Medical Robotics Magazine

Follow-Up Data from UCSF Suggests Cyberknife Monotherapy Results Improved Slightly Over Time

2011-12-23T15:41:00.000-06:00

Original Study Compared Stereotactic Monotherapy, Boost and Brachytherapy

by John Otrompke

Follow-up analysis from a small study comparing boost and monotherapy with the Cyberknife and brachytherapy for prostate cancer suggests that some monotherapy results have improved since publication, a researcher from the University of California at San Francisco said.

In the original study, published last year in the International Journal of Radiation Oncology, Biology and Physics, 20 of 38 patients were treated by the Cyberknife with stereotactic radiotherapy as a monotherapy, while 18 received the Cyberknife treatment as a boost (following external beam radiation and hormone therapy).

The article, ‘Stereotactic Body Radiotherapy as Monotherapy or Post-External Beam Radiotherapy Boost for Prostate Cancer: Technique, Early Toxicity, and PSA Response’ (Jabbari, et al), which was published December 21, 2010, reported results at a minimum follow-up of 12 months.

In the time since publication (nearly a year), PSA nadirs for those treated with Cyberknife monotherapy have come down to more closely approach the lower level achieved with patients who received Cyberknife therapy as a boost. PSA nadir for those who received boost therapy was 0.3 nanograms per milliliter upon follow-up analysis, compared to about 0.5 at the time of the original publication,according to Alexander R. Gottschalk, MD, PhD, associate professor in radiation oncology at the University of California at San Francisco, a co-author on the study.

The nadir for those treated with both external beam radiation and the Cyberknife remains at 0.1, he added.

To date, Gottschalk has treated about 110 patients with stereotactic therapy, about half with monotherapy, and half as a boost, he said. In the study, which was not randomized, sicker patients received Cyberknife as a boost, Gottschalk explained.

“Patients who got Cyberknife treatment as a boost also received hormonal therapy, because in general they had more advanced disease, which required more aggressive therapy,” he said. “I try to choose whether they should get monotherapy or boost therapy depending on their prostate cancer characteristics,” he added.

Those who received Cyberknife as a monotherapy received 9.5 Gray for four fractions, while those who received a boost received the same dose for two fractions. When stereotactic therapy was used as a boost, the patients got 25 fractions of conventional radiation with two fractions of SBRT.

At the time of the study, researchers compared the PSA nadir achieved with both forms of Cyberknife treated with that experienced in a similar group of 44 patients who received brachytherapy, or high dose rate radiation with temporary radioactive “seeds,” according to the study.

Those in the monotherapy cohort had a median PSA nadir of 0.47 in the originally-published data, compared to 0.1 in the cohort which received boost therapy.

For those who received brachytherapy, the nadir was 0.09, with a median follow-up of 48.6 months, the study indicated.

There are two types of brachytherapy: a permanent implant, and high dose rate radiation, in which a patient usually stays in the hospital for about 24 hours, Gottschalk noted.

Follow-up data indicated that grade three gastro-intestinal side effects remained the same and late grade three gastro-urinary toxicities remained similar.

In the original study, 42% of patients who received monotherapy with the Cyberknife had acute Grade 2 toxicity, compared to 11% of those who received Cyberknife as a boost, at a median follow-up of 18.3 months.

While Gottschalk still reported no early-occurring grade three gastrointestinal toxicities, about four out of 110 patients have reported a late-occurring grade three gastro-urinary toxicity, requiring a catheterization, he said.

In the original study, two patients experienced a late-occurring grade three gastro-urinary toxicity. Biochemical and clinical data show that no patients have progressed, Gottschalk added.

2011-10-19T17:55:00.002-05:00

MR Editorial Advisor Tang Attends Conference with Taiwanese President

2011-10-19T17:43:00.003-05:00

by John Otrompke

MR’s editorial advisor, Prof. Hsiao-Wei Tang, PhD, was honored to appear and speak at a conference along with the president of Taiwan, Ma Ying-Jeou.

The Invest in Taiwan forum is an event focusing on minimally-invasive surgery technology, said Tang, who is also the director of the International Center of Excellence in Medical Robot at the Asian Institute of Telesurgery, http://aits.tw/ , in Taiwan.

Tang is hopeful for progress with his developmental robotic device, the Hua Tuo robot, which will be publicly demonstrated on phantoms in Taipei, Taiwan, this month.

The prior incarnation of the robot, the Vesalius, was developed with funding from the University of Leuven, Belgium, which stopped development last year. Taiwanese surgeon Dr. Min-Ho Huang, who has funded hospitals and research centers, convinced Tang to move the project to Taipei, and now he and colleagues have developed a second iteration, the Hua Tuo Robot.

“The IP belongs to the University of Leuven. Now they are preparing to sign the the memorandum of understanding with me. Although they own the IP, I have all the know-how in my brain,” Tang explained.

The new version, which was developed at a cost of about $50,000 US, is more compact, and its position is more adjustable, according to Tang. The prior version weighed about eleven kilograms. Tang also said be hopes one advantage of a Taiwanese-made device would be its affordability- less than $12,000, Tang speculated.

Following the demonstration of the device as a camera holder in the robotic surgery context, at Chiang Kai Shek Memorial Hall on November 20, Tang will depart for another research engagement at Stanford University, he said.

Joint Working Group of Standards Organizations Meets to Define Medical Robotics

2011-10-10T13:26:00.000-05:00

by John Otrompke

A joint working group of two standards-setting organizations, the International Standardization Organization (ISO), and the International Electrotechnical Commission (IEC), met in Nuremberg, Germany for the second time last month to establish definitions for medical robots, as another step in creating standards for the design and manufacture of the devices.

While medical robots are thought as a preliminary matter to include aids for the disabled, as well as those which perform invasive and non-invasive procedures such as surgery, rehabilitation therapy, imaging and other robots for medical diagnosis and treatment, a number of theoretical issues remain undetermined, according to Gurvinder S. Virk, PhD, who chairs the entity, which is known as joint working group nine.

Distinctions in terminology could be important, according to Virk, who is also a professor of robotics at the University of Gävle in Sweden. “Up to now, robots have been classified as machines, and are therefore governed by machinery directive, established by the European Union.”

Among other categories include personal care robots, which an an individual uses to help himself or herself without any kind of medical connotations, Virk added. “Some devices, such as assistant exoskeletons such as a device called E-Legs which is available in the U.S., or the HAL (hybrid assistive limb), by the Japanese company Cyberdyne, help old people move about, but the medical people on our committee say that getting old is not a medical issue.”

Virk is also the founder of CLAWAR, the association of Climbing and Walking Robots, which is incorporated in the UK.

“What’s the difference between medical equipment and a medical robot?” Virk asked. “It seems to me to be autonomy, whereas most medical equipment in current use does not have any autonomous functions.”

The distinctions can become thorny, according to Virk. “The da Vinci is able to filter out the tremor of the surgeon, and most people would argue that that’s an autonomous capability.” However, the FDA license for the da Vinci describes the device as an endoscope, not a robot, according to Virk.

The joint working group will next meet in February of 2012, in Orlando. Virk and colleagues are also planning an annual International Colloquium on Medical Robots, to be held next July in Milan, Italy.

Multiple Training Systems Under Study at the University of Nebraska

2011-10-01T14:43:00.002-05:00

by John Otrompke

Follow-up research is underway to validate a surgical training module used in-house at the University of Nebraska. The training method has already demonstrated improvements in speed and smoothness of movement, according to a paper recently published in the International Journal of Medical Robotics and Computer-Assisted Surgery.

Following the most recent publication, researchers are validating the results with a larger trial. “Right now we’re in the middle of about 25 subjects, and hopefully we’ll get about 50 students students and fellows,” said Dr. Joseph Ka-Chun Siu, PhD, assistant professor in the College of Public Health. The current study will look at retention of skills six months following training, he said.

The training program, which is in its fifth year, has trained about 30 individuals in da Vinci surgery, using an interface provided by Intuitive and a custom LabView program manufactured by National Instruments out of Concord, Massachusetts.

The training program uses a technique called Augman video feedback, in which participants can either watch their performance in real time or obtain quantitative measures of fast they perform surgical procedures such as suturing, Siu said. The institution purchased the commercial LabView software about ten years ago for about $1,000, according to Siu, and subsequently customized the software, because “the robot has no direct communication back to the surgeon, saying how well you do in this procedure,” Siu explained.

Improvement in Some Measures, While Others Remain Enigmatic

In the training program, 15 medical students with no prior robotic surgery experience went through a four-day training program followed by a retention test a day later, according to the article (“,Training program for fundamental surgical skill in robotic laparoscopic surgery,” Suh, Mukherjee, Oleynikov and Siu).

Prior to the retention test, the average score measured by the Objective standardized assessment of technical skills (OSATS) criteria was 43.1%, but it increased to 66.4% after the training, and 74.1% at the time the retention test was administered, the paper said.

The students averaged 25 years; 12 were male, and three female. Researchers also examined the activities of the flexor carpi radialis and extensor digitorum, two muscles in the forearm that have been associated with surgical fatigue, and found that fatigue was reduced following the training program.

“We’re not going to strengthen the muscles, but rather to see how much muscle effort they use in order to complete the task,” explained Siu, who noted that the paper reported about a 30% reduction in fatigue following the training program.

Researchers found the simulator improved a measure called ‘movement curvature,’ a measure of “whether you move the robot in a smooth fashion,” according to Siu.

All students were right-handed. There were no significant differences in terms of the total distance traveled in performing the surgical procedures studied, the paper said. A prior randomized study of ten volunteers (“A Virtual Reality Training Program for Improvement of Robotic Surgical Skills,” Mukherjee, Siu, et al, Studies in Health Technology and Informatics, 2009), found that improvements in total distance traveled enjoyed by students who used a virtual reality simulator disappeared when students used their non-dominant arm. However, that study involved a virtual reality program, not the LabView module, according to Siu.

Bountiful Training Modules

Another early study from 2008 (“Validated robotic laparoscopic surgical training in a virtual-reality environment,” Katsavelis, Siu, et al, Surgical Endoscopy, 2008), noted the desirability of increasing the complexity of the virtual reality training environment.

“To increase the complexity of the tasks, we are increasing the steps for the participant to complete. That first report involved very simple tasks like bimanual carrying and needle passing, but right now we use the mesh alignment task, a procedure that people commonly use to repair a hernia, which requires multiple steps in order to complete,” Siu explained.

Another change from the earlier papers is that the virtual reality training program now uses a program called Vizart, manufactured by Worldviz, instead of the Webots program used initially.

“Worldlviz gives us more degrees of freedom, because the virtual object is written in a simple language, so that we can write it by ourself. Provide syntax so we can modify it with drop-down menus,” Siu said.

Regarding the module used in the training program, which incorporates the Labview product, but not the virtual reality simulator, Siu said the institution has not yet sold the product to anybody, although the studies have shown that 80 to 90% of participants improve their surgical skills. “We just use that one as our in-house training program. We did not have a good communication with the company” regarding commercialization, because Intuitive still has ownership of the platform, he explained.

Accordingly, the institution is also developing its own training simulator, which does not use the LabView product, he said.

Endocontrol Hoping for Year of Development

2011-09-29T12:32:00.001-05:00

Japanese Marketing Approval Sought for ViKY, as

Device is Used for the First Time in Taiwan

by John Otrompke

Endocontrol, a company based in Grenoble, France, is hoping for a year of successful developments, as the company recently submitted an application for marketing approval in Japan for its leading device, ViKY.

Elsewhere, a Taiwanese surgeon performed the first procedure with the device in Taiwan, and the company is hoping to release the world’s first five millimeter motorized needle driver in 2011.

Endocontrol submitted the application to market the Vision Kontrol Endoscopy device (ViKY) in Japan in February of this year, according to Stephen Song, MBA, vice president for sales and marketing.

Over 1,000 procedures have been performed with the ViKY since it came on the market in 2008. The ViKY is approved in Canada, the European Union, Korea, Russia, Taiwan, and the U.S., Song added.

Useful in Gynecologic Procedures

In April of this year, the ViKY was used for the first time in Taiwan by Dr. Yih-Huei Uen, who used a wireless microphone to control the movement and position of the laparoscope during a single incision laparoscopic cholecystectomy, or gall bladder removal, at Chi-Mei Medical Center in Tainan.

The ViKY is especially useful in gynecologic procedures, such as hysterectomy and gynecologic reconstruction, according to Song, performed either with or without the da Vinci. Those procedures are performed with uterine manipulator, which is an instrument inside the uterus, used as a handle to move the uterus around, or as a vaginal dilator, he said.

“The da Vinci cannot do it, because the architecture of the arms will not allow an arm to get into that position,” said Song, adding that the ViKY can be controlled either by voice, or by a foot pedal on the floor.

The ViKY can also be used for single port surgeries, in which it controls the laparoscopic telescope that goes through the access device, and in transrectal natural orifice transluminal endoscopic surgeries (NOTES), Song said.

Smaller Motorized Devices May Lead to Better Outcomes

In addition, the company anticipates releasing the world’s first five millimeter motorized instrument, a needle driver, during 2011, Song added.

The device, the JAiMY (Jaime Articulating Instrument Motorized endoscopY), which is named after the primary engineer on the project, is also reusable, according to Song.

Most instruments are currently ten millimeters in size. “But the smaller the diameter of the device, the smaller the incision that must be made to accommodate it into the body. Smaller incisions mean less pain, scarring, disfigurement and less chance of developing an abdominal wall hernia,” which currently occur with an incidence between 1 to 6% in ports that are larger than 10 millimeters, according to the literature, according to Song, who noted that the JAiMY is designed for use in any laparoscopic procedure, with or without the ViKy.

Trials on UCLA’s Robotic Training Device Postponed

2011-08-21T00:52:00.000-05:00

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

2011-08-21T00:09:00.000-05:00

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

2011-08-08T11:59:00.003-05:00

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

Robotic Surgery at the George Washington University Hospital

2011-07-18T17:01:00.004-05:00

Commercially-Sponsored Supplement

Robotic surgery has been part of the medical scene for years, and is continuing to gain prominence as hospitals and surgeons explore its benefits to patients. At the George Washington University Hospital, robotic surgery has helped patients receive the care they need without enduring the side effects of surgery with such intensity.

   Surgeons at the GW Hospital Center for Robotic Surgery, which is the first in the DC area to have the da Vinci Surgical System, have performed almost 2,000 robotic procedures. The surgeries conducted with this technology now are less invasive, helping surgeons operate using a smaller incision than is required in traditional procedures. Pain and trauma experienced by the patient are reduced, as are infection risks, potential blood loss, hospital stays, and scarring.

   As the hospital has continued to expand its use of robots in surgery, surgeons have found that the robots enable them to maneuver in tighter areas of the body, such as the kidney, more easily. Traditional minimally invasive techniques still work, but in places like the chest, robots are proving superior for the right patients. “It is very hard to replicate open thoracic procedures using conventional minimally invasive techniques because of the anatomy of the chest and the complexity of many thoracic procedures," Farid Gharagozloo, MD, Clinical Chief of Cardiothoracic Surgery Services and Clinical Professor of Surgery, told GW Hospital Health News. “At GW Hospital, the robot is changing everything. Robotic cardiothoracic surgery is the newest frontier in surgery and only a limited number of surgeons have expertise in this field.”

   In another Health News article, Harold Frazier, MD, Director of Urologic Oncology and Clinical Professor of Urology, said, “Robotic surgery is so effective that it is evolving into the standard of care for prostate surgery.” Marc Margolis, MD, Associate Clinical Professor of Surgery, was quoted as saying, “We're seeing human anatomy and structures in ways we can't see with the naked eye or with less sophisticated imaging systems.”

   In 2008, the hospital obtained its second da Vinci Surgical System, which includes a TV screen and teleprompter surgeons use to teach their students more efficiently during operations. Physicians have actively sought out the tool to learn more about improving their skills. “It’s a difficult tool to master, but when mastered it’s a magnificent tool,” Jason D. Engel, MD, Vice Chairman of Urology and Director of Urologic Robotic Surgery at GW Hospital, noted in a news release. “It can make an experienced surgeon exceptional.”

References

http://www.gwumc.edu/medctr/news.cfm?view=news&d=7503

http://gwashington.uhspublications.com/spring2009/story3.html

http://media.www.gwhatchet.com/media/storage/paper332/news/2008/10/02/News/
Gw.Hospital.Acquires.Second.Robot.To.Perform.Surgeries-3465934.shtml

http://gwashington.uhspublications.com/winter2009/story2.html

https://www.gwhospital.com/Hospital-Services-O-Z/Robotic-Surgery

Self-Funded CYCOGS Robotics Manufacturer Applies for Second Patent,

2011-07-15T14:02:00.000-05:00

Notwithstanding SBIR Grant Rejections

by John Otrompke

Engineer and entrepreneur Wayland (Ty) Tobey, president of robotics manufacturer Cycogs LLC, has been so inconvenienced by the application process at the U.S. Small Business Administration’s Small Business Innovation Research (SBIR) grants program, that he didn’t even submit a third application as intended last December. The applications are usually about twenty pages long, and grant-fundign for phase I is around $100,000, according to Tobey.

And though he received a lukewarm reception at the hands of grants application reviewers, Tobey is nonetheless in the process of filing a second patent application for the company’s robotics drive.

Tobey’s applications were rejected in April. “We received comments from the reviers such as , ‘over-ambitious’, ‘seems idealistic, unclear as to how to reach goals’, and ‘no experience with mobility systems,’” said Tobey. “That last comment actually makes me mad. I presented at Robodev 2007 on mobility systems and I have a patent on a mobility system that is for sale now,” he said.

Other criticisms included that the company’s projects were too novel, that the proposals included too few benchmarks, and that the company has no funding track record, Tobey added.

CYCOGS, a privately held limited liability corporation formed in 2004, is located near Sauk City, Wisconsin. The company is self-funded, and initially planned to fund developmental robots including a nurse's aide, a telemedicine robot and a physical therapy assistant, by selling components. Unfortunately, the recession of 2007 prevented the company from getting to market when it initially intended to, said Tobey.

Cycogs has succeeded in getting some products to market, though they have primarily been sold to hobbyists, Tobey said. “The modular components we are currently marketing are usable in general purpose robotics as well as other industries. For example, our Wheel Assembly Module can be used for a robot, wheel chair or a powered cart,” he explained.

Other modules in development include the hybrid snake arm, and Cycogs’ sensor ring. “That’s a rotatable ring of sensors that allows for ‘sensor amplification’ by rotating the sensors to cover a wider area than fixed sensors. The hybrid snake arm is basically a snake arm robot connected to a rotary platform,” Tobey said.

No Funding Sought for Snake-Armed Medical Robot

For the SBIR grant, Tobey submitted two applications, including one for wheel modules, and another for co-robots. A third application, however, Tobey never submitted, which was for a hybrid snake-armed robot.

“For the whole complete robot, we have yet to find or create a name we like,” said Tobey. As for the combined robot, however, “the combined equipment comprising the medium sized robot allows for the functionality to perform different tasks, which require a mobile robot with enough size, capacity and mass to move a good sized payload. The robot also has the ability to change its height, allowing the robot to tilt, which is needed for lifting heavy loads, and move on an inclined ramp or transverse doorways,” Tobey added.

