Miniaturization, Telesurgy Next In The Robotic Realm
Dr. Vipul Patel
Surgical Products recently had the opportunity to discuss current and future trends impacting robotic surgery with Dr. Vipul Patel, medical director of the Global Robotics Institute at Florida Hospital in Orlando. Dr. Patel has peformed over 4,000 robotic prostate removal surgeries in his career and been involved with robotic surgery techologies from its beginnings more than 10 years ago. He also works with Department of Defense-funded research into telesurgery
Surgical Products: What peaked your initial interest in robotic surgery?
Dr. Patel: My initial interest in robotic surgery came out of the need for improved medical care. Robotic surgery is a unique technology that allows doctors to deliver better care to patients combining 3D visualization, magnification and 360-degree wristed instrumentation.
SP: What would you feel are the biggest obstacles to wider-spread use and integration of robotic surgical approaches? What advice would you give to surgeons trying to overcome these obstacles in convincing their hospital to invest in a da Vinci?
Dr. Patel: The biggest obstacle to widespread integration of robotic surgery is the cost. This is a major hindrance in emerging economies and thus reduces access to the technology. In order for hospitals to have success with robotic surgery they need to build a team of expert physicians across various specialties. The multi-specialty approach is the best way for a hospital to build a successful program.
SP: What do you feel is the next step for robotics, in terms of either procedures that can be performed or technological features/capabilities?
The next step in robotics will be telesurgery, pre-operative planning and surgical rehearsal, single port surgeries and use of miniature robots.
Miniature robots can potentially be inserted into the abdomen and controlled by a remote surgeon, this will potentially reduce the cost of the robot.
Intuitive (the makers of the da Vinci surgical robot) already has built a single port robot where the flexible robotic arms are inserted through a single incision on the abdomen. However, this has not been approved yet by the FDA.
Regarding telesurgery, if competent software is used, not only will the surgeon be able to perform surgery miles away from the patient, he will also be able to plan and rehearse the key steps in a virtual patient-specific model, before operating on the patient.
SP: How far away do you think we are from using telemedicine in a real-world scenario?
Telemedicine today exists in multiple areas where doctors communicate using the web to connect with each other. The feasibility of telesurgery has been demonstrated by Prof. Jacques Marescaux, when he performed a transatlantic cholecystectomy, physically being in New York, while the patient was in France. Subsequently, Dr Mehran Anavari in Canada has done about 26 telesurgries from a distance of about 400 km. These were executed using a different robot, which no longer exists, and the only FDA-approved surgical robot (da Vinci surgical system) is not capable of telesurgery. The time delay, the lack of competent software support for compressing and decompressing the digital information, and the legal and malpractice issues (especially in the U.S.) further complicate the process. Notwithstanding, telesurgery is very much possible, and if appropriate funding is invested in the right areas, we might be able to see it sooner than we can imagine.
SP: Discuss what the World Robotic Symposium is trying to accomplish.
The World Robotic Symposium is currently the largest robotic surgical meeting is the world. The 2011 symposium will be the 6th annual event and will be held at a new location in Miami Beach. Last years event drew over 1,100 registrants for multi-specialty robotic surgery featuring sessions on urology, gynecology, general surgery, transoral surgery and pediatric surgery.
The purpose of the event is to deliver education to the global community. The symposium accomplishes this by teaching physicians through live surgeries, lectures and video-based teaching.
SP: Any additional comments for the surgical community.
Dr. Patel: The introduction of robotic surgical techniques into the modern day operating theater has forever changed our approach to minimally invasive surgery. In many specialties the penetration of robotics has been significant. Now, over 85 percent of all prostatectomies for prostate cancer are performed robotically in the U.S.