Faster, Better, Cheaper: The Future of Medical Robotic Technology

Howie Choset

Minimally Invasive Surgery Benefits

• Reduced post-operative discomfort

• Reduced Costs

• Improved access to quality medical care

vs.

+ =

Robotic Cardiac MIS

Reduce discomfort: no crack chest

Reduce cost: shorter hospital stay

Disseminate care: more can be done

What has been done:Minimally Invasive Medical Robotics

proximal body

suction pads

distal body

HeartlanderCam Riviere, and Marco Zenati

DaVinci, Intuitive Surgical

Steerable Needles, Dupont, et al;Rviere; Alterovitz, et al; Salcudean, et al., Okamura

Sonic flashlight, Stetton

Virtual Incision(U of Neb, Farritor)

Given Imaging Dario, Webster, et al

Tissue EngineeringWeiss, et. al.

Cyberknife

Vision for Medical Robotics

• Blur the boundary between specialist and surgeon

• Shorter length procedures

• Enable New Procedures– Natural orifice– single port access

• Robotic tools, not robotic surgeon

proximal body

suction pads

distal body

The United States is Unique

Robotics & Engineering

Medicine

Enterprises

Why Government Leadership?

• Small companies and academia – playing in the middle– developing technology and innovative

clinical approaches– can create a new industry

• Haphazard way of engineers and doctors meeting

• NIH is currently not the right match

Capital equipmentGE/Intuitive Surgical

Vs. Operating room toolsBSci, Guidant, Stryker

Carnegie Mellon Spin0ffFounded in 2005 …

Licensed IP from Carnegie Mellon and the Univ. Pittsburgh …

Inventors were 2006 recipient of $2.2 Million NIH grant for epicardial robotics…

Raised to date $11.6 Million (includes $2.6M convertible) in Series A financing…

Since 2004, there have been 6 generations of prototypes tested in animals and cadavers…

Clinical prototype complete and undergoing testing and verification…

Thirty five (35) patents and pending applications on snake robotics: 2 issued US patent s 33 other patents pending – 21 independent

Received ‘Freedom to Operate’ opinion from Pepper Hamilton Law PC…

Company received a formal opinion on their regulatory status as 510(k)…

Completed more than a dozen animal trials -- closed-chest access, pericardial navigation, direct visualization, transmural lesion ablation -- results published, no adverse hemodynamic or electrocardiographic impact from CardioARM…

Completed two human cadaver trials: closed-chest access, pericardial navigation, direct visualization, box lesion ablation pattern…

Costs difficult to assess

• Hospital characteristics (size, community or specialist setting, administration, etc.)

• Surgeon’s ability and experience• Types of supplies used• Different procedures costs vary• Hospitalization/OR time costs vary• Role and use of residents/fellows• Learning curve issues (make it more expensive at first)• Players

– Patient and employer– Insurance company– Tool makers

DaVinci Systems

2008: 335 units soldTotal: 1,111 units installed

875 million, 46%

Income in 2008 increased by 59% to $387MM

Source: Intuitive Surgical 10-K SEC report (ANNUAL REPORT 2008)