The third application, never filed, was for the robot’s hybrid snake arms, which Tobey refers to as ‘Snarm.’

“These intelligent modular hybrid snake arms are each two meters ong and have a
very large donut shaped working envelope. “The arms can store themselves within the round robot body. The height adjusting ability along with the holonomic mobility allows our round robot to pick up a heavy object, rotate the robots body to place a wheel
under the load and lean the robot back. This controls the overall center of gravity,” Tobey added.

Tobey said the company envisions a variety of medical functions for the device, including use as a nurse’s aide, a telemedicine robot and a physical therapy assistant.

“One example of a telemedicine application is for a first responder, where the autonomous robot with human supervision and guidance performs basic assessment and first aid. Besides sensor observations, the robot arms can perform some tasks and procedures, such as administering shots, collecting samples and physical patient manipulation,” Tobey said.

The robot is 27 inches in diameter, 75 inches tall, and weighs around 600 pounds with batteries.

Accuray’s Purchase of Tomotherapy Increases Number of Company’s Installed Products

2011-07-14T14:06:00.000-05:00

By John Otrompke

The purchase of radiation tool manufacturer Tomotherapy last month increases Accuray’s position as a radiation oncology provider, and may also provide result in new therapies being made available.

Accuray purchased Tomotherapy (located in Madison, Wisconsin) for about $277 million in cash and stock. Of shares outstanding, 79% voted in favor of the transaction, which offered shareholders a premium of approximately 30% of the stock price.

“Tomotherapy’s machine is similar to the Cyberknife, but slightly different, in that it is a gantry-based system,” meaning that the device uses a rotational ring around the patient, according to Rob Hill, vice president of engineering at Accuray.

The use of the gantry allows for 360 degree administration of radiation doses, while reducing radiation exposure to surrounding healthy tissue, according to the company.
The acquisition will also more than double Accuray’s installed base, from 226 up to 550 machines in place in 32 countries. Of the two companies’, 30% of their 2010 income was generated from service contracts to installed machines.
The company will maintain a presence in Madison, according to Accuray.

2011-07-12T16:53:00.001-05:00

New edition of Medical Robotics Magazine forthcoming soon. Stay tuned!

MR Posts Second Financial Transaction!

2011-07-12T16:52:00.000-05:00

Medical Robotics Magazine has been commissioned to run two commercially sponsored supplements from two hospitals that feature leadership in robotic surgery. More inquiries are welcome. Feel free to leave a comment, or call (646) 730-0179.

2011-05-13T13:09:00.003-05:00

Medical Robotics Announces an Early Look at the Robotic Thyroidectomy Data of Prof. Woong Youn Chung

2011-05-13T13:08:00.001-05:00

2011-05-13T13:07:00.002-05:00

Da Vinci Thyroid Studies Suggest Advantages, Disadvantages Compared to Endoscopic and Open Surgery

By John Otrompke

   Korean surgeons have now gained enough experience using the da Vinci surgical robot to perform operations for thyroid cancer that researchers are able to describe preliminary findings comparing robotic to endoscopic to conventional open procedures.

   To a significant extent, more lymph nodes are retrieved in robotic thyroidectomies than in conventional endoscopic procedures, research indicates. If compared to open surgery, however, the same number of lymph nodes were retrieved, according to a smaller, preliminary comparative study.

   The rate of transient hypocalcemia was significantly greater in robotic surgery than in endoscopic procedures, however, as was the rate of permanent recurrent laryngeal nerve palsy.

   Post-operative mean thyroglobulin level, used as a surrogate marker for remaining or recurring cancer, was lower in robotic procedures than in open procedures. Hyperesthesia or paresthesia was also diminished in patients who had robotic procedures in comparison with conventional open thyroidectomy, according to research which has yet to be published.

   “There are technically some limitations of robotic surgery compared to conventional open surgery for advanced thyroid surgery, such as trachea resection and reconstruction, as well as mediastinal lymph node dissection,” said Dr. Woong Youn Chung, surgeon at Yonsei University College of Medicine, in Seoul.

   “Compared to endoscopic surgery, however, we can applied robot surgery to more advanced thyroid cancer,” said Chung, who has been performing robotic surgeries since October of 2007.

   Robotic procedures may also offer the advantage of diminished scarring of the neck, he added.

   Chung had performed the robotic surgery in 200 consecutive patients in July 2008, and a paper describing the results, titled “Robot-Assisted Endoscopic Thyroidectomy for Thyroid Malignancies Using a Gasless Transaxillary Approach,” was published in 2009 in the Journal of the American College of Surgeons.

   Now, Chung is updating his data and comparing those patients who had robotic thyroidectomies with those who had endoscopic procedures, in a forthcoming article in the Annals of Surgery. Although mean follow-up time is relatively short at 9.5 months, by March of 2011, Chung and colleagues had performed more than 2,000 such cases, and C hung himself had performed about 1,400 of them. As of last year, a total of about 4,100 robotic thyroidectomies had been performed in Korea, Chung added.

   In a smaller group of 115 patients, Chung and colleague also have compared robotic thyroidectomy with open thyroidectomy, in research yet to be published.

An Interview with Dr. Woong Youn Chung

2011-05-13T12:59:00.004-05:00

professor in the department of surgery and chief of the endocrine surgery division at Yonsei University College of Medicine, in Seoul, and past director of the Yonsei Robot and Minimally Invasive Surgery Center.

Medical Robotics: Is it just the learning curve that accounts for these differences?

Chung: From a Korean multicenter comparative study of differences in the learning curve between endoscopic and robotic surgery, the time requirement for overcoming the learning curve was shorter in robotic group (it was 10 to 15 cases less in the robotic group). This suggests that robotic surgery is easier to learn, and also that a well-organized training program is very important.

MR: Does it take less time now for the preparation or set up of a robotic operation, or for the operation itself?

Chung: In the beginning period, the time requirement for flab dissection was about 50 minutes, docking time was more than 20 minutes, and console time more than 80 minutes. Currently, however, the time for flab dissection is about 30 minutes, docking time less than five minutes, and console time is about 50 minutes. Briefly speaking, the total operation time for a less-than-total thyroidectomy with central lymph node dissection is less than two hours, and for total thyroidectomy with central lymph node dissection, less than two-and-a-half hours.

MR: You said there were no recurrences in the study comparing robotic to endoscopic procedures?

Chung: Papillary thyroid cancer has a mild biological behavior and a favorable prognosis. Papillary thyroid carcinoma is the most common type of thyroid malignancy. It accounts for more than 90% of all thyroid cancers. Although the prognosis of thyroid cancer is excellent (on the basis of World Health Organization data, the 10-year survival rate is more than 90%) , there is a relatively limited indication for robotic thyroidectomy which means we exclude the highly advanced cancer patient as a candidate.

MR: Did physicians choose which patients had robotic surgery, and how?

Chung: I always explain three types of thyroid surgery (open, endoscopic and robotic surgeries) to patients. Robotic surgery is the most expensive procedure in Korea because it can not be covered by national health insurance. Patients choose.

MR: Could you tell us about your gasless approach to thyroid surgery? What is the gas used for?

Chung: We have done only the gasless trans-axillary approach. The bilateral axillo-breast approach requires the use of CO2 gas to maintaining a working space. The gasless trans-axillary approach doesn’t require the gas, because the working space can be maintained during the operation by my own Chung’s retractor.

Comparing Open with Robotic Surgery

2011-05-13T12:56:00.006-05:00

   In a smaller study comparing robotic thyroidectomy with open procedures, levels of thyroglobulin (used as a surrogate marker for remnant tissue or recurring cancer) were smaller in the robotic group 0.36 nanograms per milliliter compared to 0.83, but the figure was not statistically significant, according to Chung.
   On the other hand, both procedures retrieved the same number of lymph nodes, he said.

   “If compared to open surgery, the operation cost is higher, and operation time is longer, in the robotic group. However, robotic surgery could provide more benefits to both patients and surgeons in terms of cosmesis, swallowing comfort, pain sensation and surgeon’s ergonomics,” according to Chung.

   The study, which is a prospective study in-progress, is destined for the Journal of Surgical Endoscopy, looks at 58 patients treated with open conventional thyroiedectomy, compared to 57 treated robotically.

   Preliminary results showed that although the number of lymph nodes retrieved was the same in both groups, rates of some injuries, such as trachea injury, were higher in the robotic group than in those treated with open surgery (1.8% compared to 0%).

   On the other hand, rates of some adverse events, such as hematoma, were higher in those treated with open surgery. Use of the robot was also associated with diminished hyperesthesia or paresthesia, a strange sensation of the skin in the anterior neck, according to Chung.

Comparing Endoscopic to Robotic Thyroid Surgery

2011-05-13T12:56:00.005-05:00

   In a study which has been accepted for publication in the Annals of Surgery, Chung and colleagues compared 570 patients by conventional endoscopic thyroidectomy with 580 patients with the same condition treated with the da Vinci surgical system. The patients had papillary thyroid microcarcinoma (in which the tumor is smaller than a centimeter) without definite extrathyroidal tumor invasion ; those treated endoscopically were treated between November of 2001 and July of 2009, while those treated robotically were enrolled between October of 2007 and July of 2009.

   The number of retrieved central nodes was significantly greater in the robotic surgery group (4.3) compared to the endoscopic group (3.6).

   However, the rate of transient hypocalcemia was significantly more frequent in the robotic surgery group (37.8% versus 19.7%), as was the rate of permanent recurrent laryngeal nerve palsy (four patients in the robotic surgery group, or 0.7% of the total, compared to only one in the endoscopic group.
Postoperative hospital stays were not significantly different in either group, and there was no recurrence of the disease in either group, Chung said.

An Early Look at the Robotic Thyroidectomy Data of Prof. Woong Youn Chung

2011-05-12T12:37:00.000-05:00

Preliminary Data from Two Journal Articles

An Interview with Dr. Woong Youn Chung

2011-05-12T12:30:00.000-05:00

professor in the department of surgery and chief of the endocrine surgery division at Yonsei University College of Medicine, in Seoul, and past director of the Yonsei Robot and Minimally Invasive Surgery Center.

Medical Robotics: Is it just the learning curve that accounts for these differences?
Chung: From a Korean multicenter comparative study of differences in the learning curve between endoscopic and robotic surgery, the time requirement for overcoming the learning curve was shorter in robotic group (it was 10 to 15 cases less in the robotic group). This suggests that robotic surgery is easier to learn, and also that a well-organized training program is very important.
MR: Does it take less time now for the preparation or set up of a robotic operation, or for the operation itself?
Chung: In the beginning period, the time requirement for flab dissection was about 50 minutes, docking time was more than 20 minutes, and console time more than 80 minutes. Currently, however, the time for flab dissection is about 30 minutes, docking time less than five minutes, and console time is about 50 minutes. Briefly speaking, the total operation time for a less-than-total thyroidectomy with central lymph node dissection is less than two hours, and for total thyroidectomy with central lymph node dissection, less than two-and-a-half hours.
MR: You said there were no recurrences in the study comparing robotic to endoscopic procedures?
Chung: Papillary thyroid cancer has a mild biological behavior and a favorable prognosis. Papillary thyroid carcinoma is the most common type of thyroid malignancy. It accounts for more than 90% of all thyroid cancers.
Although the prognosis of thyroid cancer is excellent (on the basis of World Health Organization data, the 10-year survival rate is more than 90%) , there is a relatively limited indication for robotic thyroidectomy which means we exclude the highly advanced cancer patient as a candidate.
MR: Did physicians choose which patients had robotic surgery, and how?
Chung: I always explain three types of thyroid surgery (open, endoscopic and robotic surgeries) to patients. Robotic surgery is the most expensive procedure in Korea because it can not be covered by national health insurance. Patients choose.
MR: Could you tell us about your gasless approach to thyroid surgery? What is the gas used for?
Chung: We have done only the gasless trans-axillary approach. The bilateral axillo-breast approach requires the use of CO2 gas to maintaining a working space. The gasless trans-axillary approach doesn’t require the gas, because the working space can be maintained during the operation by my own Chung’s retractor.

All contents copyright 2011 John J. Otrompke, JD

2011-05-11T17:53:00.001-05:00

New Products from Tekscan May Boost Robotic Innovation in the Medical Field

2011-05-09T21:20:00.003-05:00

Sensors May Go Into Experimental "Laprobot" at UCLA

by John Otrompke

A new engineering strategy on the part of a major manufacturer of robotic components may already be spurring changes in the reviving economy.

New sensor kits and connection options made available at the of last year by Tekscan may be incorporated into a new surgical robot being worked on at the University of California- Los Angeles.

“We were responding to demands from the market for more connection options,” said Elizabeth Hood, marketing specialist at Boston-based Tekscan. “We now offer alternate connection methods,” Hood explained. “Whereas our traditional connection method involves terminating our sensors with pins, we now also offer a single-sided connection method which lets customers use zero insertion force or low insertion force connections,” she said.

The new products are proving popular. “We have seen a lot of interest among the robotic community in our standard sensors and in the starter kits,” Hood said. Tekscan sensors are already used in medical applications such as mammogram models, dental applications, and infusion pumps.

The new robot under development would use the Tekscan sensors as part of a pneumatic balloon-based tacticity system, according to Dr. Martin Culjat, PhD, adjunct professor and research director at the Center for Advanced Surgical and Interventional Technology at UCLA.

The Center, which is a customer of Tekscan and was founded in 2004, has already designed a haptic system for use in lower-limb prosthetics, using the sensors, Culjat said. “We’ve been able to incorporate a sensor on the prosthetic feet of amputees, which transmits the force to the limbs,” he explained.

“There aren’t many sensors that are very thin, and light-weight with appropriate pressure ranges for tactile sensitivity. There are proposed solutions, but this is a really challenging problem,” he explained.

The haptic system under development at UCLA may be applicable to any surgical robot, although the researchers there are working specifically with the da Vinci. Furthermore, the Center is also building its own robot, called the Laprobot, Culjat added.

“We literally dice the sensors up ourselves, and carefully place them on to the big grasper. Our actuator has six elements for a much better response to the human sensory system,” according to Culjat.

2011-05-09T21:16:00.003-05:00

New One-Stop Flexiforce Kits from Tekscan Now Available On-line for Only $99!

“Our new starter kits are actually a new addition to our product line in response to customer demand. We just added them at the end of 2010,” said Tekscan’s Elizabeth Hood.

“Prior to this, we never sold the circuit components directly, so customers had to source the components themselves. The kit contains all the components necessary to build any of our three recommended circuits, along with a detailed user manual and 2 free sample A201 sensors,” she added.

Prominent Engineer in the Field of Medical Robotics Joins Editorial Advisory Board

2011-05-08T15:39:00.002-05:00

Professor Hsiao-Wei Tang, PhD, Joins the Board

   Medical Robotics Magazine welcomes the addition of Professor Hsiao-Wei Tang, PhD, to the editorial advisory board. Professor Tang is Director of the International Center of Excellence in Medical Robot, a part of Institut de Recherche contre les Cancers de l’Appareil Digestif/European Institute of TeleSurgery (IRCAD-EITS).

   Dr. Tang, also Adjunct Assistant Professor, National Cheng Kung University in Tainan City, Taiwan, previously designed the experimental VESALIUS Robot.

   “The new Center of Excellence is not intended to be limited to Taiwan only,” Tang said. “My idea is to make the Center of Excellence the meeting place of new surgical techniques and new engineering solutions.”

Manufacturer of Vision Components for Robotic Assembly Lines May Add an Optometry Application

2011-04-30T13:53:00.000-05:00

By John Otrompke
     The Imaging Source, a manufacturer of vision components based in Charlotte , North Carolina , may be adding an optometric tool to the list of health care applications in which its products are used.

    While cameras and other equipment from The Imaging Source are used in several medical applications, “the biggest sector in the medical industry that is starting to use commercial cameras is the field of optometry and ophthalmology,” said John W. Berryman, general manager at The Imaging Source.
    Cameras from the Imaging Source, are sometimes purchased by integrators to build home-spun robotic assembly-lines. One such company is Industrial Dynamics, based in Torrence , California , a bottle inspection company.
     “They build their own assembly line from scratch, using a product of ours called a QC camera, rather than just buying a robot from a third party for $150,000,” explained Berryman, who was a physics professor at Florida Atlantic University between 1994 and 2007.

    Inspection companies like Industrial Dynamics use the equipment in automation which inspects blister packs, spectroscopy as well as machine vision. “They have to database every bottle, to make sure it’s filled with pills, and take a picture of the bar code,” explained Berryman, who presented the company’s equipment at the recent AUTOMATE conference in Chicago.

    In May, Berryman said, the company awaits the announcement of a medical abstract describing the beginning of a clinical trial using a 1/3" CCD camera (model DMK 31AG03) from The Imaging Source in an optometric context. The abstract will likely be presented at this year’s meeting of the Association for Research in Vision and Ophthalmology ( ARVO) in Fort Lauderdale , Berryman said.

    Other medical applications of the company’s equipment include use in dentistry, where the devices are used by manufacturer Periogen in a device used to look “under the gums,” according to Berryman.

    Another company in Canada uses model number DMK 31BF03-Z2 in conjunction with phosphorescence angiography to examine cardiac tissue for infection, Berryman said. "That model is the only fully digital camera with an intergrated optical zoom lens on the market," he added.

    The Canadian company just started mass production of the product, Berryman said.

Magazine Hits 10,000 Visit Milestone

2011-04-20T14:58:00.000-05:00

   Medical Robotics magazine, the print and online commercial magazine, attracted the 10,000th visitor to it's web-site today, April 20, 2011, less than one month after it's initial commercialization with Google Ads.

   Plans for the magazine for 2011 include a second print volume, an expanded Board of Editorial Advisors, and the creation of a subscription-based portal.

   Contributions, inquiries and suggestions are welcome.

(c) 2011 John J. Otrompke, JD

2011-04-15T13:44:00.001-05:00

International Trade Fair for Machine Vision to See Debut of Medical Technology Parcours

2011-04-15T12:53:00.003-05:00

By John Otrompke

April 28, 2011

The 24th annual International Trade Fair for Machine Vision will see the debut of a special track for health care vision technology, October 8 to 10, in Stuttgart, Germany.

“We do this for the first time, as we recognized an increased demand for this topic, both exhibitor-wise and visitor-wis,e in our yearly survey over the last 2 years,” said Florian Niethammer, VISION Project Manager. “In our annual exhibitor and visitor survey, we asked the exhibitors, ‘Which are the visitor sectors that you want to have at VISION?’ and the medical device sector was the fifth largest group” in terms of demand, Niethammer added.

Possible factors leading to the increased demand include the greater need for quality in the health care sector, as well as the fact that health care industry is more stable and recession-proof than other industries.

“By ‘parcours,’ we want to express that there is not a centralized special stand for the medical technology topic at VISION 2011,” Niethammer explained.

The medical sector came in fifth, behind machine vision, mechanical engineering, the automotive supply industry, and the automotive industry, in terms of demand, he added.

Last year at the conference, 8% of 6,752 visitors said that they were in the medical device industry, compared to 13% in 2009, according to Niethammer. The change amounted to an actual decrease in the number of attendees from the health care sector.

Last year’s show included 323 exhibitors and an exhibition area of around 20,000 square meters.

