy, and made operations easier on the patient. Additionally, a three-dimensional magnification screen offered greater visibility during an operation.

Perception from the Public and Medical Professionals

As robots have gained a stronger foothold on the medical industry, both surgeons and the public have been drawn to their applications, and particularly the idea of less invasive surgery, which may shorten recovery periods. The list of operations for which robots are used is growing, but the cost of undergoing these operations is pricier than the more traditional counterpart.  

The Future

Because technology can change so rapidly, it’s possible that many unanswered questions about robotics in surgery will be answered with time, and that many new questions will arise. In 2004, a study published by the National Institutes of Health noted that training requirements, issues of medical malpractice liability, training, and other credentialing requirements will remain prominent aspects of robotic surgery which must be addressed.

However, the study also recognized that robotics have tremendous potential to continue revolutionizing surgery. Indeed, the public’s interest in minimally-invasive surgery has increased demand for these instruments, driving medical facilities to acquire this technology and remain competitive in the marketplace. Not only will researchers continue refining the procedures they conduct, and further advances in the technology will help solidify the role robots place in surgery in the future.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/ 

http://www.njurology.com/_roboticsurgery/robotic_surgery.php 

http://www.roboticoncology.com/history/ 

http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group02/Group%2002%20Website/history_robotic.htm 

http://www.manateememorial.com/P-Z/Hospital-Services/Surgery-Center/da-Vinci-Robot