Telerobotic surgery

1
Telerobotic surgery ready for primetime?

• Telerobotic surgery
• in US alone, over 300,000 heart surgeries
  performed annually, over 600,000 performed
  worldwide
• previous difficulties in telerobotics due to
  complexity of heart surgery
• telerobotics now evaluated for use in minimally
  invasive heart surgery, endoscopic coronary
  artery bypass surgery

2
Telerobotic surgery ready for primetime?

• Intuitive Surgicalä
• da Vinciä Surgical System
• original system designed to mobilize internal
  thoracic artery endoscopically with robotic
  assistance
• surgeon sits at a console and manipulates hands
  as if in chest cavity
• motions are transmitted through computer to
  instruments within patients chest

3
Telerobotic surgery ready for primetime?

• Telerobotic surgery
• current study of single bypass surgery,
  performed by telerobotics, is more than 3/4
  complete
• average back to work time - 10.4 days
• no sternotomy, no heart-lung machine
• anastomosis is under direct vision through a
  small incision,minimally invasive

4
Results of robotic beating-heart endoscopic CABG
in human patients
heartwire / Feb 10, 2000 / Robotic systems make
major headway in minimally invasive beating-heart
CABG
5
Telerobotic surgery ready for primetime?

• If you look at the car manufacturing industry,
  after 100 years the tools are more precise and
  almost everything is automatic. In surgery,
  though the technology is available, we still use
  the same tools as 100 years ago."
• Dr Friedrich Mohr
• University of Leipzig

theheart.org / Views / February 28, 2000 /
Robotic surgery (2) rival robots wrestle for
hearts and minds of surgeons
6
Telerobotic surgery ready for primetime?

• Cost-benefit ratio
• not entirely clear from current study, limited
  to single vessel bypass
• ideally would like data for total endoscopic
  coronary artery bypass on a beating heart
• cost of technology analogous to introduction of
  heart/lung machines 40 years ago, and not out of
  line with major expenses incurred in a heart
  surgery program

7
Telerobotic surgery ready for primetime?

• Cost-benefit ratio
• mediastinal sepsis present in 1.5 of patients
  with current operative techniques
• robotic surgery eliminates possibility of
  mediastinal sepsis
• robotic operation typically uses only 3-4 small
  ports in side of chest

8
Telerobotic surgery ready for primetime?

• If we can avoid opening the breastbone, if we
  can decrease the trauma, and do the same
  operation, this is going to be of benefit to our
  patients. I think that's the bottom line.
• Randall K Wolf MD
• Associate Professor and Director
• Minimally Invasive Cardiac Surgery and Robotics
• Ohio State University Medical Center

9
Comparison of commercially available telerobotic
systems used in endoscopic CABG
adapted from theheart.org / Views / February 28,
2000 / Robotic surgery (2) rival robots wrestle
for hearts and minds of surgeons
10
Telerobotic surgery ready for primetime?

• Future technology
• additional miniaturization
• devices that aid in vessel anastomoses
• navigational systems
• novel sealants and sutures in association with
  robotic techniques

11
Telerobotic surgery ready for primetime?

• This is a major changewe're transcending the
  framework of conventional cardiac surgery and
  we're just now seeing that maybe we can enter the
  information age.
• Randall K Wolf MD
• Associate Professor and Director
• Minimally Invasive Cardiac Surgery and Robotics
• Ohio State University Medical Center