2011-04-13T18:38:00.000-05:00

MEDICAL ROBOTICS MAGAZINE POSTS FIRST FINANCIAL TRANSACTION

   Yesterday, April 12, 2011, Medical Robotics Magazine earned it's first dollar through a Google Ad, sponsored by a Chicago-area hospital.

   The connection was considered apropos because Medical Robotics Magazine, founded in 2007 by John J. Otrompke, was created in the Chicago area. However, in addition to attending conferences which take place in other regions, the magazine is intended as a publication of global interests.

   In 2011, the publisher intends to offer Medical Robotics Magazine in part on a subscription-only basis, offering print issues (at least one in 2011), and access to high-quality content on the web-site, for subscription only.

    Subscriptions are priced at $100 for two years.

    For more information, email John_Otrompke@yahoo.com or phone at 646-730-0179.

Early Survey of National Claims-Made Database Finds No Paid Claims for Robotic Surgery

2011-04-12T20:48:00.000-05:00

by John Otrompke

An early review of a robust claims database maintained by an association of physician insurance companies reveals no paid claims based on robotic surgery, according to spokespersons for the Physicians Insurance Association of America (PIAA).

However, due to the nature of litigation, as well as claims databases (which are based on litigation), caution may be called for in interpreting the positive preliminary results, according to Divya Parikh, MPH, director of research and loss prevention at the PIAA.

Since the ICD-9 codes for billing for medical procedures were amended in 2008 to includes codes 17.41 to 17.49 for robotic surgery procedures, one single claim was made following robotic surgery, but the claim was closed without being paid, explained Kwon Miller, PIAA data analyst. There were no open claims up to the end of 2010, according to Parikh.

The PIAA databasem established in 1985, is considered robust, comprising companies that insure as many as 60% of physicians practicing in the United States, Parikh said. All told, about 260,000 claims are contained within the database.

"It's nice to see this, but it isn't highly unusual, because of the long tail effect wuith insurance; it can take up to four years to close a claim in some jurisdictions, and many times we don't see a claim for five to ten years," Parikh said.

"In addition, we may not be capturing data from solo physicians; the physicians in the database may not even be performing these procedures," she added. The database does not currently incude data from doctors in Physician-Hospital Organizations (PHOs), Parikh said.

"Another problem is that we use the ICD-9 manual, which is used for billing," according to Parikh. For claims made prior to 2008, the database includes claims for procedures such as radical prostatectomy, sacrocolpopexy, and mitral valve repair, which may be performed in a minimally invasive manner. However, the minimally invasive procedures included both robotic and laparscopic procedures prior to 2008, and they were not broken down into the categories, she said.

The database was established in 1985, Miller said. "For each claim, we identify a person's condition, and what the doctor performed, then another field shows the alleged error," she added. Of the 260,000 claims in the database, only about 72,000 resulted in an indemnity payment, Miller said.

Therein lies the original raison d'etre for the database, Parikh said. "Only one third of claims or less result in a payment, which is why the PIAA database exists. This shows why there is an increase in defense costs. Sometimes the numbers shift to even less claims paid, sometimes going down as low as 26%," she explained.

Medical Robotics Magazine is a Magazine!

2011-04-02T12:14:00.000-05:00

Medical Robotics Magazine is the world's first and only commercial feature news magazine devoted to all aspect of the medical robotics industry- including robotic surgery, physical therapy robots, hospital orderlies, and other topics related to robotic medicine.

As a feature magazine, Medical Robotics features interviews, business news, conference coverage and editorials, as well as a generous portion of articles written by noteworthy robotics surgeons as well as clinical trials reports.

MR has been on-line since 2007, and first appeared in print in January of 2008 at the annual meeting of MIRA (the Minimally Invasive Robotics Association) in Rome, Italy. Medical Robotics Magazine is copyrighted, features a nascent Board of Editorial Advisors, and is indexed by the U.S. Library of Congress. Now nearing our 10,000th web visitor, Medical Robotics Magazine entered a new active phase in March of 2011.

Science or Litigation?

2011-03-30T16:48:00.000-05:00

Which is a better way of determining the medical benefit of a technology- through litigation or clinical studies? Join Medical Robotics Magazine's discussion on our site at the Wall Street Journal Community. http://online.wsj.com/community/groups/medical-robotics-scientific-measurements-1310/topics/scientifically-evaluating-medical-robotics-performance

Upcoming Robotics Conferences 2011-2012

2011-03-25T13:47:00.000-05:00

TIROS (Taipei International Robotic Show)- Taipei, August 31 to September 3, 2011- http://www.tiros.org.tw/
National Robot Safety Conference 23- Knoxville, September 19 to 21, 2011- http://www.robotics.org/
Vision 2011- Stuttgart, November 8 to November 20, 2011- http://www.vision-fair.de/
Robotics Industry Forum- Orlando, January 18-20, 2012- http://www.robotics.org/
International Symposium on Robotics 2012- Taipei, August 29 to 31, 2012- http://www.isr2012.org/

Seeking contributed essays and nominations

2011-03-24T15:57:00.000-05:00

Please submit your proposal for an article or essay on medical robotics, engineering, surgery, practice and related topics to John_Otrompke@yahoo.com

Also seeking thought leaders to join our Board of Editorial Advisors. Our Board currently consists of prominent surgeons Dr. Tom Lendvay and Dr. Chuck Miller. Please e-mail us your nominations. Thanks!

Copyright Information

2011-03-24T15:27:00.000-05:00

Medical Robotics an Active Specialty at Lake Superior State University in Michigan

2011-03-23T19:11:00.001-05:00

Small School’s Acclaimed Program in Undergraduate Robotics Pursues Technology Transfer by Doing “The Opposite”

By John Otrompke

March 23, 2011- Chicago

Lake Superior State University in the brisk town of Sault Sault Marie, Michigan, had a quandary.

“For years, we had an abundance of senior projects, but we were turning away a lot of good projects, and good ideas,” said Eric Becks, president of the school’s technology transfer project, SSMart.”

To date, the department has worked on more than its share of innovative medical projects, Becks said. “We just finished working on a surgical platform for a veterinary project, and now they are waiting on the FDA,” he added.

Veterinary platforms, while honorable, are not the only work the small school has done in the area of medical robotics. Inventors are often drawn to the public college on Michigan by the school’s unique approach to technology transfer.

“In most technology transfer departments, the school takes an idea, and tries to get somebody to commercialize it,” Becks said. “We work in ‘the opposite’ direction: the inventor is getting the license and patent, and we’re just getting paid for the engineering work,” he added.

Development of a prototype in medical robotics could cost a researcher between $10,000 and $100,000, not including the FDA approval process, according to Ron DeLap, PhD, dean in the college of engineering.

Not only is the school’s work a good deal for medical robotics inventors, but it is also attractive for students, Becks said. “Very few schools, like Princeton and Carnegie-Mellon, have an undergraduate program in robotics, and they tend to be a lot more expensive than our school is,” he explained.

Classes usually size about ten to fifteen students per class, and the program costs just $8,000 per year, plus an additional $8,000 per year in room and board, DeLap said. Graduates tend to get at least three to five job offers, he added.

In addition to the veterinary surgery platform and another project in preliminary discussions involving the design of a miniature surgical robot, the program also worked for a New Mexico doctor who ordered the construction of an anti-deep vein thrombosis machine to prevent blood clots, Becks said.

Light-Weight Robot Unveiled at AUTOMATE May be Used in Medical-Surgical Applications

2011-03-23T18:42:00.002-05:00

By John Otrompke

March 23- Chicago

A robot newly unveiled in the United States by KUKA Robotics Corporation, which makes the robotic component of Accuray’s Cyberknife device, is being explored for use in a new surgical design by Titan Medical, out of Canada, according to James Cooper, vice president of sales and marketing for KUKA.

The light-weight system, referred to as the KR5 Sixx in technical literature, was already introduced in the European marketplace in 2010, but the current AUTOMATE show in Chicago was the first time the robot was exhibited in North America, Cooper added.

“The difference with our light-weight model is that has torque feedback in all the joints,” said Corey Ryan, account manager for KUKA. “All the electronics are inside the robot, whereas with the other ones, the electronics are in a cabinet far away. This robot has variable stiffness and active dampening, which means that if you push on it, you can get it to move a little, or a lot,” he explained.

The new system is better than the current Cyberknife system, according to Ryan. “With the Cyberknife, you have to have the patient immobilized, and the robot has to know their exact position. Here, the robot can find its way, and know if it touches a person . If you set up a force perimeter, it will know it touches something m ore solid,” he added.

Mako Surgical Robots May be Revolutionized by Changes in Movement Control System Made to Underpinning Technology from Barrett Technology

2011-03-23T18:13:00.002-05:00

By John Otrompke
Chicago- March 23, 2011
An alternative method of controlling power and movement to robotic arms controlled by Barrett Technology and recently patented by the company may add increased tactile sensitivity to Mako Surgical Robots if licensing talks go through, according to William Townsend, president of Barrett Technology, which manufactures a surgical arm used in Mako Surgical robots.
The new power source, which is approximately two centimeters tall, received a patent in February of 2011, Townsend said. By contrast, the old box, still in use in current Mako robots, measured about half a meter cubed, he added.
“The new system will drain less power, and be much more compact. You could fit many more robots around the operating theater, and they will offer more tactile precision,” if the licensing proposal goes through,” Townsend explained.

The FIRST and ONLY Commercial Feature News Magazine

2011-03-23T14:12:00.001-05:00

Devoted to the Field of Medical Robotics, Broadly-Defined,
to Feature a Board of Editorial Advisors and Commercial Advertising

Coming up next...

2011-03-21T12:53:00.001-05:00

Coming soon to MR...

News from the 42nd International Symposium on Robotics in Chicago

Liability and Medical Robotics

...and other exciting topics in anticipation of MR's 10,000th Visitor!

Now Seeking Nominations for the Board of Editorial Advisors

2011-03-21T11:33:00.002-05:00

Tabula Rasa for 2011

Medical Robotics Magazine Extends a Hearty 'Thank-you' to the talented doctors who served on the Board of Editorial Advisors for the past number of years. For 2011, we extend an invitation to submit a nomination for the Board for the coming year. Thanks!

De-Monetize Me!

2011-03-21T11:28:00.003-05:00

Medical Robotics Magazine is now seeking a skilled advertising executive, as well as other talented and innovative help.

Media Publishing Executive

Commercial Sponsorship:

Gold Sponsorship: $1,000

Platinum Sponsorship: $2,000

Advertising Revenue: $100 per ad
Web-site Link: $100 per year (selected web-sites only)
All-Access Subscriptions: $100 for 2 Years

Prices for White Papers and Paid Supplements Available On Request

Monetize Me!

2011-03-21T11:26:00.001-05:00

Now announcing the debut of paid advertising on the Medical Robotics Magazine web-site, courtesy of Google!

Would you complete our short survey?

2010-04-04T21:57:00.002-05:00

Medical Robotics Survey

Hi,

As a participant in the burgeoning field of medical robotics, and a potential consumer of my magazine and other products, would you please take a moment to answer a few questions about your interest in medical robotics and how we might serve you better?

Just cut-and-paste and email to me at John_Otrompke@yahoo.com

Thank you,

John Otrompke
publisher and consultant
718-755-6069
John_Otrompke@yahoo.com

John Otrompke
718-755-6069
John_Otrompke@yahoo.com
www.MedicalRobotics.blogspot.com

Medical Robotics Survey

Available in print and on-line at www.medicalrobotics.blogspot.com

As a participant in the burgeoning field of medical robotics, and a potential consumer of my magazine and other products, would you please take a moment to answer a few questions about your interest in medical robotics and how we might serve you better?

What field of medical robotics are you most involved with- surgical robots, physical rehabilitation, allied health, pharmaceuticals, clinical research, genetics, or other?

1. To your knowledge, what is the best source specializing in the medical robotics field:

a. On-line?

b. In print?

2. Is the time right for a specialty magazine focusing solely on medical robotics?

3. How would such a publication fund itself, whether by subscription, advertising, venture funding, or other?

4. What would be the right subscription price for a magazine?

5. How important is independence from industry to such a magazine?

6. Would you most like to see coverage of the following sorts of topics in a magazine format?

a. More clinical news related to medical robotics

b. More conference coverage

c. More business news

d. Regulatory affairs

7. Where should the content come from, professional writers, or contributions from scientists, physicians, executives, consultants, students?

8. Would the readership include health care consumers? Would it be mostly health care consumers?

9. Is there more development in medical robotics in the United States, in Europe, Asia, or elsewhere?

10. Are there other topics in the field of medical robotics you would like to see covered?

11. Can you help us identify any other unmet needs in the field?

12. Do you have other suggestions?

Just cut-and-paste and email to me at John_Otrompke@yahoo.com

New Code of Ethics Adopted

2010-03-12T20:59:00.002-06:00

The Medical Robotics Code of Ethics

Medical Robotics magazine and web-site hereby promises, voluntarily, that it will continue to offer high-grade journalism of this emerging industry. Medical Robotics may sometimes consider accepting paid advertising, or paid supplements. However, Medical Robotics will never allow its editorial policy or the quality of its journalism to be affected by commercial concerns. If questions of impartiality are ever caused in this regard, the matter may be submitted for comment to the Board of Editorial Advisors, which may be expanded.

March 12, 2010

New Standards to Define Quality and Safety in Medical Robots

2010-03-12T09:57:00.002-06:00

Meanwhile, the Quest for a Definition Goes on

By John Otrompke

A workshop convened by the FDA in Maryland last month may have heralded the creation of quality and safety standards unique to the robotics industry. The meeting, which was only a first step in what might be an on-going process, was intended to coordinate efforts already going on in standards-setting organizations, which would supplement pre-existing generally-applicable standards at the FDA.

“There are existing standards that may not say ‘robotics’ on them but a robotics manufacturer would be able to use them in the design and development of robotics,” said Carol Herman, director of the standards management staff at the Center for Devices and Radiological Health of the FDA. “Our role is to help identify where standards could help us get products to market,” she added.

Standards are voluntary, but may make the FDA certification process more efficient, Herman said. “When there are standards in place with which the FDA is comfortable because we helped develop them, it allows the reviewer to spend time on other matters,” she explained.

The meeting, which was convened by the FDA with support from Medtronic and the Association for the Advancement of Medical Instrumentation (AAMI), was called to coordinate efforts going on in multiple voluntary standards-setting organizations.

“We started this process rolling because the subcommittee of the International Standards Organization, ISO TC 184, which deals with robots and robotic devices, now has a work program to develop standards for medical robotic and personal care robots,” said Chuck Sidebottom, PE, secretary of subcommittee 62A of the International ElectroTechnical Commission.

The sort of standards under discussion are for the devices themselves, not for the manufacturing process, clarified Sidebottom, who spoke in his role with the IEC, although he is also the director of corporate standards at Medtronic. “What are the gaps a medical robot might bring which are not already covered by existing standards?” he asked.

Where do Gaps Exist?

Part of the group’s work will consist of identifying gaps in existing standards posed by the emergence of medical robotics technology. One example might be where the computer of a surgical robotics system freezes up in the midst of a surgery.

“My impression is that there are some areas of medical robotics which are ready for standards, though some areas are not developed enough. Surgical robots would probably be the most advanced, since there is already a product on the market. An example of the yet-to-be-developed would be more autonomous robots. Standards would normally not be developed at that point because innovation is still happening,” said Mary Logan, JD, CAE, president of AAMI, who attended the meeting.

Standards created for medical robotics may help solve problems in other areas of health care technology. “These would be useful not only for robotics, but for systems at a higher level of complexity which put together multiple components tied together with communications networks,” said Joel Myklebust, PhD, deputy director in the office of science and engineering laboratories at the FDA.

“Take an operating room or an emergency room, for example, and think of all the multiple devices in that room. Wouldn’t it be great if somehow all the devices were appropriately networked, if they didn’t have cables running all over the floors, and you could actually rely on the devices to all work very well together,” Herman explained.

Just as hospital room devices should be interoperable, perhaps there should be a high degree of coordination among standards-setting organizations as well. “AAMI’s standards philosophy is one standard world wide. We try not to have duplicate standards, so we participate very actively with the ISO and the IEC,” said Logan.

The Search for a Definition

Part of the group’s first meeting was spent trying to define the area to be standardized. “What are characteristics of a thing which makes it a robot?” Sidebottom asked. “We came up with motion, multiple degrees of freedom, a degree of autonomy from human control. Then you have the question, ‘What is a medical robot, as opposed to a personal care robot, for example?’” he mused.

Some attendees were bemused by the inquiry into definitions. “I’m not entirely sure what the point of the meeting was,” said Howie Choset, PhD, associate professor of robotics at Carnegie Mellon University in Pittsburgh. “We spent a lot of time on definition of what a robot is, but we never got anywhere specific. We should not come up with a classification of medical robots, but should look at the question on a task-by-task basis,” he added.

Other organizations like AdvaMed and Intuitive Surgical also participated in the meeting. Another meeting could take place this year, but probably not before the fall, according to the FDA’s Carol Herman.

Are Robotics a Good Idea for Cardiac Surgeons?

