Early this year, TransEnterix plans to launch its SPIDER™ Surgical System, a completely new and innovative platform to facilitate minimally invasive surgery in the OR. In an exclusive interview, Surgical Products talked with Todd M. Pope, CEO of TransEnterix about the development of this technology and how the company is looking to create a ‘new class of surgery’ as procedures continue to become less invasive.
Can you provide a bit of background on TransEnterix?
The SPIDER™ Surgical System enables Flexible Laparoscopy.
Pope: We started by looking at technology and really melding two different disciplines together—laparoscopic surgery and interventional medicine with its catheter-based technology. We thought about the technologies that have been introduced in interventional medicine and asked: ‘how could they be applied into general surgery?’
If you think about cardiovascular care before catheter based technology, surgeons performed large sternotomies which involved big incisions in the chest. Later, technology allowed surgeons to snake small tubes through the blood vessels and pass different devices through those tubes. We now perform a lot of the interventions on the heart through a small access site using flexible catheters.
That same technology was applied to neurosurgery to treat brain aneurysms. Once surgeons performed craniotomies, a very invasive procedure. Now, a catheter is inserted through the patient’s femoral artery, which requires only a small incision. Patients go home sooner after the intervention and aren’t in the hospital as long.
These technologies provided incredible patient benefit.
So, we started thinking about how those technologies could be applied to other specialties, and that is how TransEnterix began.
Can you give us more details about the new SPIDER™ Surgical System?
Triangulation achieved through a single site.
Pope: We went out and talked to physicians, and there seemed to be a big interest in NOTES as well as single port surgery. However, there also was a big frustration with tools that were available.
We said to them, ‘you’re frustrated with different products and solutions but you still see the value in minimally invasive surgery? Then we asked, ‘What do you need? What do you want? What are the ideal characteristics a product should have?’
They told us five things:
1. They said any new procedure needs triangulation. Surgeons are used to having the camera in the middle of the field and both of their instruments coming from the left and right so it forms a triangle. Surgeons don’t want to give up the triangulation they’ve used in laparoscopic procedures for the last 20 years. Triangulation had to be replicated.
2. They wanted good retraction. When performing surgery in the abdomen, you have to retract the liver, retract the stomach and manipulate the bowel around. So surgeons needed robust instruments to provide retraction because that is vital in abdominal surgery.
There was apparent frustration that current solutions for this type of surgery only offered three ports—one for the camera and two for instruments, but not a forth for retraction. They told us, ‘If you are going to offer us retraction, which we need, you really need to offer us four working channels, not three.’
3. The surgeons expressed a need for the profile of the port to be smaller. They wanted it to be 20 mm or less to make as small an incision as possible.
4. Surgeons said they need all the tools required to do the procedures—the access port and all the instruments—grasper, clip applier, scissors, dissectors, cautery, suction irrigation, etc.
5. Finally, they wanted all this in a system that was easy to learn, not something so complicated that it would increase their operating room time. It’s hard to introduce a new technology and ask physicians to spend two or three times longer to do a procedure than they’re currently performing.
We took all that feedback and developed our SPIDER™ Surgical System.
How does this system differ from other options currently available to surgeons?
Pope: We are using flexible instruments to replicate a very similar experience surgeons had with laparoscopic surgery and, in many ways, the dexterity realized in open surgery.
Twenty years ago, before laparoscopic surgery, a surgeon’s hands were inside the body. When laparoscopic surgery emerged as a new alternative for treatment, it removed one large incision and instead provided four or five small incisions. Then, trocars were created and rigid instruments were put through those trocars.
With rigid instrumentation, a surgeon’s hands have largely been taken out of the equation, causing the dexterity and motion associated with the hands to be taken out as well. By providing flexible instruments and flexible tubes, we are able to replicate many of the same movements that the physicians experience with their hands and fingers.
It’s a new class of surgery we call “flexible laparoscopy” because it’s laparoscopy, but it uses flexible, catheter-based technologies with incredible range of motion.
What do you see for the future as surgery continues to become less invasive?
Pope: The industry has to continue to be committed to partnering with surgeons and bringing new innovations to minimally invasive surgery. If you look back at the history of surgery, minimally invasive advances have always driven positive shifts in patient care.