By Lena Levin, Co-Founder and CEO, Via Surgical
Thanks to science fiction films and TV series, many people have the impression that use of robotics in surgeries means robots are handling procedures from start to finish. In reality, the level of automation we have achieved so far is “robot-assisted” surgeries, in which a robotic arm completes a portion of a surgical procedure while guided by a surgeon at a control panel away from the patient.
The first use of a robot in the surgical field was documented during a brain biopsy in the mid-1980s. Since then, robots have been most commonly used for laparoscopic surgeries and surgeries in delicate spaces that are difficult to reach, particularly in gynecology, urology, and general surgeries such as hernia repair and lower or upper gastrointestinal (GI) procedures. The use of robotic arms enables movements that are typically not possible during traditional laparoscopic surgeries and allows for access to areas that are unreachable by other means.
Despite being around for nearly 40 years, a study published by the Journal of the American Medical Association in 2020 noted that robot-assisted procedures accounted for only around 15.1% of all general surgery procedures in 2018. To boost the use of robots in ORs, there are a few hurdles that must first be overcome.
What’s holding back growth in robot-assisted surgeries?
There are multiple factors contributing to the slow adoption rate for robotics in ORs. First and foremost is the limited cost-effectiveness of robots. Robots are expensive, so they make the most sense in facilities that perform a high-volume of surgeries where a robot can be used. An additional consideration is the fact that, when it comes to patient outcomes, there is little to no discernable difference between robot-assisted and traditional surgery methods.
Another issue is size. Robots are large and take up valuable space in an operating room. Currently, some robotic platforms can work with certain accessories for a few specific types of surgeries, while a hospital would need to buy a different platform with other accessories for different surgeries. As additional competitors come on the market, with still other accessories for further procedure types, there comes a limit to how many robots hospitals can accommodate.
The complexity of robotic devices also poses a hindrance to adoption as the devices require highly sophisticated maintenance by professionals, and repairs can be costly. On top of that, robot-assisted procedures require a significant amount of training for surgeons and operating room staff, yet the devices can only be used for some parts of a surgery. Surgeons must still scrub up and go in at the end to finish every surgery manually.
What needs to happen to increase the use of robotic devices for surgery?
The first thing that needs to happen is for hospitals that currently own robotic devices to expand their training of OR personnel for robot-assisted surgeries. These training sessions should include all attending medical staff, because a bedside assistant needs to understand how to monitor whether a procedure is being done correctly and how to react in case of any problems.
Currently, device manufacturers have to craft an accessory specifically to fit one company’s robotic arms. If that manufacturer wants to sell the accessory to a different company, they have to start over and design it to be integrated with a different type of robotic arm. One development that could drive down costs and boost competition would be transitioning to a standardized “plug and play” interface for attaching accessories to robotic arms -- similar to the development of the USB port for computers. With this type of standardized port, a manufacturer could create one accessory that could be sold to multiple robotic arm manufacturers.
Ultimately, a focus on the creation of accessories for robots will also be critical for driving an increase in adoption by medical facilities. As more accessories are developed, the robotic platforms can be used for more types of surgeries, thereby increasing their cost effectiveness.
What are the benchmarks for success in this field?
There must be perceivable benefits to robot-assisted surgeries as compared to manual surgeries, and the benefits should address the needs of patients as well as surgeons. For surgeons, there are some clear benefits. The maneuverability of the robotic arms provides surgeons with access to areas that could not otherwise be reached. However, when it comes time to suture, surgeons have to scrub up and finish the job. Therefore, for robotic platforms to make sense, they must be adaptable through use of accessories to expand the number of procedures that can be accomplished.
On the patient side, more studies and clinical trials must be conducted, assessing the actual outcomes, to determine the benefits to patients of robot-assisted versus traditional laparoscopic surgeries. Without evidence to support the amount invested in robotic platforms, interest by hospitals will continue to be sluggish.
The future is robot-assisted
Other industries are currently far ahead of the medical field when it comes to robot-assisted functions. Think about autopilots, backup cameras, and accessories that will stop a car when it gets too close to the vehicle in front of it. Many industries are already incorporating technological features that prevent potential accidents. This is the direction in which robot-assisted surgery should also move, helping surgeons to better perform procedures and reducing the medical error rate.
Implementing the above measures and innovation paths has the potential to make robotic surgical devices more attractive and cost effective. To increase adoption by hospitals and use in more procedures, ultimately, the outcomes must be worth the investment.
This article was originally published in MedTech Intelligence.
About Lena Levin
Lena Levin is Co-Founder and CEO of Via Surgical, a leading developer of novel surgical fixation solutions. She served as Co-Founder and CFO of PolyTouch Medical, which was acquired by Covidien in 2011. As an expert in financial and accounting management of growth-oriented medical device companies, she has completed numerous capital fundraisings and completed an M&A transaction with a multi-billion-dollar international medical device company.