2010-03-08T09:06:00.000-06:00

By: Chad Sumulong
(senior at Maryknoll High School in Honolulu, Hawaii)

According to the American Heart Association, Heart Disease is the leading cause of death in the United States. This issue could be caused by the growth of the fast food business, or the lack of health awareness around the country. Whatever the cause may be, something needs to be done about this problem. Through surgical technology and the development in cardiology (study of the heart) many advancements have been made that could help combat the problem of heart disease. But is too much money and thought being put into futile machines that show no or little net gain in the case of surgery?
Over the years, new technology has been created that has impacted cardiac surgery in a positive way. Equipment such as the heart-lunch machine, and the artificial heart have been essential to the success of heart surgery and the survival of many who have encountered heart problems. According to Henry Louie MD, these pieces of technology have allowed cardiac surgeons to stick to the same routine throughout the years, “Ironically, heart surgery has not really changed in approach since its inception from the late ‘70s. We still use needle and thread to construct bypass grafts, sew in or fix defective valves or close holes within the heart. Materials and imaging techniques to fix or see into the heart have dramatically improved however” (Louie MD). But there are new machines that many say will change the face of the cardiac practice.
In 2000, the FDA approved a revolutionary machine called the DaVinci Robot. This machine specializes in surgical processes, and uses its tiny mechanical arms to create a more accurate but less painful procedure. It also decreases the patient’s stay in the hospital by a couple of days. One would think that the DaVinci Robot is a very prestigious tool that would serve well in the field of cardiovascular surgery. Many people want to see the rise of robotic technology in their every day life because technology has made life easier for many others. Robotic technology can help create confidence in many of those undergoing the procedure. But what is the difference between a necessity and an option?
According to the educators and doctors at Brown University, there is none to little difference when comparing heart surgery with the conventional method and the robotic method. Robotic surgery, however, is slightly on the expensive side. Each machine needs an investment of about $1 million. “Cardiac surgery for the patient is about the same with or without robot assistance… However, overall the cost is slightly greater for robotic assisted surgery than for conventional surgery” (Brown University). Also, the size of these machines does not fit the right criteria needed for cardiology. When dealing with the heart, the surgeon needs space to properly conduct the operation. The fact that these machines could take up half a room denies the surgeon the legroom and breathing space that would be comfortable. “The sheer size of robots in this technology presents a problem for cardiac surgery, especially in the area of pediatrics. Surgeons look toward smaller instruments with tactile feedback as well as a reduced cost of equipment” (Brown University). Brown University also interviewed Dr. del Nido, who does cardiac surgery in children. When asked about the major drawbacks of robotic surgery, his response was that, “The biggest drawback is that you don’t have any sense of feel. You have no sensation. The robots have no sensors on it. So if you’re putting your hands into a box, and you know that there are things inside, you can feel around with your hands and get a pretty good sense of what’s going on and what’s in there. The robot gives you no tactile feedback. You’re basically going by visual to what you’re doing to the tissue and that’s the biggest drawback.”
Robotics and technology are becoming growing resources in America, and the thought of robotics in surgery appeals to every American. Robotics in surgery would fulfill many dreams of having a technology ruled society; however, there are things that robotics cannot rule over (just yet), and that is cardiac surgery.
When speaking with Dr. Mark Grattan, a thoracic surgeon at Straub Medical Center, his views of robotic surgery are clear. In a recent Q&A session, Dr. Mark Grattan shares his opinion:

Q: So how do you feel about the use of robotic surgery? Would you rather use that in the future?
A: Not now, I don’t think robotics has gotten to a point yet where it’s safe to use on a lot of patients. To do robotics means that you have to do certain other things in order to protect the heart because you have to stop the heart. (Mark Grattan M.D)

Q: So when medical magazines say robotics can make surgery safer, technically it’s not true?
A: No, it’s not true, that is not true. They can make nice small incisions, and when you talk about robotics what you’re talking about is you want to make a smaller incision. So we make a smaller incision, but we don’t use the robot, there’s a minimally invasive surgery that does not necessarily need the robot. (Mark Grattan M.D)
Also, by speaking to Henry Louie, another thoracic surgeon in Hawaii, the views of robotic surgery become much clearer.
Q: How do you feel about the use of robots in heart surgery?
A: Robotic innovations have revolutionized many surgical procedures, but for heart surgery it has not really made an impact. For some technical reasons, robotics may not be suited for cardiac surgery because of the need for the heart lung machine use during the procedure. The heart lung machine is used to maintain blood flow to the patient while the heart contractions are arrested so the surgeon is able to work on a still heart without blood flow. (Henry Louie M.D)
The use of robots is definitely an intriguing and interesting idea for surgery. Robotics may be used in many different aspects of the medical community, but in the views of different scientists and surgeons, robotics does not currently fit the criteria of cardiac surgery. So in conclusion, is robotics a good idea for cardiac surgery? In the future there may be some exceptions to include robotic arms in the operating room, but currently, the size, cost, and complexity of robotics is too overwhelming for those in the operating room.

Works Cited
Grattan, M.D, Mark. "Interview with Dr. Mark Grattan." Personal interview. 9 Nov. 2009.

Louie, M.D, Henry. “Interview with Henry Louie MD.” Personal interview. 18 January. 2010.

"Robot-Assisted Surgery: Da Vinci." Division of Biology and Medicine. Web. 05 Mar. 2010. .
"Robot-Assisted Surgery: Glossary." Division of Biology and Medicine. Web. 05 Mar. 2010. .
"Robot-Assisted Surgery: Interview." Division of Biology and Medicine. Web. 05 Mar. 2010. .

2010

2010-02-16T10:02:00.001-06:00

ANIMAL RIGHTS UPDATES

Amendment to TOSCA May Drive Alternatives to Animal Testing

2010-02-16T10:01:00.000-06:00

By John J. Otrompke, JD

A legislative office working on an amendment to the Toxic Substances Control Act, the Kid-Safe Act, expected to be introduced in 2010, has asked for language to be included that resembles European Union directives that outlaw animal testing in some cases.

People for the Ethical Treatment of Animals [PETA] has been asked to prepare language which may resemble the text of the EU Cosmetics Directive or European Community Directive 86/609, said Catherine Willet, PhD, science policy advisor at PETA.

The 21st century has been a gaining year for those who want end animal testing, with five tests banned in Europe as of 2009. Other aspects of the European cosmetics directive, which does not apply to medicine, food or other chemicals, are still coming into force. For instance, deadlines for animal tests for skin and eye toxicity are in 2013, Willet said.

Another European restriction, directive 86/609, provides that if a non-animal method exists, animals may not be used to test either cosmetics or medical treatments.

“Right now, this represents an opportunity to get new technology in use,” said Willet. “Most testing uses technology from the 1930s, but there’s been a revolution in biology in the last 30 years. We can design tests much more effectively,” she explained.

For instance, L’oreal recently announced a collaboration with Hurel, which has a technique for combining microenzymes with cultures of human cells. “They develop and grow human cells really well in three-dimensional structures tat mimic tissues,” Willet said.

There are hopes that efforts to revise toxic substance testing legislation will drive improvements in the U.S. as well. “In 1976, most chemicals were grandfathered, and the EPA can only ask for information if there is some sign of a problem,” Willet said. This shortfall in TOSCA has led to periodic efforts to reform the rule, such as a proposed amendment in 2008 which did not get any co-sponsors. The latest incarnation, the Kid-Safe Act, is expected to be announced at the ends of February.

PETA hopes that a revision will include more flexible language for testing. “For instance, if instead of saying for every chemical that exists, you have to do a rabbit reproductive test, you could just say, you have to do an evaluation for reproductive toxicity. That kind of language will drive alternative technologies for doing tests,” Willet explained.

2010 Cloned Meat Update

2010-02-16T09:57:00.001-06:00

Environmental Assessment Project at Oxford University
Finds Cultured Meat Superior to Agriculturally-Grown Meat

PETA May Increase Prize to Get Cloned Meat on Market

By John Otrompke

A research project conducted by Jason Matheny of New Harvest found that the production of cultured meat by an in vitro cloning process would be more efficient and produce less environmental damage than agricultural models currently in place.

“We conducted an environmental assessment comparing an in vitro system to the organic system of meat production, and found that the in vitro method uses 90% less land and water and generates 90% fewer greenhouse gases,” said Matheny, who founded DC-based non-profit New Harvest to study and promote alternatives to traditionally-generated meat.

“In vitro meat is more than twenty times more effective than raising animals for food,” said Bruce Friedrich, voice president for policy at People for the Ethical Treatment of Animals (PETA). “You have to put 20 calories into a chicken or a pig to get one calorie out in the form of meat, or six to eight in for one calorie of eggs or dairy,” Friedrich explained.

PETA has offered a prize of one million dollars for the first organization to bring cloned meat to market by June 30, 2012. “Our announcement generated a significant buzz in the scientific community. We did receive inquiries from scientists, although we were also told that our prize ought to be more like $20 million,” said Friedrich, who added that PETA would like to see cloned meat on the market “like yesterday.”

“In order to get a commercialized product on the market, the prize should be not in the millions, but in the billions,” said Matheny, who noted that other prizes exist, such as the Innocentive prize from Eli Lilly, and the NASA Millennium Prize, among others.

“Still, PETA’s prize might be good for incremental development; for instance, the creation of a new culture medium might be amenable to a prize,” Matheny explained. Current cultures for cloning allow for the growth of only thin strips of meat, because meat can’t be cloned in three dimensions, while new techniques for cloning like that offered by Hurel allow cloning in three-dimensions, but use a culture which is inedible and silicon-based.

“If Jason called us, and said, ‘We need $20 million and we’ll have a product on the market, we don’t have $20 million right now, but I imagine we’d start making some calls,” said Friedrich.

Compelling Arguments for Cloned Meat

The need for cloned meat may grow in urgency as the Earth approaches a critical stage of pollution. “By 2050, we’re looking at a doubling of greenhouse gas emissions, which also means a doubling of soil pollution, cancer and cardiovascular disease associated with meat consumption, and a doubling of swine and avian flu,” said Matheny. According to PETA’s Friedrich, raising animals for food is the number one cause of global warming.

Agricultural societies tend to be more interested in cloned meat, and invest more heavily in the project. “In the Netherlands, people live closer to hog farms, and are concerned about the smell and the water pollution, so the government supports projects looking at meat alternatives,” said Matheny. Other funders of cloned meat research include NASA, and a couple of commercial start-ups exist related to cloned meat, including one in Australia and on in the Netherlands.

Cloning meat may be a way of making meat consumption healthier for the individual, too, PETA’s Friedrich said. “We may be able to create meat with less saturated fat, less cholesterol, more omega 3s, and we may even be able to clone meat with vitamins,” he explained.

While the success of cloned meat ultimately depends on non-vegetarians, the final product is likely to be superior in quality to the ground meat which is currently on the market, according to Matheny, who is a vegetarian. “This is meat that has been pulled from the animal with a vacuum tube, and then whipped into a slurry which then has a binder, textures and seasoning added to it,” he explained.

In favor of Cloned Meat

2010-01-26T15:02:00.001-06:00

Cloned Meat: Yea

By John J. Otrompke, JD

Some of you might have heard of PETA’s recent announcement of a $1 million reward for the company to produce and market cloned meat by a certain deadline, and you may be wondering, What should I think about it?

The answer is simple: I am for the proposal. (In fact, I tried for the better part of last week to talk PETA out of some of its money in order to work on the cloned meat project).

You may be wondering, why? The answer to this is a little more morally and rationally ambiguous.

Everybody knows that biotechnology is fraught with both physical danger and moral hazard, and by now everybody should know as well that consumption of animal products is generally unnecessary for human well-being.

From this perspective, perhaps, the idea of cloned meat is irrational.

But my opinion on cloned meat is not necessarily grounded in reason. Rather, I sometimes enjoy animal products, though I could not possibly say enough good things about vegetarianism.

Also, cloned meat is well, cloned; that is, it doesn’t involve the suffering of the animal, so it is not outright evil in the way eating live animal meat is. Perhaps voluntarily taking on physical danger for the purpose of enjoying cloned, non-live animal products is a little more acceptable, perhaps as a form of individual freedom or under a victimless crime argument.

In any case, if cloned meat ever makes it to my plate, I intend to eat a lot of it!

Posted by -Medical Robotics Magazine at 9:04 PM 1 comments

2009-02-27T18:02:00.001-06:00

New and Improved Mako Surgical Product

2009-02-27T18:01:00.003-06:00

By John Otrompke

A new and improved version 2.0 of Mako Surgical’s ground-breaking robotic technology for orthopedic surgeons was unveiled at the American Academy of Orthopedic Surgery meeting in Las Vegas this year, allowing orthopedic patients a less-invasive alternative to total knee replacements, in addition to numerous other advantages.

“The field of medical robotics is coming of age, and MAKO is commited to leading the way in orthopedic surgery,” said Dr. Maurice R. Ferre, President and CEO of MAKO. The new technology also allows partial knee resurfacing to be performed on the patellofemoral portion of the knee, in addition to the medial portion, MAKO said.

The release comes on the heel of the release this month of a special issue of the American Journal of Orthopedics devoted to robotic unicompartmental knee arthroplasty. The issue featured some articles devoted to the discussion of the MAKO robotic technology.

The robotic technology, known as the RIO Robotic Arm Interactive Orthopedic System, is a far cry from traditional methods of using mechanical guides, saws and external jigs to guide a surgeon’s hands, surgeons said.

The first generation of the MAKO robot is in use in 17 commercial sites, and over 700 patients have benefited from the use of MAKO’s first device.

2009-02-27T18:01:00.002-06:00

MAKO Releases Orthopedic Robot version 2.0

Now Introducing the RIO

Robotic Surgery Simulation: An Unintuitive Reflection

2008-10-01T15:19:00.000-05:00

by Dr. Thomas Lendvay, MD

Robotic surgery is widely becoming the standard of care in the treatment of many diseases, but the rapid acceptance may be out-pacing the ability to adequately train surgeons. This past year more than half of all radical prostatectomies in the U.S. were performed with a surgical robot (http://www.medicalnewstoday.com/articles/112626.php) and since the FDA approval of the use of the da Vinci® robot for gynecological procedures in 2005 (http://www.medscape.com/viewarticle/504035), this field of surgery seeks to become the busiest user of robotic-assisted laparoscopy (RAL). Despite the rapid adoption of RAL surgery, long-term surgical outcomes data have yet to definitively demonstrate benefits over open surgical techniques. Prostate cancer margin positivity rates, even in the most experienced hands, have only equaled and not yet improved upon open surgical outcomes. Many argue that despite the ‘intuitive’ nature of RAL surgery, there is a learning curve and the dilemma lies in how to train future roboticists to be technically competent on their first RAL case.

There is growing traction in the medical community for the use of surgical simulation training for procedural skills acquisition. Driven by the demand for improved quality of care and accountability in surgical outcomes, increasing restrictions on the use of animal models, dwindling resident case logs, medico-legal pressures, and fiscal mandates for cost-effective performance many institutions are turning to surgical simulation for procedural training and even procedure credentialing. In pure laparoscopy, surgical simulation training, both dry lab and virtual reality (VR) modalities, has been shown to improve surgical performance. The realities of robotics, however, is that access to the surgical robot for practicing skills is limited since 1) institutions rarely have the financial or space resources to acquire a robot solely for training, 2) existing robots tend to remain utilized and stored in OR suites which prevents daytime access for surgeons to train, and 3) set-up of the da Vinci® system for training is somewhat cumbersome. Amidst growing acceptance of VR technology in laparoscopic simulation training, two companies have created robotic simulators that model da Vinci® telemanipulation – MIMIC Technologies, Inc., Seattle Washington and SimSurgery, Oslo, Norway. The MIMIC® simulator relies on a da Vinci®-like human-computer interface with telemanipulators similar to the real da Vinci® while the SimSurgery® simulator utilizes an existing laparoscopic simulator platform with software upgrades to simulate robotic instrument movements. The benefits of simulation training in robotics have yet to be formally evaluated, yet preliminary validation studies have demonstrated the ability for robotic simulators to discern experienced from non-experienced roboticists which is an initial validation criterion for applicability for any simulator. [1]

It remains to be seen if robotic surgical simulation will offer improved surgeon performance and patient outcomes, but the speed at which surgical robotics has been adopted in the United States warrants confirmation that all robotic surgeons are adequately trained to perform these surgeries.
[1] Lendvay, T., Casale, P., Sweet, R., Peters, C., Initial validation of a virtual-reality robotic simulator, J Robotic Surg, (o

announcing...

2008-07-08T10:38:00.000-05:00

MEDICAL ROBOTICS MAGAZINE ANNOUNCES:
Second Prominent Robotic Surgeon Joins Board of Editorial Advisors

Medical Robotics magazine is pleased to announce that Dr. Thomas Lendvay, MD, attending pediatric urologist at Seattle Children’s Hospital and assistant professor at the University of Washington has joined the Board of Editorial Advisors. Dr. Lendvay, a contributor to this magazine, also practices in the unique and life-saving field of pediatric robotic surgery, correcting birth defects in small children.

His clinical and research focus is on minimally invasive surgery using laparoscopy and telerobotic surgical technologies. He has spear-headed the newly developed robotics program at Children’s and collaborates with the Biorobotics engineering department at UW relating to clinical applications of new telerobotic technologies. Additionally, he is a member Expert of the ISIS (Institute for Surgical and Interventional Simulation) center at UW to help advance surgical education for medical students and residents through simulation curriculum and is involved in the development of a virtual reality percutaneous catheter placement simulator. Through his work with the Biorobotics lab, he plans to be involved in an upcoming NASA Extreme Environment Mission Operations (NEEMO 12) demonstration of remote telerobotic surgery to be performed from Seattle to a submerged space station of the coast of Florida this Spring. Dr. Lendvay has also published this year on outcomes and practice patterns for the management of vesicoureteral reflux disease and the management of incontinence in spina bifida patients using multi-center databases.

With HealthCanada Approval, Project neuroArm Performs Brain Surgery on First “Public Patient”

2008-06-12T15:11:00.000-05:00

By John Otrompke

With full approval for marketing and use from the Canadian government, Project neuroArm performed robotic brain surgery on a meningioma patient on May 12. While it was the project’s first “public patient,” according to Dr. Garnette Sutherland, MD, who lead the team, the device had actually been used on several human patients prior to then, Sutherland said.

“We received our HealthCanada approval just last month; that allows us to use the neuroArm on anyone,” Sutherland said. The project is just now planning its FDA strategy, Sutherland said.

For its first public patient, the team chose a young woman with a benign brain tumor called a meningioma. “The nice thing about a meningioma is that it has a benign histology. When you take it out, it’s out,” said Sutherland. “We wanted to do someone who had a more straight-forward thing,” he said.

Despite the benign histology, Sutherland said, the family of tumor may still grow while in place, and eventually the patient can develop headaches or lose her sense of smell, he said.

The procedure was performed on Paige Nickason, 21, at Foothills Medical Centre in Canada. The neuroArm is a robotic surgical tool designed specifically for brain surgery; like the da Vinci surgical system, the neuroArm is controlled by a surgeon from a computer workstation, and works in conjunction with intraoperative MRI. During the recent operation, surgeons performed a mixed procedure, alternating between robotic and manual surgery.

Before taking on another “public patient,” the project is making some adjustments to the equipment, Sutherland said. “Right now we’re upgrading our magnet to 3 Tesla. That should allow us to get faster images and further integration into robotics. It should take a couple of months, and then we’ll go back on stream,” Sutherland said.

http://www.neuroarm.org/project.php

Tacticity Research in Robotic Surgery

2008-06-05T08:41:00.001-05:00

Rahuldev Bhalla M.D.
Director of Robotic and Minimally Invasive Surgery
Department of Urology
StonyBrook Medical Center

Prostate cancer is the most common cancer in men in the United States. In 2006, an estimated 234,460 men in US were diagnosed with prostate cancer. Currently, radical prostatectomy is the only treatment that has been shown to decrease disease-specific mortality from prostate cancer. However, concerns over the morbidity of open radical prostatectomy, including pain, blood loss and length of hospital stay, have led the impetus to develop minimally invasive approaches to radical prostatectomy. Laparoscopic radical prostatectomy (LRP) was first reported in 1992. However, this procedure has not gained widespread popularity. Since 2000, robotic assisted radical prostatectomy (RARP) has been adopted as the technique of choice for performing radical prostatectomy. The inherent advantages of RARP include 3-dimensional visualization and endowrist instrumentation, both of which permit a shorter learning curve in addition to a more precise surgery. However, direct haptic (force or tactile) feedback is not available in current commercial robotic surgical systems. The addition of haptic feedback has been proposed as a way to further enhance the performance of these systems. Direct tactile or force feedback is necessary to decrease the number of broken sutures and the number of loose knots as well as limit tissue damage, and will result in a more consistent application of forces. Haptic feedback also increases operator performance and surgeon comfort during telerobotic manipulation. Feedback of grasping pressure is critical in many microsurgical tasks. However, due to limitations in current sensing and control technologies, implementing direct haptic feedback to the surgeon’s hands remains impractical for clinical application. In this project, we intend to investigate a set of effective sensing techniques to provide real-time force feedback for current commercial robotic surgical systems. Here at StonyBrook Medical Center, we are developing a novel haptic system. This is composed of two end effectors on each instrument as well as a single tool effector which will give visual tactile feedback to the user in the form of a color strain gauge. The research is on-going and promising.

