Pushing Boundaries in Healthcare with Robotic Assisted Surgery
By Madan R. Krishnan
AI & Robotics are heralding a new era of efficient & life-saving medical care
Every day, numerous lives are improving due to advances in surgical treatment. Despite these advancements, surgical procedures are limited by lack of infrastructure and trained clinicians. However, with the advent of robotic assisted surgery (RAS) it is an exciting time as surgeons can now perform more difficult and new procedures and more lives can be improved. The assistance is across the board -- spine surgeries, cranial, orthopaedics, urology, general surgery, gynaecology, neurology, cardio-thoracic and gastro-enterology among many others. We can achieve operational and cost effectiveness, leveraging technology with better utilization of human resources, while delivering good outcomes. Through developments in artificial intelligence (AI) and data analytics, medical devices are advancing disease management by empowering clinicians to personalize medicine like never before. These technologies provide revelatory insights into individual patients, in real time.
Robotic-Assisted Surgery: The Next Game Changer
With the use of robotics, we are witnessing tectonic shifts in the way surgeries are performed. As a form of minimally invasive surgery, robotic-assisted surgery offers the potential for fewer complications, shorter hospital stays, faster return to normal activities, and smaller scars.1–3,† The benefits for surgeons come from the ease of performing procedures, along with advanced visualization, ability to plan with precision, improved ergonomics and improved clinical outcomes. RAS allows sophisticated localisation of problems, and highly refined action to address them. Eventually, robotics can streamline and drive efficiencies in the procedure, the preparation and the recovery to allow even more patients to be treated. Recently, the Medtronic cranial robot was used for a surgery as part of treatment of an epileptic patient in India. The surgery took one hour as compared to the five hours a conventional surgery would take.
Even for spinal surgeries, RAS is facilitating highly accurate and predictable execution of the treatment plan and marks the beginning of a new era in spine surgery. This is seen specially in the insertion of implants in the spine. Pedicle screw placement is a common spinal surgical procedure, but it remains technically demanding. The anatomical proximity to the central nervous system and main blood vessel structures means that inaccuracy of pedicle screws may result in serious morbidity, complications, and revision surgery. But with RAS, up to 100% accuracy in screw placement is being recorded. 4-7
Medtronic has created RAS solutions for use across a broad spectrum of surgical procedures and expected to complement the clinical expertise garnered by surgeons over the years. We believe an ideal robotic system tackles today’s barrier to adoption and is future-proofed. That really revolves around flexibility - mobile from OT to OT, cost-effective to use, upgradeable as technology advances, instead of becoming obsolete, and compatible with trusted instrumentation so surgeons don’t need to compromise.
Where there are Opportunities, there will be Challenges
Robotics are a welcome approach, and the technological dimension they offer can allow us to leapfrog from a traditional care continuum to a most modern, continuum of care approach. While the advantages are well-known, strongly established, and come with innumerable data cohorts that can offer solid evidence, the acceptance of robotic-assisted surgery in India is still abysmally low. Barely 1% of all surgeries in India are robot-assisted.* Of course, there are reasons for this, but it is very important for us to understand those reasons in a nuanced and intelligent way so that rational approaches can aid the growth of our surgical capability as a nation. The lack of scale in Robotic surgeries, sub-optimal awareness about the advantages of robotic-assisted surgery, the anxiety about innovative technology investments and viability along with the lack of incentives for quality outcomes and the choice to go with episodic action – all of these have impacted the low penetration of such life-changing technologies.
One of the greatest challenges to be addressed is to bring about an attitudinal shift amongst patients with the inculcation of health seeking behaviour that will drive a greater acceptance of technologically driven options. Patients invariably tend to disregard the long-term costs of continuous medication when considering the immediate cost of surgery – which could potentially add many healthy years to their life. It is this measuring of value in terms of long-term outcomes rather than short-term transactions that will ultimately precipitate a transition to value-based healthcare.
Another opportunity is how we can really accelerate and enhance training and skill building. For any hospital planning to move to robotic surgery, the focus should not be only to acquire the asset but to put the entire robotic program in action, which involves surgeon training, disease profile selection and robotic procedure cost planning based on overall plan of cases. Medtronic conducts a wide range of clinical education and training programs for healthcare professionals in India to address capacity and awareness barriers and increase patient access to various therapies. Medtronic recently inaugurated the Surgical Robotic Experience Center (SREC) in Gurugram, Haryana to focus on standardized training for surgeries using RAS systems. SREC is Medtronic’s first experience centre in the Asia Pacific and one of ten world-class facilities around the globe today where clinicians can experience and train on these advanced systems.
What does the Future Hold?
Data, artificial intelligence, and automation are the linchpin to greater efficiency, more value, and reducing surgical variability. We’re taking full advantage of rapidly advancing technologies, like data analytics, AI, and robotics to unlock new experiences and opportunities, for customers and patients. And truly put the ‘tech’ in med tech.
Reference-
†Compared to open surgery.
1. Fitch K, Engel T, Bochner A. Cost differences between open and minimally invasive surgery. Managed Care. 2015 Sep;24(9):40–8.
2. Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety, efficacy, and cost effectiveness of common laparoscopic procedures. Surg Endosc. 2011;25(4):1127-1135.
3. Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innovation. 2005;12(3):261–287.
4. Kim HJ, Jung WI, Chang BS, Lee CK, Kang KT, & Yeom JS. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robotics Comput Assist Surg. 2016 13(3), e1779.
5. Khan A, Meyers JE, Yavorek S, et al. Comparing Next-Generation Robotic Technology with 3-Dimensional Computed Tomography Navigation Technology for the Insertion of Posterior Pedicle Screws. World Neurosurg 2019; 123, e474-e481.
6. Onen MR, Simsek M, & Nader S. Robotic spine surgery: a preliminary report. Turk Neurosurg, 2014 24(4), 512-518
7. Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions. Spine (Phila Pa 1976) 2017;42(6):353–8
* Based on internal estimates and Medtronic report, FY20 market model: procedural volume data.
Author:
Madan R. Krishnan, Vice President and Managing Director, Medtronic India