Ikonisys Expects to Submit 4th FDA Clearance Application

2008-06-04T12:53:00.000-05:00

Cancer Screening Device Described at ASCO
Indicates Breadth Of Medical Robotics Industry

By John J. Otrompke, JD

A medical robot manufactured by Ikonisys was described at this year’s annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

Ikonisys is expected to submit its 4th application for a clearance by the Food and Drug Administration (FDA) later this year.

The poster, and abstract 11084, was presented on June 1. While it was apparently the only research presented at ASCO concerning medical robotics, it illustrated the breadth and applicability of the robotics industry in medicine.

“Our developing system uses a robotic approach for magnifying slides with an efficiency and frequency sufficient to allow the detection of cancer cells with a frequency of as little as one in a million,” said Nicholas Romas, founder of Ikonisys, who presented the poster.

The robot works by using a process known as automated fluorescence microscopy, thereby avoiding complex purification procedures which risk cell loss and can create unresolved clusters of normal and cancer cells, according to the abstract, ‘Analysis of circulating tumor cells in prostate, colorectal and ovarian cancer using microscopy.’

In the study, blood samples were collected from seven prostate, ten colorectal and four ovarian cancer patients, as well as 11 healthy controls.

The device found the cells in all of the colorectal and ovarian patients, and five out of seven prostate cancer patients. There were no false positives, the abstract reported.

Since 2002, the Ikonisys system has received FDA approval for use of the device in detecting bladder cancer, as well as prenatal diagnosis of birth defects. The company also has submitted an application for breast cancer clearance, and expects to submit one for cervical cancer by the fall of this year.

Ikonisys currently has systems in place in Belgium and Switzerland, and Great Britain. The largest private lab in Italy, Centro Diagnostico Italiano, in Milan, also uses the Ikonisys system, said Romas, adding that more than 20 devices have been sold since the company began community placements less than a year ago.

The list price in the U.S. is $200,000, he added.

Whither the Dinosaur Industry?

2008-05-09T19:31:00.000-05:00

by John J. Otrompke, JD

Should human agency clone a dinosaur? Perhaps surprisingly, the question is not whether it is plausible to bring back the legendary giant, but whether it is desirable to do so. This essay comes to a conclusion that may surprise you.

Before I begin with a bioethical analysis, however, the most important thing I can write today is to tell anyone reading this that the a federal agency recently announced a notice and comment period, and I want absolutely everybody here to do something about it. This is not the usual agency we’re all used to dealing with, the FDA, but another one some of us don’t hear about so often, the U.S. Department of Agriculture, and the notice-and-comment period I’m referring to was about proposed regulations for the treatment of elephants in captivity. And the treatment of elephants, it turns out, has everything to do with whether people should clone a dinosaur (and how many).

Throughout the long history of elephants’ exploitation by humankind, there has been no act of cruelty or deprivation inflicted on elephants which was not also inflicted on humans. In fact, the similarity in the litanies is almost eerie.

So, even though the USDA some time ago closed the notice-and-comment period on elephants, they have not announced any new rules yet, so everybody reading this should nonetheless send in a respectful letter, seriously commenting on this important issue.

For What Benefit?

According to experts, scientists have recovered much of the DNA of the ancient dinosaurs. At first glance, the notion that humankind could clone dinosaurs, a phenomenon which is nearly scientifically possible, seems attractive. But why should human beings do so, assuming we could?

Is it for the dinosaur? By most reports the process of cloning a dinosaur would be long, and involve numerous errors, and many euthanized animals that had been malformed or ill-treated. Upon successful completion of this remarkable venture, what would be the result?

Would people clone one or two dinosaurs, and relegate them to a zoo? If so, it remains to be seen whether the dinosaur would be happy. It is the conclusion of this meditation that if the result were to clone simply one or more dinosaurs, who would then be unhappy, then dinosaur cloning should not take place. But some animals appear to respond to zoos differently from others.

Alternatively, perhaps a very, very large tract of the planet somewhere could be forested somewhere and set aside for dinosaurs, and other animal species, and it is this outcome that this essay hesitatingly, but seriously advocates. Otherwise, perhaps it could be an amphibian dinosaur that could be cloned and put in Lock Ness; I understand they already have problems over there in Lock Ness.

This essay takes the position that if the mission were to clone a live population of dinosaurs, who would then be permitted to repopulate sustainably, then that would be a benefit to the dinosaurs. Doing this is an interesting idea, but I don’t think anyone is ethically obligated to do this, should it be possible.

Is it for other animal species? This essay takes the position that by cloning dinosaurs, humankind should become capable of reestablishing other extinct species, this might be a benefit to the animal species, depending on the relationship and the environmental circumstances.

Is it for humankind? Truly, the awesome project of cloning a dinosaur assumes seemingly miraculous, impossible proportions, similar to the lunar voyages. Also, beyond sheer titillation, this project would likely involve an immense expansion of human knowledge in a wide variety of realms.

But beyond pure science, does the marvelous nature of such a project accomplish anything else for people? One thing it would accomplish would be to establish the relative scarcity of impossible achievements in the university. Perhaps by accustoming human beings to such achievements, people might become accustomed to making much more immediate demands of other ventures thought unattainable, including, perhaps most notably, a nonviolent humanity, and perhaps getting it.

Is it Urgent? Perhaps because of the sorry history of human maltreatment of animals, the question of whether people ought to clone a dinosaur is close to being indeterminable, and according to philosopher William James, ethics says you shouldn’t guess in these cases, unless compelled to by circumstances. If people might some day lose the ability to clone a dinosaur, or if it might contribute to the solution of other emergencies, then people should do it.

Who Should Clone

If you conclude that people should clone a dinosaur, then who should do it? Right away, three stakeholders are ruled out: science, industry, and the federal government. Science should not be permitted to undertake this venture without input from other sources, while big business and the government lack the institutional legitimacy to do it.

Nonetheless, the scope of the venture is most comparable to that of the space missions, so perhaps it should be modeled on the NASA programs, only this time involving other countries, perhaps under the auspices of the United Nati ons.

Next Up: Nonetheless, the next essay assumes that the entity involved in cloning the dinosaur is a company, private or non-profit, and describes what the regulatory framework for such cloning should look like, as well as what regulatory framework a development company should follow.

MEDICAL ROBOTICS MAGAZINE

2008-05-09T11:41:00.004-05:00

Welcome to the on-line portal of Medical Robotics magazine!
Our first print issue was released in March, and plans for a second issue are in ther works!
MR is indexed by the U.S. Library of Congress and features the work of first-line robotic surgeons, researchers, businesspeople and consultants, in the fields of robotic surgery, rehabilitation robotics, medicine, research and more!
All contents (c) 2008 John J. Otrompke, JD
John_Otrompke@yahoo.com

Success In Robotic Surgery: Not Just the Institution, but Patient Selection is Key

2008-05-07T12:52:00.000-05:00

An Interview with Dr. Raul Parra, the Pioneering Partial Nephrectomist

By John J. Otrompke, JD

Many institutions are learning that establishing a successful robotic surgery program can be a hospital-specific endeavor, with a smooth roll-out often depending on whether the hospital is really a good fit with the robot. But in terms of what really counts- improving outcomes for patients with cancer- perhaps it takes a robotic surgeon to establish the important role of patient selection in getting the best cure rate possible.

“It’s all about patient selection,” said Dr. Raul Parra, MD, chief of the department of urology at Cooper University Hospital. “For example, when we do a robotic partial nephrectomy, we limit the cases to tumors less than four centimeters, whereas for larger tumors we are embarking on doing total removal in selected patients.” To date, Parra and his institution have done 21 partial removals, and in doing so, have accumulated the largest experience right now in the country.

The team has also performed about a half dozen total removals, which are a relatively new technique, said Parra, who will deliver a talk on rolling out a robotic surgery program at a medical robotics conference in Philadelphia this June.

Parra’s superior experience is paying dividends in the form of a presentation at the annual meeting of the American Urological Association in Orlando this month, as well as a recent manuscript to the Journal of Urology, comparing the team’s first ten robotic partial nephrectomies to a contemporary group which performed ten open partial nephrectomies.

“Both sets of procedures were done by me during same the period of time,” Parra said. “We found that cancer control, or the ability to remove the entire cancer from the kidney was the same. Robotic surgery is as effective as open surgery to eradicate cancer. Additionally, the operative time was equal to or less than open surgery,” said Parra, who added that the group started using robotic surgery for kidney procedures in September of 2007, and data for the study was gathered between September and November of 2007.
The hospital had already been using the Da Vinci for prostate cases for five years, he said.

The Educated Patient

Having the latest therapies available for patients diagnosed with a serious condition is important from a business point of view, Parra said. “In my experience,
patients who are diagnosed with tumor in the kidney do some sort of research and investigate, then prefer those surgeons providing minimally invasive surgery. The main advantage is that conventional laparoscopic surgery is like operating in two dimensions, like watching TV, and it is very difficult to perform certain maneuvers, in particular suturing,” said Parra. The same difficulties are lessened with robotic procedures, which is more comparable to doing an open case,” he added.

“In today’s health care environment, in the major metropolitan areas, those institutions that are not doing robotic surgery, will probably be at a disadvantage, because patients are very savvy,” said Parra.

Robotic surgery is also preferable from an efficiency standpoint. “In my experience, robotic surgeries for the kidney are taking no more than to do them open, and sometimes less time. And they take significantly less time than for laparoscopic procedure,” said Parra noting that his work showed the average time for a robotic partial nephrectomy is less than two hours, compared to sometimes more than three hours to do them laparoscopically,” he said.

With Parra’s evidence and experience beginning to mount, he said his institution is looking into buying a second Da Vinci. “Now our experience with partial nephrectomies is almost 25 patients, and we’ve done a total of 400 total robotic procedures. The results are very encouraging,” he added. The institution is considering the second Da Vinci primarily because of demand, he said.

The demand for robotic surgery could create a dilemma for some institutions.
“The problem we face is that market forces are such that institutions that want to compete with the one across street, if they’re not going to have a high-volume place you’re not going to have the same outcomes. You’re not going to improve over the results that you have now, and it places a significant burden on the shoulders of administrative departments, the legal department, physicians and everybody, to get by the learning curve,” said Parra, noting the evidence in the literature that shows that it takes between fifty and 100 cases for a surgeon to become adept at performing a robot prostatectomy. “And in my opinion, if you don’t make the prostatectomies, you should not be attempting to operate on the kidney which is significantly more complex, because the kidney is very deep within the abdominal cavity, is well-vascularized and is very fragile,” Parra added.

As one way of dealing with the important learning curve issue, Parra said he was instrumental in creating at his institution all agreed on a strict mentoring program, prior to implementing the roll-out of the robotic surgery program. “Any of the surgeons in this hospital who wants to use the robot has to take a certified course provided by Intuitive Surgical in how to work the machine, and has to perform at least five procedures, beginning with the easier ones, while supervised and trained by an experienced robotic surgeon,” he said.

Parra noted that as the popularity of robotic surgery grows, improvements to the device itself will continue. “For instance, I think the robot is a very large, cumbersome piece of equipment, and it takes up a lot of space. In the future, the Da Vinci will be miniaturized, and more incorporated into the operating room. Improvements in ergonomics and size are all within the current technology,” Parra added.

Rolling Out a Robotic Surgery Program:

2008-05-07T11:02:00.002-05:00

Dr. Dieter Bruno, Intuitive Proctor and Experienced Robotic Surgeon, Teaches How to Manage a Successful Roll-Out

A Complex Endeavour with the Potential for Astronomical Success
By John J. Otrompke, JD

In any newly developing field, greater experience assumes a role of greater importance. But in a field like robotic surgery, where not only a hospital’s fiscal health and reputation, but patients’ lives, can be at stake, having real experience can be something of a rarity.

That’s why Dr. Dieter Bruno, MD, a practicing robotic surgeon and a proctor for Intuitive Surgical, has drawn on his wealth of personal experience to modify the training process for physicians new to using the robot.

“I originally started in robotics before there were fellowships or training courses, because it was only a couple of years after the robots had been FDA-approved in this country,” said Bruno, who was the first urologist in North Carolina to use the Da Vinci when the program was first rolled out at East Carolina University in Greenville in 2002.

Bruno will be speaking at a robotic surgery conference in June in Philadelphia, on rolling out and managing a robotic surgery program.

“We set up model back then was very different,” said Bruno. “I was in private practice, but at an academic institution. After a course by Intutive we started doing cases, and we got specialists such as ob/gyn, general surgery, cardiac surgeons and urologists, and we helped each other because we all understood about the robot.”

Bruno was one of about seven physicians at the university who first began using the robot, but of the five physicians in Bruno’s urology practice, he was the only one who began learning robotic surgery.

Since that beginning, Bruno, who practices surgery at four different California hospitals, has performed well over 100 robotic prostatectomies, and if you add kidney surgeries and pyeloplasties, that number is much higher.

Partly due to Bruno’s influence, today’s training programs are structured much differently. "In the past cases were difficult because you had to struggle through an entire case on your own. Now with the adoption of robotics into training programs learning is easier because residents and fellows can do part of a case and work on specific skill sets. However, there is a difference between doing a full case 10 times and being able to do a part of 10 different cases. In the old paradigm by the time you had been involved in 10 cases you had a reasonable amount of experience because you had to struggle through the entire endeavor," he said.

A Systems Approach

“When rolling out a robotic surgery program, people need to take a step back and say, ‘This is an expensive piece of equipment.’ Unless the whole health care system understands, the program is doomed to failure. There are institutions that bought a robot and never did a case,” Bruno added.

Everybody from the Board of Directors to the operating room nurses, recovery and floor nurses should be facile with using the system.

“This really requires many different points of contact. But when it is done well, the success is really just astronomical,” Bruno said.

Part of that is improvement in the reimbursement picture for robotic surgeries, Bruno said, which has definitely improved the profitability for hospitals. “Economics becomes a very complicated issue depending on what point you start assessing your data. The bill for robotic surgery is higher, but when you look at being a center of excellence, it allows you to get a secondary gain,” he said.

It used to be the case that there were no codes specifically for a robotic procedure. Today, the picture varies from one insurance company to the next. “The actual surgeon fees aren’t significantly higher, but the hospitals really do better, because they get reimbursed a lot more,” said Bruno. “I may get a few hundred dollars more than when I did an open procedure, but the hospital may get many thousands more,” he added noting that reimbursement by certain Blue Cross plans may go as much as 45% more for a robotic than a traditional open surgery case.

In addition, quality and outcomes for patients are better using a Da Vinci, Bruno said. “In the prostate model, you have better chances of negative margins, and a better likelihood that there will be a curative operation. And data for continence from large series shows that people who undergo a robotic operation will get a return to continence sometimes as much as six to nine months earlier,” he added.

Just what does it take?

In addition to sound business planning, relevant training and a well-honed surgical team, a successful roll-out also requires a certain degree of marketing. “You need to start working with marketing early, to do a dual-phase rollout, and know how to market your program to the medical community that services your hospital,” Bruno said. “The area that I’m in is high-income, so everybody knows about the Da Vinci. But in other areas, you can talk to patients all you want about robot, robot, robot, but if they go back to their primary care doctor and haven’t heard of it, then what are you going to do?”

In sum, having a successful roll-out requires not only a good environmental fit, but the willingness to make it work. “A lot of what goes into the success of a program depends on what goes on behind closed doors, before the institution ever buys it. It takes a significant commitment to get a good core group of surgeons. Some hospitals offer a multidisciplinary approach. But other hospitals I go to don’t give a darn about marketing the robot,” Bruno said.

An Interview with Dr. Rahuldev Bhalla, MD

2008-05-07T09:53:00.005-05:00

In Robotic Surgery Center of Excellence, Stony Brook's
Executives Rely on Bhalla's Commitment

By John J. Otrompke, JD

Dr. Rahuldev Bhalla, MD, director of robotic surgery at Stony Brook University Medical Center in New York brings a unique perspective to rolling out a robotic surgery program. Bhalla not only directs the robotic surgery program at Stony Brook beginning in August of last year, but also started another program at a state university across the river in New Jersey, between 2004 and 2007.

Yet comparing the two programs is like comparing apples to oranges, largely because of differences in institutional support.

“The roll-out here was a lot more smooth not only because I knew what to expect, but because both the dean and the CEO here are very into having this robotic program succeed. At the other hospital there was not as much support,” said Bhalla, who will be speaking on how to ensure a successful roll-out of a robotic surgery program, at a conference on robotic surgery in Philadelphia this June.

“It is imperative that the hospital has a vision or a plan,” said Bhalla. “Listen, we’re the only tertiary care center in Suffolk County, serving most of Long Island. We’re going to be able to deliver health care at 2010 levels. In addition our urology program is one of the top fifty in the whole country,” he said.

But even when environmental circumstances are right for a new roll-out, the institution has to figure out how the program will fit in with the rest of the hospital. “It takes operating room time, money to buy the machine it, and resource support. You initially have to be able to take a big hit financially,” said Bhalla, who noted that total costs for starting up with a Da Vinci ‘S’, such as Stony Brook has, run between $2.2 and $2.5 million, inclusive of all services, instruments and related costs. “But we’re doing the community a service by having this here,” he said.

Bhalla stated that he is getting a lot of work out of his institution’s Da Vinci, with 80% of the institution’s urology cases being done robotically. Thirteen urologists practice at Stony Brook, Bhalla said.

Qualified physicians are mandatory, he added. “You definitely need someone who’s skilled and going to bring a reputation here because if you go through the learning curve and have a fault, you’ll get a bad reputation and not get any more referrals,” he said.

Nevetheless, opportunities abound in robotic surgery, even outside the treatment context. Stony Brook, for example, has a large robotics program on the university side as well, developing robotics for lung cancer. Bhalla himself is involved with research to add tactile feedback to the Da Vinci system’s other advantages.

2008-05-05T13:38:00.002-05:00

Surgeons May Turn to A New Biotechnology Product to Solve the Problem of Interoperative Bleeding

Recothrom: A Tool in the Minimally-Invasive Surgeon's Toolbox

By John J. Otrompke, JD

In advance of the 5th Annual Global Bioindustrial and Bioprocessing Forum, biotech company ZymoGenetics announced the results of a Phase II trial examining its newly-FDFA approved product Recothrom in the treatment of 71 serious burn injury patients on April 30th.

Recothrom is a recombinant product which may serve as a substitute for bovine thrombin. “Recothrom is an alternative to bovine plasma, which works with other proteins in the body to help start the clotting that stops bleeding,” said Susan Specht, director of corporate communications at Seattle-based ZymoGenetics.

The burn news was announced at the meeting of the American Burn Association in Chicago. The patients in the study had wound sizes of approximately 15% of the patient’s total body surface area.

Bovine thrombin, the earlier product for oozing and bleeding wounds, was approved in the early 1940s, and was grandfathered in by the FDA, but carried a black box warning until its most recent FDA review and approval in 2007, for an ultra-filtration process that removes non-thrombin proteins. However, Recothrom also showed lower immunogenicity in a Phase II clinical trial, Specht says. In Phase III trials prior to FDA approval, Recothrom has so far been tested in spinal surgery cases, liver resections, peripheral artery bypass, and arterio-venous graft construction.

It may be the rare robotic surgeon to admit that intraoperative bleeding can be a problem in these cases, but as the range of surgical procedures in which robots may be an option expands, it5 is wise to remember that Recothrom may be just another device in your toolkit.

ZymoGenetics, which was formed in 1981, has also outlicensed a number of drugs prior to its breakthrough with Recothrom, and has other novel products in development, such as Atacicept, which is aimed at treating autoimmune disease by blocking two factors, April and BLyS, without totally depleting B-cells like some drugs.

Other products in development at ZymoGenetics include Interleuken-21 and Peg Interferon Lambda, which is aimed hepatitis C.

Copyright Information

2008-04-16T09:04:00.000-05:00

Standard Da Vinci vs. the Da Vinci 'S' From a Nursing Standpoint

2008-04-09T12:40:00.003-05:00

By Patricia Francois, RN, CNOR,
Surgical Robotics Coordinator at Advocate Lutheran General Hospital in Park Ridge, Illinois

At Advocate Lutheran General Hospital we currently own both robotic systems : the standard Da Vinci and the Da Vinci “S”. There are mechanical and technical differences between the two robotic systems, which makes it difficult to train new people. This article will detail the differences between the two robotic systems in five specific areas: narrow profile, patient side cart, range of motion, brake system, and the battery backup.

Narrow Profile and the Patient Side Cart

The Da Vinci “S” patient side cart has a narrow profile and is designed to have smaller arms with two inches longer instrumentation than the Standard system. The Da Vinci “S” patient side cart has a 4th robotic arm that can be counter-balanced or “homed” in its stowed position in the back of the system. This cannot occur with the Standard system; all arms must be properly positioned and “homed” before use is possible. The “S” system also has greater range of motion than the standard system with the robotic instrument arms. With the range of the instrument arms in addition to the longer instrumentation it is found easier to get into tight abdominal spaces as well as accomplishing better range of motion with suturing techniques such as a “figure eight” stitch.

Brake System

The brake is another mechanical difference between the two systems. The “S” system has a built-in auto-lock safety when docked to the surgical field. Therefore, when robotic arm cannulas on the patient side cart are attached to camera and metal trocars at the surgical field the cart has a safety lock and an alarm which will not allow the system to move when trocars are attached to it. The standard system does not have a safety lock alarm, furthermore, if you do not manually lock the wheel s upon docking the system it has the ability to move at the surgical field even if trocars are attached. Nevertheless, the standard Da Vinci side-cart weighs 1200 lbs which originally took two nurses to move the cart into the surgical field without hurting your back. An upgrade was made to the break pad system which made it 50% easier to move but can still be a nuisance especially to those with back problems. On the other hand, the Da Vinci “S” system has the ability to be moved manually or motorized by shifting the gears at the base of the cart from “D” drive to “N” neutral. The drive mode is controlled by your fingertips and a throttle mechanism built into the steering system. The system easily and slowly glides across the operating room in the drive mode which is the mode used for docking the system. The neutral option on the brake system allows faster free long distance movement of the cart. In addition, in the neutral mode this cart can be moved using one hand except when turning the cart around a corner or an object.

Battery Back-Up

Unlike the standard system, the “S” system has a backup battery for both the surgeon’s console as well as the patient side cart. The standard system only has a battery backup for the surgeon’s console because this is the primary source of power for the robot. Also, if the robot is stored incorrectly, i.e. if the robotic arms are sticking out and not protected you could change the position of the arms of the “S” system by pressing a button, which allows the robot to be powered on from the battery backup system and the arms can be moved at this time. But with the standard system, if you need to move an arm that is not stored correctly you have to connect all the heavy cables of the robot to the surgeon’s console, power on the entire system, and only then will the system allow you to move the arms into their correct stowed position.
The “S” system was created to be more technically user friendly than the standard system, starting with the button labels available on the surgeon’s console, to the LED lights available on each arm (which are color-coded for specific tasks that are done with that arm), to the built-in sterile adapters available on the drapes of the robot and the integrated touch screen monitor with telestration now available for the patient side cart (this can be utilized for teaching purposes). None of these options are available on the standard system, which makes things less user-friendly for everyone involved.

Relative Advantages and the Learning Curve

In conclusion, when I start the process of training new people, I have to decide which system to start with, and usually we start our training with the user-friendly system, which is the Da Vinci-S. Furthermore, there are numerous options available on the Da Vinci “S” which make it easier to learn how to operate the system safely and effectively. As a robotics team nurse the ability to learn quickly and efficiently is very important with moving forward in the training process of learning to use the robot.

Medical Robotics Popularity Leads to New Specialists, New Educational Necessities

2008-04-08T15:23:00.000-05:00

The robotic surgery sensation is not only transforming care, but improving the jobs market and affecting intellectual property trends as well

By John J. Otrompke, JD

On a typical day at work, Patricia Francois, RN, begins the day by readying operating rooms at Advocate Lutheran General Hospital in Park Ridge, Illinois. “We have to get the room set up an hour and a half before the patient even comes into the room,” Francois said.

“Three nurses are involved in each case,” she continued. “One team member scrubs in to assist the surgeon at the sterile field, and the other two team members are circulating nurses which are very necessary to share the role of taking care of the patient , documenting the procedure , and troubleshooting any issues that occur during the operation. If there is a troubleshooting issue occurring in a room that I am not present in at that time, and the nurse in that room is capable of trouble-shooting, then I am called into the room to assist,” she said.

Nurses everywhere may be used to busy case loads, but Francois is extra dynamic, because her cases are not ordinary cases; she is the surgical robotics coordinator at Advocate Lutheran General, and when she is not busy in the operating room, she is occupied with putting together educational curricula for an entirely new field of specialty: the medical robotics nurse. [See attached article].

“I created a resource book, called “The Robotics Resource Manual,” which has pictures of the surgical room set-up. For each procedure (robotic prostrate surgery, for example), it will tell you where to put the patient side cart, because you have to put the robotic arms or the patient side cart in the right place during the procedure to make it easier for the surgeon. (For prostate cases, it is placed at the foot of the bed, whereas for liver resection, it has to go at the head of the bed). And I have some anatomical pictures with information explaining the robotic procedures, as well as a log of different types of trays, and a log of different types of Da Vinci trays and single instrumentation available, as well as doctor-specific preference cards for each case if the procedure gets converted to an ‘open.’ For example, I have in there how to access error log if you have a problem during a case,” Francois said.

The nursing manual is the first of its kind in existence, but Francois said it is for use for in-house use only so far. This manual is hospital-specific with professional robotic room set-up pictures created by robotic team nurses and media team services. The nursing manual is the first of its kind in existence, but Francois said it is for use only in-house so far. Not even Lutheran General’s sister hospitals use the manual.

“One of my goals for 2008 is to teach a robotics preceptorship for other Advocate hospitals, and once we offer that course I will have the opportunity to share those surgical illustrations with them,” she said.

A Booming Business

While Advocate Lutheran General already owns two da Vinci surgical robots, the hospital is considering purchasing a third, because the cases are coming in quickly. “We have the standard Da Vinci and the Da Vinci S, and two upgraded robot-specific operating rooms,” Francois said. The hospital is doing as many as 3 or 4 cases per day, and up to 6 robotic surgery cases per week. Last year, Advocate Lutheran General hospital handled over 200 robotic cases, she said. But with those cases, come technical difficulties, she said.

“Intuitive has provided representatives that have taught the robotic team nurses and myself how to trouble-shoot certain problems which occur during a procedure. “The robot will alarm if something occurs that the system doesn’t like, such as if the doctor is too rough with the instrumentation or uses jerky movements. It’ll let you know what the problem is. You just acknowledge the alarm by hitting a button, and it clears itself.

“But sometimes if you do something, such as repeated non-intuitive motion, the robot will sometimes give you a non-recoverable fault, and lock you out, and its not going to let you go forward until you fix the problem. Me being coordinator, if I can’t solve the problem, I have an 800 number, and it will take you right to Intuitive technical support, and talk to a live engineer, in about 30 seconds if you’re in the middle of a case. That’s if I don’t have an Intuitive representative in the room with me,” said Francois.

The robot creates a page of errors as they occur during a case, and these errors are translated as codes which are stored in what’s called an error log in the system. “I’m reciting line by line from a whole page of errors that’s on the monitor, and the engineer I’m speaking to has a book of codes, and helps me to identify and solve the problem,” she said.

At the beginning, the Intuitive representative was present for 98% of the cases, she continued. Now that the hospital has been doing robotic surgeries for several years, the original rep hasn’t been in all the time, “but we do have a new representative who has been here to help support a new surgeon beginning to use the robot,” she continued.

Another of Francois’ new duties as coordinator involves facilitating a semi-monthly meeting of the entire robotics team of 17 multi-service staff members, to discuss any updates, research topics, or problems which have occurred. “Communication and teamwork is the number one key to having a successful robotics program,” she said.

Still, notwithstanding the learning curve, Francois said, “overall, it is just fantastic what the surgeons are able to do robotically. We did a robotic inguinal hernia the other day, and it took an hour and a half total room time. And when you view the 3-D image, as opposed to a two-dimensional laparascopic image, you can see small, delicate vessels, and they are much more defined,” she said.

Robotic Surgery Developer Wins Microsoft Award

2008-04-08T14:47:00.001-05:00

Early Surgical Robot Developer Behind Microsoft Award for Neonatal Technology

By John Otrompke
A system for improving health care delivery to premature babies and neonates which recently won a prestigious award issued by the Microsoft Healthcare Users Group (HUG) may have had part of its genesis in one of the first surgical robots ever developed.
The LacTrack System, designed by Neoteric Technology Ltd., won a first place award for Healthcare Innovation in the category of Delivery Transformation. The SafeLx solution was honored for preventing infant feeding errors at Sunnybrook Health Sciences Center’s Neonatal Intensive Care Unit (NICU) in Toronto.
“At Sunnybrook, our technology is being used to prevent misfeeds. They operate a very large fridge for storing the mothers’ milk (which they nickname the ‘Dairy Queen,’” said Geof Auchinleck, President of Neoteric.
“We’re a regional perinatal unit where babies are ventilated, and our expertise comes in looking after particularly small ones, such as babies born under 26 weeks, who weigh under a kilo. These babies are only a little over halfway through gestation,” said Dorothy Dougherty RN lactation consultant and developmental care team leader at the 42 bed clinic.

The collaboration between Sunnybrook and Neoteric was especially important, because due to mergers, the Sunnybrook is currently housed at Women’s College Hospital, while the new unit is being built at Sunnybrook, said Doughterty, who noted that Neoteric allowed Sunnybrook to help design the system. “We’re making darn sure when move that everything has to talk to each other,” said Dougherty, adding that the clinic is actually connected to Sunnybrook electronically.

“We have been following the problem of neonatal misfeeds now for a decade,” said Dougherty. “But somehow we could never seem to prevent the errors from happening
Data from Sunnybrook indicate that between August 27 and December 5, 2007, the technology captured and prevented 168 feeding errors out of 28,000 feeds given to 175 premature patients. Each baby received 161 feeds, for a total of more than 31,000 transactions including ordering, beginning and ending feeds.

Robotic History

Part of the idea for not only LacTrack, but many of the products Neoteric offers, may have come from Auchinleck’s pioneering work in the robotics field. In 1984, Auchinleck worked on a device called the Arthrobot, which was intended to position the patient’s limb for orthopaedic surgery. Together with Dr. Jim McEwen and Dr. Brian Day, who is this year’s president of the Canadian Medical Association, Auchinleck and colleagues performed over 200 procedures with the Arthrobot.

“While the Arthrobot project ultimately morphed into software which ultimately entered the market, the endeavor led me into the realization that there were major problems and opportunities in data management in the labs that started with poor quality patient identification,” said Auchinleck. In 1997, Neoteric was founded, and today offers a suite of process management tools.

“We began to press for adoption of electronic positive patient identification, which to us means barcodes or RFID id, then added blood transfusion, mothers’ milk administration and medication administration options,” he continued.

In addition to the neonatal unit, Neoteric’s technology is widely used in managing blood transfusions. “We manage the movement and transfusion of blood in more than 80 hospitals, most in the UK and Ireland. For example, our system controls every blood unit in the city of Glasgow, also the city of Leeds,” Auchinleck said.
Neoteric uses a range of Microsoft technologies in its products, including the operating systems, as well as development and database products. “As many of our products are PDA based, we use the Windows Mobile platform as well,” Auchinleck explained.

“Yet, we were given the award because by using these tools, we have come up with products that change the way health care is delivered.”

It has even said by at least one expert that “this is the most important advance in blood transfusion in decades.”

Reminder- Animal Testing Essay Contest!

2008-04-08T14:36:00.002-05:00

Please Repost!

For the next year, Medical Robotics magazine will solicit proposals from essayists describing any one or more new ways to reduce or eliminate the deleterious effects of harmful animal testing. Some time prior to Spring of 2009, the essayist with the most beneficial submission will be awarded $1,000 US.

You may submit your essays to :

John J. Otrompke, JD
Medical Robotics Magazine
John_Otrompke@yahoo.com
312-217-3394

Thanks much!

Prominent Robotic Surgeon Joins Board

2008-03-21T10:28:00.002-05:00

Dr. Charles E. Miller Joins Board of Editorial Advisors

Medical Robotics Magazine is pleased to announce the addition of Dr. Chuck Miller, president of the AAGL (formerly the American Association of Gynecologic Laparoscopists) to its Board of Editorial Advisors, effective Thursday, March 20, 2008.

Dr. Miller is Director of Minimally Invasive Gynecologic Surgery at Lutheran General Hospital in Park Ridge, Illinois, as well as a professor.

"The AAGL is truly an international society," said Dr. Miller, who has presided at several courses in robotic gynecology.

The 37th annual congress of the AAGL will take place this year in Las Vegas in October. "This is the largest meeting where robotics has such a large focus in gynecology," said Dr. Miller.

(c) 2008 John J. Otrompke, JD

2008-02-24T18:45:00.001-06:00

MEDICAL ROBOTICS MAGAZINE

ON-LINE EDITION

MEDICAL ROBOTICS MAGAZINE

2008-02-13T09:32:00.003-06:00

Welcome to the on-line portal of Medical Robotics magazine. Our first print issue was released in January!
All contents (c) 2008 John J. Otrompke, JD

John_Otrompke@yahoo.com

CONFERENCE SCHEDULE

2008-02-13T09:02:00.000-06:00

Here follows a list of some upcoming conferences pertaining to medical robotics:

March 14-15, Northampton
Association of Chartered Physiotherapists Interested in Neurology
http://www.acpin.net/events.html

March 17-19, Orlando
Third Annual World Robotic Urology Symposium
The Global Robotics Institute, www.GlobalRoboticsInstitute.com

April 9-12, Lisbon
World Congress on Brain Injury
http://www.internationalbrain.org/news.php?dep=0&page=1&list=85

May 30-31, Beijing
International Symposium on Robotic Cardiac Surgery
www.roboticsurgery301.net

June 12-13, Philadelphia
Robotic Surgery –Innovation of Today, Tomorrow and The Future, For Administrators and Surgeons
www.acius.net

June 12-14, Fellbach
Physiokongress
http://www.thieme.de/physioonline/physiokongress/2008/index.html

July 11-12, Seoul
12 Live Da Vinci Cases: YONSEI University Health system, www.yuhs.or.kr/en/mis

September 10-12, Prague
European Robotic Urology Symposium
congress@ismar.com

Papers at MIRA Describe Experiences in Liver Surgery Techniques

2008-02-13T09:00:00.000-06:00

By John J. Otrompke, JD

Speakers at this year’s MIRA conference in Rome commented on difficulties inherent in liver procedures, and how robotic surgical technology can be used to gain an advantage in the tricky procedures.

Operating in the context of colon cancer which has metastasized to the liver can be especially difficult, according to one paper, ‘Robotic Minimally-Invasive Short-Interval Staged Approach to Synchronous Colon Cancer and Liver Metastases,’ by O. Mansouri and colleagues.

The paper noted that simultaneously resecting the liver in cases of colon cancer leads to a higher mortality. Mortality is between 7 and 12% when the resections are done simultaneously, versus 2% when staged resections are done. Further, mortality reaches 24% when the simultaneous liver resection is a major hepatectomy, according to the abstract.

The abstract noted that one patient, who received both operations with a Da Vinci surgical system on a short-interval basis, was mobiled the day after the operation, began oral feeding the second day afterward, was discharged on the 11th day after the operation in excellent condition.

Another abstract, by F.M. Bianco and colleagues, discussed a five-trocar technique in respect to data from 47 patients. The abstract noted that new tools are needed for liver procedures.

Both abstracts were by a surgical team operating at the University of Illinois at Chicago.

Two 2008 Studies Provide Data on Robotic Surgery Complications

2008-02-13T08:04:00.002-06:00

MIRA 2008

Two large studies indicate equipment malfunctions occur and provide data on robotic surgery complications

By John J. Otrompke, JD

Two large studies released at MIRA 2008 provide data on Da Vinci equipment malfunctions, and indicate that complications from robotic surgery with the da Vinci decrease when the surgery is performed in a high-volume institution or a center of excellence. Nonetheless, the presenter of the studies called for surgeons who experience complications or equipment failure to register their results with a download from the device.

“Every surgeon should register errors when they occur,” said Dr. Kenneth Palmer, MD, a resident at Florida Hospital Celebration Health, who presented the two studies at MIRA. The studies were noteworthy for their size, as the first, ‘Robotic Equipment Malfunction During Robotic Prostatectomy: A Multi-Institutional Study,’ involved 11 institutions and a total case volume of 8,240.

The second study, ‘Intra Operative Complications During Robotic Assisted Laparoscopic Prostatectomy,’ involved 1,256 consecutive cases at Ohio State University.

The twelve institutions in the first study, regarding device malfunctions, included Vanderbilt University, the Prostate Cancer Center of Austin, Texas, Cornell and Ohio State Universities, and others, according to Palmer.

“With the Da Vinci robot, the computer board can go wrong, or there can be problems with the arms or with the optics,” said Palmer, noting that the carbon dioxide which is normally used to inflate the patient’s abdomen can also prevent camera fogging. “Defaults can be overridden, and the procedure can be converted to either laparoscopic or open surgery. Most critical failures can be identified before the procedure, because the Da Vinci performs a self-test. It all depends on the volume of the center or the experience of the surgeon,” Palmer added.

Of more than 8,000 Da Vinci prostatectomies performed in the study, critical failure occurred in 0.4% of the cases, leading to 23 cancellations, one laparascopic conversion, and eight open conversions. Recoverable failure occurred in 1.5% of cases, according to the abstract.

Medical complications were slightly more common, however. According to the second study, complications occurred in 64 out of 1,256 cases, or just over 5.1%. However, there was no mortality or immediate return for second procedure associated with these complications. The study involved a follow-up of 19.7 months.

The complications included four blood transfusions, four myocardial infarctions, and two lymphoceles, among others.

As with equipment problems, complications appeared to decrease with the experience of the center and surgeons.

Other doctors on the study included Dr. Vipul Patel, MD, founder of the Global Robotics Institute, which is hosting its third annual World Robotic Urology Symposium in Orlando, March 17-19 (see calendar). The studies were on-going, Palmer said.

Another study released by Palmer, Vatel and colleagues at MIRA 2008, ‘Robotic Assisted Laparascopic Radical Prostatectomy: Perioperative Outcomes of 1,500 Patients,’ reported positive results in 1,500 consecutive prostatectomy cases.

Robotic Rehabilitation Study Inspires Massive Follow-On at the Veterans’ Administration

2008-02-13T07:55:00.000-06:00

Prior Study Found Significant Benefits of Robots by Interactive Motion Technology in Stroke Patients

By John J. Otrompke, JD

A successful study completed at Burke Medical Research Institute, results from which was published in the journal Neurorehabilitation and Neurorepair this month, inspired so much confidence in the Department of veterans’ Affairs that the VA has begun a study of robotic devices manufactured and marketed by Interactive Motion Technology (IMT) (T), testing the device in 160 patients, 70 of whom have already been recruited. The study aims to confirm results from a prior trial that found that use of the robots offers stroke patients double the benefit of using just therapists alone.

“This is a gold standard clinical trial which could form the basis for a new standard of care in evidence-based medicine for these patients,” said Dr. Albert Lo, MD, PhD, associate professor of clinical neuroscience and engineering at Brown University. Lo is also a physician at the Providence VA Medical Center, one of the sites where the trial, CSB 558, is taking place. Other centers are in Baltimore, Gainesville, Seattle and Westhaven.

The study aims to confirm the bedrock principle of neuroplasticity, on which IMT’s successful medical rehabilitation robotics program is founded. All in all, four separate robotic devices from IMT are being used. The article, “Intensive Sensory Motor Arm Training Mediated by Therapists or Robot Improves Hemiparesis in Patients with Chronic Stroke,” by Dr. Bruce T. Volpe, MD, went on-line on January 9, and will in hard copy in the print edition in March.

Numerous Ongoing Studies Illustrate Clinical Benefit

This is not the first time IMT’s commercial robots program has illustrated its beneficial application. “We’ve treated well over 300 patients with the IMT robots,” said Volpe, who is a professor of neurology and neuroscience at Cornell University Medical College, as well as a physician at Burke. Together with occupational therapist Avrielle Rykman, OT, clinical research coordinator for Burke’s robotics program, Volpe has trained as many as 50 staff from the VA at Burke in how to make the best use of the IMT robots.

Positive experiences with the IMT robots have led Volpe and Rykman to organize several other studies with the devices. In addition to the on-going VA study (for which the duo serve as clinical consultants), Burke is the home for three other clinical trials. The largest one, the ‘order effects study’ which investigates the proximal-distal relationship of the robots to the patient’s nervous system, looks at whether a clinical benefit is enjoyed if the patient is treated with a shoulder-elbow robot before the hand-wrist robot.

Seventy patients are already in the process of completing the order effects study at Burke, and another 80 have already been recruited and will be treated in 2008. “We already have all the patients recruited; one of the hardest things with any study is patient recruitment,” said Volpe.

Another IMT robot trial currently underway at Burke is a vertical study, which uses an anti-gravity robot to treat patients with subluxation, or shoulder dislocation. There are currently 30 patients in the study of the vertical robot.

Other studies look at patients who have suffered from spinal cord injuries, or even the use of IMT robots in patients who are children who suffer from cerebral palsy, such as the study just beginning now at Blythedale Hospital in Valhalla, New York, according to Avrielle Rykman.

[sidebar]

Compassionate Care

Robots by Interactive Motion Technologies offer promising treatments for patients who have been considered very difficult to treat in the past. The Burke spinal cord study, for example, is currently treating five patients who were previously paralyzed with IMT robots. “One of the patients was in a car accident, two were in diving accidents, and one was in a skiing accident, for example,” said Dr. Volpe, noting that the patients are between the age of 16 and their mid-40s. “We are treating the 40-year-old patient 25 years after his injury,” Volpe noted.

The patients, who have all had their spinal cords broken off around cervical five area, suffer from paraplegia and quadriparesis. “The patients have very weak arms, and we are trying to treat the muscles in the area of the broken neck, which controls the biceps and forearms. Currently, the IMT robot appears to add functional capacity in their arms,” said Volpe.

Unfortunately, some patients do not qualify for the studies, according to Avrielle Rykman. “For those patients who don’t qualify, either because they had multiple strokes, or brain bleeds, we offer a compassionate care program, in which patients are treated for 6 weeks,” she said.

And another very exciting study has begun at Blythedale Hospital, looking at the use of IMT robots in treating children who suffer from cerebral palsy. Both Avrielle Rykman and Dr. Volpe trained five staff from Blythedale, including the medical director, two physical therapists and a research technician.

MIRA 2008: Two New Miniature Robotic Device Models Unveiled at MIRA May Lead to Even Less Invasive Robotic Surgery

2008-02-05T08:30:00.000-06:00

By John J. Otrompke, JD

Two studies released by Dr. Marco Zenati and colleagues at MIRA 2008 offered fascinating insights into what may become two new miniature robots of the future: a highly-articulated device for epicardial injections, and miniature device called the Heartlander which can crawl on the surface of the heart.

The first device, which consists of many articulated, rigid cylindrical links, was successfully tested in animals and in a human cadaveric environment, according to the first paper, ‘An Highly-Articulated Robotic Surgical System for Minimally Invasive Epicardial Interventions,’ while the Heartlander crawled with inchworm-like locomotion on the surface of a beating animal heart. “The Heartlander is an organ-mounted robotic system, like examples we are familiar with in the field of orthopedic surgery and elsewhere,” said Zenati, a researcher at the University of Pittsburgh.

The epicardial intervention device is joystick controlled by the physician and allows the use through its ports of catheter-based instruments which are already commercially available.

With this device, epicardial ablation, pericardial biopsy, and left atrial appendage ligation, as well as pulmonary vein isolation, were all performed, without adverse events.

Devices used in conjunction with the epicardial robot included a radiofrequency ablation catheter, an endobiopsy catheter, and the EndoLoop.

With the Heartlander, which also uses a magnetic tracking system, epicardial injection, pacing-lead placement, and radiofrequency ablation were all performed.

The device requires about 10 to 15 minutes to create a real-space 3-D model of the heart by acquiring and elaborating the surface points of the organ, which otherwise would not be available without rotating the heart, Zenati said.

The Heartlander is 5 millimeters high, and equipped with an injection needle.

Studies pertaining to the Heartlander were presented in November of 2007 at the Scientific Sessions of the American Heart Association, he noted.

2008-01-29T12:18:00.000-06:00

First Print Issue Now Available!

The first issue of Medical Robotics magazine is now available in print in a hard-copy edition. It is a collectible, folks!

For your copy of the print issue, please subscribe for 2008 by sending a check made out to John Otrompke for $25 US for individuals, or $100 US for institutions, to the address below.

Hi-Q Consulting

John J. Otrompke, JD, also offers diverse consulting services based on an in-person format. A portfolio and more information available on request.

John J. Otrompke, JD
6167 N. Broadway #264
Chicago IL 60660
011-01- 312-217-3394
John_Otrompke@yahoo.com

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Copyright information

2008-01-08T17:19:00.000-06:00

A Leader for a Changing Field

2008-01-02T09:28:00.000-06:00

Dr. Cristoforo Giulianotti Tracks the Development of Medical Robotics from Rome to Chicago and Back Again

By John J. Otrompke, JD

While Rome may be the site of this year’s annual meeting of the Minimally Invasive Robotics Association (MIRA) (please see live coverage featured in our blog at http://www.medicalrobotics.biz/ as well as print coverage of the most timely and fascinating abstracts and medical news from this conference is our next print issue) as well as in all respects a timeless and world-class city, a windy city several thousand miles away may have garnered the title of capital of the world of medical robotics for 2008.

This is as globally noted robotics surgeon Dr. Pier Cristoforo Giulianotti has made the move to lead the University of Illinois at Chicago (UIC) as chief of the division of general, minimally invasive robotic surgery at the University of Illinois Medical Center.

The move may be considered auspicious for both parties, as UIC has made its Da Vinci robotics program an important marketing strategy, and advertised the program locally, and Giulianotti is also an innovator with the device. Giulianotti is the current president of MIRA, an organization founded in 2003, the same year the first-ever robotic ‘Whipple’ procedure was performed, and also performed the first ever robotic ‘Whipple’ procedure in the Midwest of the U.S.A. recently at UIC.

“The ‘Whipple’ is named after the first surgeon who performed the open resection of the head of the pancreas in the 1940s,” said Giulianotti.

The robotic way of doing surgical procedures is preferable to the open variety, Dr. Giulianotti says. “Patients are clearly volunteering,” he said. If you are asked, ‘Have you any doubt, would you prefer to be operated on for gallstones with three small holes or with open surgery,’ many patients prefer minimally invasive treatment, because its bloodless surgery, post-operative recovery is accomplished in less time, there’s less pain and smaller incisions,” he said.

Speaking directly of the Whipple, Giulianotti said, “In comparison to open surgery for certain steps, using the robot makes it easier; suturing is so precise using the robot,” he said. “You can do some extra movements compared to the human hand, for example,” he said.

Still, Giulianotti believes the state of the art is not yet maximally developed. “It is an economical quandary, because you know there are millions or billions available for developing the market for computer games, so that today’s generation of computer games is absolutely incomparable to the first video games. If only there was the same sort of economic support for developing medical instruments, but unfortunately the market is not so rich. That explains some delay, and some difficulties surgeons still experience, mainly due to the lack of specific tools and the need to develop smaller and thinner instruments, or an inner for scanning and cutting tissue simultaneously, for example,” Giulianotti said.

As a result, Giulianotti has ambitions for medical development during his tenure at the University of Illinois at Chicago. (See sidebar).

While the situation in the European Union is inconsistent or “like leopard spots,” robotic surgery is unfortunately not reimbursed in the EU much better than in the U.S., and this is despite the consistent popularity of the procedures with patients. “At the end of the day and you realize this is very beneficial even solely from an economic point of view. Even consider just the operating costs, it ends up being a little more expensive than open surgery, but if you consider all the elements, including the hospital stay, the readmission rate, the consumption of drugs, and the recovery rate for going back to work, doing procedures robotically has a lot of advantages,” said Dr. Giulianotti who formerly performed operations at Grosseto Hospital in southern Tuscany prior to moving to UIC, and served as chief of surgery and director at the National School of Robotic Surgery before that. (Dr. Coratti from Crosseto will also be presenting at this year’s MIRA conference, Giulianotti said)

Worthy of Note

Expected medical and scientific breakthroughs expected at UIC before the of the year

1. Medical robotics teaching software
2. Research involving two connected robotic surgery consoles, with two different stations working cooperatively on the same patient at the same time
3. A new method of evaluating resection margins in cancer cases (surgeons currently are unable to make their evaluations by touching)
4. An ultrasound device capable of simultaneously scanning with a probe. “Currently, you do not see the vessels depicted on the surface of the liver, but with an augmented reality device which is in development, the imaging becomes available,” said Giulianotti.

2007-12-13T14:03:00.000-06:00

The Intuitive logo is provided courtesy of Intuitive Surgical 2007

2007-12-13T13:57:00.000-06:00

2007-09-15T10:26:00.000-05:00

Pediatric Robot Surgery with the Da Vinci Surgical System by Dr. Thomas Lendvay, MD

2007-09-15T10:14:00.001-05:00

Pediatric Robot Surgery with the Da Vinci Surgical System

By Dr. Thomas Lendvay, MD

Member, Medical Robotics Magazine Board of Editorial Advisors

Since the introduction of a commercially available surgical robot in 2001, the number of patients undergoing robotic surgery has exploded in the US. The surgical robot is an adjunct to existing laparoscopic surgery (keyhole surgery) and enables the surgeon to move instruments with more degrees of freedom than a human hand. The principles involve a surgical console where the surgeon sits and controls robotic instruments that are placed through small incisions in the patients’ cavities (chest, abdomen, neck, etc.). The surgeon has a 3-D view of the operative field through a visor on the console that projects images form two stereoscopic cameras placed within the patient. The robot dampens natural human tremor and allows for motion scaling for more precise movements (e.g. if the surgeon moves her hands 3 cm through space, the robot will only move the instruments one cm through the patient. The advantages to patients is that they avoid having large surgical incisions and they experience less post-operative pain while receiving surgery that recreates open surgical success.

Initially, the robot’s use was limited to adults because many thought that the robot was too bulky for operating on children, but the delicate robotic movements are ideal for the reconstructive surgeries children require. To date, the robot has been used to fix many types of birth defects in children and is used to remove poorly functioning or cancerous organs. The areas of pediatric surgery, urology, cardiothoracic surgery, and neurosurgery have embraced robotic technology. Doctors at Children’s Hospital and Regional Medical Center in Seattle, WA have used the robot to repair birth defects in the genito-urinary system, the intestinal tract, and the lungs. Some of the more common procedures performed include repair of congenitally obstructed kidneys (pyeloplasty), refluxing urinary systems (where urine goes backwards from the bladder to the kidney), duplicated kidney systems, repair of gastro-esophageal reflux in children, and removal of abnormal lung masses. The robot has also been used to repair children born with ambiguous genitalia (removal of female internal organs in genetically male boys) and has been used to create urinary channels in spina bifida patients so that they can better empty their bladders. Children as young as 5 months old and as small as 20 lbs. have successfully undergone robotic surgery.

The major advantages to robotic surgery in the future will be in surgical education and ensuring that patients receive the finest care from the most skilled surgeons yielding the best outcomes. Through improved resident education, the robot will allow learners to rapidly acquire the skills needed to perform safe and effective surgery with faster learning curves than open or conventional laparoscopy.

In April, Children’s became one of only a handful of pediatric institutions nationwide to incorporate the da Vinci® robotic system into minimally invasive surgery. Robotic-assisted laparoscopic (RAL) surgery has penetrated adult urology, general surgery, cardiac surgery, and gynecology. Many people, however, have reported that robotic surgery is not applicable to children before adolescence due to the smaller working spaces and the robot’s size. At Children’s Hospital and Regional Medical Center, we are using the robot to assist in performing urinary tract reconstruction formerly difficult with pure laparoscopy. We have performed over 20 robotic surgeries including extravesical ureteral reimplantation, pyeloplasty, ureteropyelostomy, nephrectomy, and Mitrofanoff and ACE procedures. We have operated on children less than 10 kg and under one year of age. Our goal is to determine if patient outcomes can be improved with the use of RAL. Laparoscopy has been shown to reduce post-operative pain and lessen hospital stays in adults, but little literature has focused on these advantages in children. Few surgeons perform complex urinary tract reconstructions on infants and toddlers because fine suture material is required for delicate anastomoses and smaller working spaces overstep the limitations of pure laparoscopic equipment and techniques. The robot, however, allows for increased precision and articulation required for complex reconstructions in small children.

In the Fall we will begin our first prospective study with the robot comparing RAL extravesical ureteral reimplants with open extravesical reimplants. Our primary study end-point will analyze post-operative pediatric pain scores. In addition, we will compare narcotic requirements, operative times, length of hospital stays, and surgery outcomes. We will also collaborate with pediatric urologists from the University of Connecticut to assess RAL pyeloplasty outcomes in children less than 4 years of age, a particular age group of patients thought not to be candidates for RAL due to patient size.

In addition to my clinical research endeavors, I will be focusing on advancing robotics in the realm of surgical simulation. CPR, PALS, ATLS, and ACLS are all examples of medical simulation training modules which focus on first teaching disease didactics and subsequently recognizing and applying appropriate interventions. Historically, surgical training has been based on the doctrine, “See one, do one, teach one.” Although current and past surgical training has remained relatively unchanged, demands from clinicians, the public, and the government to improve patient outcomes have encouraged us to re-evaluate our training techniques. Airline pilots spend hundreds of hours in flight simulators before they ever get into a cockpit. This type of training will be applied to surgical residencies in the future. The models for surgical simulation have become evident in teaching basic laparoscopy but the techniques in pure laparoscopy, especially suturing, are associated with a slow learning curve. We are working with a surgical simulation company in Seattle to validate a virtual reality da Vinci® robot simulator. In addition, I am collaborating with the University of Washington Biorobotics and Engineering department in their goal to create a dual trainer-trainee robot consul to teach robotic techniques with immediate trainer oversight, much like in a cockpit.

Through collaboration with the ISIS (Institute for Surgical and Interventional Simulation) Center at the University of Washington, Dr. Sangte Park and I will be developing surgical simulation curricula to help instruct residents on safe and efficient practices for bedside procedures. The first simulation module we plan to develop is a percutaneous suprapubic tube (SPT) placement module for the management of acute urinary retention. When surveyed, residents reported that a simulation module to train SPT placement would have benefited them and most respondents reported knowing of patients who suffered morbidity from inadequate placement or positioning of these tubes. We plan to develop a prototype virtual reality suprapubic tube placement module with haptic feedback to help urology residents learn how to minimize morbidity and understand the indications for such tubes. Once designed, this module could be adapted to training Emergency Medicine and Pediatrics residents on how to safely perform suprapubic bladder aspiration for pediatric fever work-ups, as well as be adapted for other percutaneous needle insertion/catheter placement techniques such as thoracentesis. Hospitals around the country are moving towards individual procedure credentialing and will require that residents have completed appropriate didactics and simulation before performing procedures on actual patients. Similar to general surgery and anesthesiology who have designed mannequin-based central venous line placement simulators incorporating ultrasound (US) guidance, our simulator will use US to mitigate patient morbidity. The University of Washington’s ISIS Center has a cooperative relationship with the University of British Columbia and McGill University in Canada to share simulation modules and residents/medical students for validation studies. Through additional collaborations with faculty at Emory University and the University of Minnesota, we will have a robust resident population to evaluate and ensure statistical power for any validation studies.

Medical training is now based on learners achieving goals laid out within the Clinical Core Competencies. Each resident must reach these goals before advancement and we have been tasked with ensuring that the public has confidence in our surgical skills. Training our future clinicians through discrete curriculum-based surgical simulation modules demonstrates our unending pursuit to improve patient outcomes.

Dr. Thomas Lendvay is an attending pediatric urologist at Seattle Children’s Hospital and is an assistant professor at the University of Washington, Department of Urology. His clinical and research focus is on minimally invasive surgery using laparoscopy and telerobotic surgical technologies. He has spear-headed the newly developed robotics program at Children’s and collaborates with the Biorobotics engineering department at UW relating to clinical applications of new telerobotic technologies. Additionally, he is a member Expert of the ISIS (Institute for Surgical and Interventional Simulation) center at UW to help advance surgical education for medical students and residents through simulation curriculum and is involved in the development of a virtual reality percutaneous catheter placement simulator. Through his work with the Biorobotics lab, he plans to be involved in an upcoming NASA Extreme Environment Mission Operations (NEEMO 12) demonstration of remote telerobotic surgery to be performed from Seattle to a submerged space station of the coast of Florida this Spring. Dr. Lendvay has also published this year on outcomes and practice patterns for the management of vesicoureteral reflux disease and the management of incontinence in spina bifida patients using multi-center databases.

2007-08-31T07:52:00.000-05:00

Robotic Thymectomy by Kemp H. Kernstine M.D., Ph.D. (with interview)

2007-08-08T12:24:00.001-05:00

[editor’s note: In this interview, and his accompanying article, Dr. Kernstine commented on the use of the da Vinci surgical system in these sensitive myasthenia gravis cases.]

“Myasthenia gravis is an uncommon disease, which strikes young females in their 20s to 30s. In 10 to 15% of all cases, the patient will have a thymoma, which is a cancer of the thymus. In the past, the method of treatment has been a median sternotomy, although you can imagine that a young 20-year-old female being told they need to have this extensive surgery doesn’t sit very well,” said Dr. Kemp Kernstine, MD, PhD, director of the department of thoracic surgery and lung cancer and the thoracic oncology program at the City of Hope Medical Center in California.

The open surgery method requires extensive dissection from the diaphragm, all the way up to the thyroid, into the left and the right chest; in short, the surgeon has to completely remove all the mediastinal tissue in these patients.

As an alternative to the traditional open method for myasthenia gravis cases, Kernstine makes a selective use of the da Vinci surgical system.

“We use the robot selectively. If we feel this is going to be a curative, not a palliative procedure for this patient, we will typically choose robotics,” Kernstine said.

Myasthenia gravis can be a terribly debilitating disease in these patients, he added. “They have blurry vision, droopy eyelids, difficulty talking and swallowing, as well as muscle and respiratory weakness. They can wind up on a ventilator,” Kernstine said.

While Kernstine does not intentionally use robotic surgery to remove a thymus from a myasthenia gravis patient, the doctor did note his success so far with the operation.

“Where’s the cost effectiveness of adding robotics? I think it’s going to be in a wider, more complete resection, with less likelihood for local recurrence,” he said.

City of Hope’s large medical robotics program uses three of the original da Vinci models, he said. “We haven’t got the ‘S’ model yet, although I’ve gone up to Sunnyvale to examine it, and it has some features that may be more useful to the non-prostate, non-heart surgeon. The robotic arm chassis is a little lighter. The older system has these arms that stick out away from the patient’s abdomen or chest, and with the ‘S’-model, these arms are collapsible so they don’t hit against each other when they’re moving at extremes of robot,” Kernstine added.

Robotic Thymectomy
Kemp H. Kernstine M.D., Ph.D.
City of Hope Medical Center and Beckman Research Institute
Los Angeles, California

The thymus is vestigel organ that exists in the upper anterior mediastinum draped over the great vessels and superior aspect of the heart from the thyroid gland to the mid-heart level. Its function is largely in immunological development largely prior to birth. As its functional importance is lessened, it begins to atrophy, roughly at 6 to 9 months of age. By 20 years of age, the thymus is fairly small and in the majority of patients there is minimal tissue by 40 years of age. Several disease processes can occur within thymic tissue; including cancer, hyperplasia, the presence of foreign active tissues such as the thyroid, parathyroid and germ cell tissue, remnants stem or multipotent cells that may develop into defined tissues such as eye, bone, cartilage, hair etc.. The most common reason for removal of the thymus is to evaluate and diagnose masses or nodules within the thymic gland suspicious for cancer. Historically the thymus removal or thymectomy was performed in the same fashion as heart surgery, by median sternotomy or by thoracotomy, incisions in the midportion or on either side of the chest. As a result, patients would remain hospitalized for 5 to 10 days and would not return to work for 6 weeks, not being able to lift any more than 10 pounds for that period of time.

The presence of myasthenia gravis is another common reason for thymectomy. Since the early 1900s the correlation between thymic pathology and myasthenia symptoms, weakness with repetitive use, has been recognized. Basic science discoveries have found that the thymus is an important organ in the initiation and potentially perpetuation of the disease. The resultant development of antibodies directed against the post synaptic endplate acetylcholine receptors results in gradual and persistent destruction so that the clinical presentation of weakness continues to worsen until the patient is unable to breathe or perform any of the simple routine daily tasks. In any patient, this is a devastation, but the typical patient is female in their 20s to 40s, the prime of their lives. Numerous medications have been developed to control, but not arrest, the symptoms. Approximately 10% of patients will spontaneously go into remission regardless of the management.

The potential of surgical removal arresting the disease was theorized in the early 1900s, but it was not until the 1940s that the first series of thymectomies was reported. The video-assisted and transcervical techniques were later developed and in relatively small retrospective series, appear to provide a similar remission rate as the open technique, 30 to 60% by 5 to 8 years. Though, they do not appear to have the same rate of remission as the more surgically-aggressive extended thymectomy, and complete removal of the thymus and all peri-thymic tissue from diaphragm up to the thyroid gland and into both chests through a median sternotomy and additional neck incision, over 80% at 10 years. Unfortunately, these percentages are from retrospective reviews with nonstandard definitions of remission. As a result, many neurologists and their patients are reluctant to subject themselves to a major operation of which the majority are performed by a large midline sternal incisions and are associated with a relatively long recovery. Concerns have been raised about the less invasive approaches, the transcervical thymectomy and the video-assisted technique, as they may not remove all of the thymus or the remnant thymic tissue often found in the anterior mediastinal fat, potentially reducing the likelihood for remission.

Computer-assisted surgical systems or robotic surgery was approved by the Food and Drug Administration in the mid to lower 1990s. The first United States robotic chest procedures were performed in 2002. One of the first was thymectomy. Our own thymectomy series started in the Fall of 2002. Our earliest findings have found reduced pain with smaller incisions, earlier return to preoperative function, reduced cost of care and apparent reduced likelihood for postoperative myasthenic crisis. We have yet to demonstrate that the greater dexterity, visibility and likely ability to more precisely remove all thymic tissue will result in an improved remission rate. Perhaps, with this approach, it will be a potential therapy for patients earlier in the course of their disease, potentially increasing the rate of remission.

Canadian Firm Draws Big Funding for Developing Device for Robotic MicroSurgery: $27 Million

2007-08-08T10:58:00.000-05:00

By John J. Otrompke, JD

A robotic surgery device intended for “image-guided microsurgery” has drawn big funding and expertise, and is expected to human trials in Canada this year.

The NeuroArm, being developed by the University of Calgary in conjunction with engineering firm MacDonald, Dettwiler and Associates is capable of both biopsy-stereotaxy and microsurgery, according to Dr. Garnette Sutherland, MD, a practicing surgeon and professor of neurosurgery at the University of Calgary.

Funding for Delicate Procedures

MDA is the engineering firm which has designed a robotic arm called CanadArm for the space shuttle and international space station. Sutherland said the multi-year effort has been funded with $27 million Canadian, including $10 million for research and development.

“Probably the first patient will be a person with a brain tumor, which will probably be very accessible, and we’ll use NeuroArm for part of it,” said Sutherland.

Sutherland added that developments in science furnished a reason for building a new robotic surgery device.

“Everything that has happened in neurosurgery could be linked to advances in lesion localization, starting with an air-injection process called pneumo-encephalography in about 1914. Then in the 1930s they introduced contrast angiography. But the real inventions that revolutionized neurosurgery came in the 1970s, with CT imaging and MR imaging. Then in the late 1990s they introduced MR imaging into the operating room, further enhancing lesion localization, and allowing craniotomies to become ever smaller.

“There has been a trend towards minimalist surgery, with the smallest incision about a centimeter and the smallest instrument a few millimeters,” he continued.

The NeuroArm can manipulate spatial tissue as small as 50 microns, he said.

“When we started our project, we had engineers from MDA come to the operating room at Calgary and park there and watch how neurosurgeons manipulate tools, pass them to the nurse and back again to the head, because the robot has to integrate as a team member,” said Sutherland, adding that NeuroArm was the firm’s first foray into surgical robots.

Why a New Robot?

Sutherland stressed that while he envisions the NeuroArm, if it ever gets approved as operating in a different context from the Da Vinci, there may be areas in which the NeuroArm offers improvements, at least for certain procedures, he said.

“I don’t see us as competing with the da Vinci, which is a really good robot for minimally invasive endoscopic procedures,” said Sutherland, who has worked with a da Vinci device. “We work in a different field, biopsy-stereotaxy and microsurgery, although endoscopy is also a form of microsurgery, since there’s a microscope,” he added. The Da Vinci system is the only surgical robot presently licensed in Canada, according to Sutherland.

Microsurgical procedures include plastic surgery, opthalmologic surgery, and laryngology, “where people do ear operations, and try to replace the little bones,” he said.

Sutherland said the NeuroArm will also try to make other contributions to the field of robotic surgery, especially in the areas of haptics and sound.

“Surgeons discriminate tissue plains based on the feel, if one is softer, and one firmer, and they take advantage of the soft tissue boundary between tumor or aneurysm and the brain. The surgeon must feel what our machine feels. What is the alphabet of touch and what are the ingredients that make up touch, and can engineers recreate that for surgeons?”

The other improvement being worked on is sound, according to Sutherland. “We want to recreate the sound of surgery. When a surgeon has a little suction device, and it sucks on something soft, it makes a little different pitch from when it sucks on something hard.”

Sutherland said he hopes the NeuroArm will be licensed soon. The good thing about working with a company like MDA is that the aerospace industry is very good at documenting safety, and that’s what the regulatory bodies for medicine are all about.

British Universities Study Rehabilitation for Spinal Cord Injuries with Intelligent Exoskeleton Robot

2007-08-08T10:56:00.000-05:00

By John J. Otrompke, JD for Medical Robotics Magazine

A team of research institutions in the United Kingdom are developing a new sort of rehabilitation robot. The prototype NeXOS system is designed to be an intelligent exoskeleton which can be instructed to remember and repeat specific limb movements which have been programmed by a physiotherapist.

“We specifically identified spinal cord injuries, and wanted to look at lower limb rehabilitation. These patients go through a process of needing a lot of passive movement, and a lot of them have incomplete lesions,” said Dr Sue Mawson, PhD, a researcher at Sheffield Hallam University in the United Kingdom.

The only robot currently available for rehabilitation in the UK is the Manus system, developed by MIT., according to Mawson.

Public funding for the NeXOS project was awarded in 2002, and the study began the following year, and was complete by 2006. Team members interviewed physiotherapists in designing the prototype.

Another feature of the robot is that physiotherapists can monitor their patient's progress from another location, such as non-clinical settings including their own homes, gyms and sports centers.
The NeXOS design is relatively low-cost and could be deployed over a large number of patients easily were it approved, according to David Bradley, PhD, professor of mechatronic systems at the University of Abertay Dundee in Scotland.

Other collaborators include the University of Sheffield and Barnsley Teaching Hospitals.

Army-Funded Small-Cap May Offer Complement to da Vinci

2007-07-23T11:55:00.001-05:00

Army-Funded Small-Cap May Offer Complement to da Vinci

By John J. Otrompke, JD

An experimental device intended for remote surgery and partially funded by the U.S. military may be a more light-weight and useful complement to the da Vinci in battlefield or disaster situations, according to a researcher at the University of Washington in Washington state.

The experimental device, called The Raven, has its genesis in an experimental process which analyzed the physical underpinnings of surgical technique, by surgeon or device, and which could offer insights into even the da Vinci’s performance.

“Our lab had been working on different robotic applications performing scientific analyses of surgery by looking at the forces and torques exerted during surgery with another device we designed called the Blue Dragon,” said Mitchell Lum, a PhD candidate in electrical engineering at the University of Washington College of Engineering, who also worked on the experiments.

“The Blue Dragon would track a surgeon’s motions as we had 30 surgeons go through a number of different tasks, such as suturing, measuring out a set length of bowel, moving from left to right and then from right to left, grasping or grasping and pulling or grasping and sweeping,” he said. “Then we were able to quantitatively assess the skill level of the surgeon when compared to an expert. We could tell if they were an expert, and we could make a good guess whether they were a complete novice, a first-year resident, or a fifth-year surgical resident,” Lum continued.

The Blue Dragon had other uses as well, Lum said.

“You can think of it like a flight data recorder. “If there was some kind of problem during surgery, you could recall what happened during the surgery based on the robot’s motions, whether was there a spike in pressure, or torque on one of the joints, or if something went wrong in the controls,” he said.

Based on their research, the institution started working in 2002 on what’s now called The Raven Surgical Robot, funded with approximately $1 million by the US Army Medical Research and Materiel Command. “Our robot is comprised of 3 basic parts- the patient site, where the Raven manipulators are, then there’s surgeon site, and then the connection. We did an experiment in last year in Fimi Valley, California where a surgeon was in tent simulating a test flying field, and the patient site was in a second tent and connected the two with a wireless network that would simulate an unmanned aircraft.

In comparison to the da Vinci, the Raven is more mobile, said Lum. “That operation would take
1 ½ Da Vincis to perform: a complete da Vinci where the patient is, and another where the surgeon would be located. In using a da Vinci, the manipulator sits on a what looks like a palette jack, then they get the patient in the operating room, and then roll the robot over the patient. There’s a command console where the surgeon sits in the same room as the patient.”

To be fair, however, in comparisons between the two devices, the da Vinci has performed much faster than the simpler Raven, Lum added.

“A surgeon from Seattle Childrens’ Hospital performed the same procedures, such as block tying and intracorporeal knot-tying with the two devices, and the da Vinci was much faster,” he said.

For more information, see brl.ee.washington.edu

Small Companies May Add to Da Vinci’s Efficacy

2007-07-23T11:09:00.000-05:00

Small Companies May Add to Da Vinci’s Efficacy

By John J. Otrompke, JD July 19, 2007

A prominent medical robotics researcher in the Midwest has discovered a manner in which miniature, developmental surgical robotics can contribute to the use of the Da Vinci surgical robot, according to an oral presentation at this year’s meeting of the Minimally Invasive Robotics Association (MIRA) in New York in January.

“Recently we performed a Da Vinci procedure on an animal, and we put the device in for an extra pair of eyes. Its harder to do with the Da Vinci, because its hard to move around,” said Dmitry Oleynikov, MD, assistant professor of surgery and director of minimally invasive and robotic surgery at the University of Nebraska.

Olehnikov said his experiment showed that his miniature robot provided an added benefit in concert with the Da Vinci.

“Our device allows a surgeon to place a remote device inside the body cavity and to be able to drive on the inside, and see on the inside, as well as to manipulate and actually perform surgery on the inside, all without having giant gears or things reaching from the outside,” said Oleynikov, who has been working on his device for about three years.

“You can put it through a belly button incision or through a natural orifice opening. Imagine if you want to remove a gall bladder; you can use an endoscope, and go through the stomach. But you can always get one endoscope through, and can have many little robots with separate tasks. They can act as eyes and little assistants. Then you can use the endoscope to cut or remove the debris through the stomach,” said Oleynikov, who added that the smallest version of his robot is about 1 ½ inches long, ten millimeters wide, or about the size of a lipstick case.

“The stomach has very few pain fibers, and as a result, patients don’t feel any pain when they wake up. This phenomenon has been investigated by other physicians using the endoscope alone, but the problem is that the endoscope is only one tool, and it is hard to get more than one endoscope in,’ he said.

“But the robots are not necessarily connected to the endoscope. They can be operated by remote control as well as well a little skinny wire tether, which operates them, and give them a little energy supply,” said Oleynikov.

Smaller models may add to the Da Vinci’s core competencies, as the device is not ideally suited for natural orifice surgery, but is better suited for laparoscopic surgery, he said.

The robot is a collaborative effort of the University of Nebraska Medical Center and the University of Nebraska - Lincoln. The faculty leaders of the project are Dr. Oleynikov and Dr. Shane Farritor, Associate Professor of Mechanical Engineering from the University.

For the next year, Oleynikov and colleagues are planning a new generation of robots for natural orifice applications. Reports will be presented at the next MIRA meeting.

www.unmc.edu/dept/mis

Robotic Surgery is Big Now: Chief of Robotics is a Whole New Title

2007-07-23T11:07:00.000-05:00

Robotic Surgery is Big Now:

Chief of Robotics is a Whole New Title

by John Otrompke, JD July 19, 2007

Another bell has rung in the medical robotics revolution, as another high-reputation medical institution, Mt. Sinai has appointed a chief of medical robotics.

David B. Samadi, M.D, was appointed chief of Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at the Mount Sinai Medical Center in New York.

“I have the highest volume of these cases on the East coast. In the past two-and-a-half months, I have performed 115 robotic laparoscopic prostatectomies,” said Samadi, who was formerly Director of Robotic Laparoscopic Surgery at Columbia Presbyterian Hospital.

Samadi said the future of medical robotics lies in realizing that a properly trained surgeon carries three competencies: open, laparoscopic, and robotic surgery.

“In prostate surgery, you can’t be just a technician, without knowing how to save the nerves that lead to sexual function, and develop earlier recovery of continence. And all that knowle3dge comes from open surgery,” said Samadi.

“The robot is like a bridge between the two fields,” he continued.

Along with colleagues, Samadi performed the first 11 robotic surgeries ever performed in France in 2001, with the former robot, the Aesop, and the Da Vinci, at Henri Mondor Hospital, under the mentorship of Professor Claude Abbou.

All told, Samadi has performed over 1000 of these cases, including about 100 with the new robotic Da Vinci.

Samadi has also been pioneering new procedures with the Da Vinci, including robotic surgery for invasive bladder cancer. “Now we’re moving to complete bladder surgery,” he said. “We create a new bladder using a segment of the small intestine. The removal of the bladder and prostate in done with the robot, and the creation of the new bladder is done through a small 3 inch incision,” he said.

“I’ve done now close to fifteen of these surgeries, and there are another 7 or 8 on schedule. I’m hoping in the next few months to advance our skills to do kidney cancer and renal cell carcinoma,” said Samadi.

Samadi said the Da Vinci has improved outcomes, even in the hands of an experienced surgeon like himself. “Because of the magnification camera has and the three-dimensional view robot has, and the lack of blood, if you’re a good open surgeon, and you’re trained to know where nerves are, 99% of patients are being discharged within 24 hours after surgery,” he said.

EU Project to Develop Psychically-Linked Team of Hospital Robots

2007-06-12T22:38:00.000-05:00

EU Project to Develop Psychically-Linked Team of Hospital Robots

By John J. Otrompke, JD, for Medical Robotics magazine

A three-year research project funded by the European Union will endeavor to develop a more communicative team of robots which will interact with each other to specialize or reassign tasks as the case may be, according to researchers.

Scientists from the universities of Warwick, Newcastle, and Dublin celebrated the kick-off of the ISWARM project last month, according to senior researcher Thomas Schlegel. Test runs of the $5 million project are expected in the second half of this year, according to Schlegel, who is associated with the Institute for Industrial Engineering at Fraunhofer Institute in Germany. The EU contributed $2.5 million of the $5 in funding for the project.

“Today we have single robots, not swarms, which can carry parts in a hospital, but they’re normally quite huge robots,” said Schlegel, who has previously worked on similar projects with RoboSoft, an organization which develops robots for service and transport. Other robotic prototypes under development in Europe include the CareBots I and II, he added.

The ISWARM robots are intended to be unique in the hospital setting, because they will be part of a three-robot team which will be able to communicate with one another through wireless channels or out loud if necessary, and be able to reassign tasks among the team, Schlegel said.

“If you ask the robot to clean the floor and he’s not able to, he will call another one in his Swarm to do this task,” said Schlegel. “They will be able to warn each other if they see somebody coming around the corner, in a rush, for example,” he said.

Other capabilities planned for the project include facial and voice recognition. “They could also recognize unusual cases, like where somebody is lying on floor,” added Schlegel. The robots also could be equipped with a laser thermometer to measure body heat from a distance and could be used to administer medication. Communication modes may include wi-fi or Blueteooth, he said.

Four hospitals, located in England, France, Spain and Turkey will partner with the developers to host trials of the project later this year.