Surgical Robots/Technology BazaarSurgical Robots/Technology BazaarSurgical Robots/Technology BazaarSurgical Robots/Technology Bazaar

Dennis L. Fowler, MD, MPHDennis L. Fowler, MD, MPH

Gerald and Janet Gerald and Janet CarrusCarrus Professor of Clinical SurgeryProfessor of Clinical Surgery

ColumbiaColumbia University, College University, College of Physicians and Surgeonsof Physicians and Surgeons

American Association of Thoracic Surgeons

San Francisco, CA

April 28, 2012

DisclosuresDisclosures

Applied Medical Corporation Applied Medical Corporation –– Board Board Member Member –– EquityEquity

Promethean Surgical Devices Promethean Surgical Devices ––Clinical Advisory Committee Clinical Advisory Committee ––

Promethean Surgical Devices Promethean Surgical Devices ––Clinical Advisory Committee Clinical Advisory Committee ––

EquityEquity

Surgical Excellence Surgical Excellence –– Board Member Board Member ––EquityEquity

Titan Medical, Inc. Titan Medical, Inc. -- ConsultantConsultant

Why Robots? Why Technology?Why Robots? Why Technology?

Improve OutcomesImprove Outcomes

�� Less Invasive Less Invasive –– Less TraumaLess Trauma

�� Fewer complicationsFewer complications

�� Improve efficiencyImprove efficiency

�� ? New/better procedure? New/better procedure

ImagingImaging

�� The big incisionThe big incision

�� To To be able to seebe able to see

�� Smaller Smaller incisionsincisions

�� Possible because of new methods of imagingPossible because of new methods of imaging�� Possible because of new methods of imagingPossible because of new methods of imaging

�� LaparoscopyLaparoscopy

��XX--ray, MR, or ray, MR, or ultrasoundultrasound

�� Major benefit to patientsMajor benefit to patients

The Way It WasThe Way It WasTelescopesTelescopes

The Way It WasThe Way It WasTelescopesTelescopes

The Way It WasThe Way It WasTV CamerasTV Cameras

1970’s TV1970’s TV

Camera

The Way It WasThe Way It WasTV CamerasTV Cameras

1970’s TV1970’s TV

Camera

The Way It IsThe Way It IsTV CamerasTV Cameras

•The turning point

•1986

•Computer chip

video camera

Current Current

Laparoscopic/Laparoscopic/ThoracoscopicThoracoscopic

ParadigmParadigm

�� Multiple holes/insertion pointsMultiple holes/insertion points

�� Assistant(s) needed to control Assistant(s) needed to control cameracamera

�� Reverse hand motion neededReverse hand motion needed

Monocular viewingMonocular viewing�� Monocular viewingMonocular viewing

�� Pushing long sticks into small Pushing long sticks into small openings is still the idea!!!openings is still the idea!!!

Current Robotic ParadigmCurrent Robotic Paradigm

Minimal Access SurgeryMinimal Access Surgery

�� Still pushing long sticks through small holes, Still pushing long sticks through small holes,

butbut

�� Added 3D imagingAdded 3D imaging�� Added 3D imagingAdded 3D imaging

�� Added wristsAdded wrists

�� Eliminated counterEliminated counter--

intuitive movementsintuitive movements

Surgical Robots Surgical Robots –– Current TechnologyCurrent Technology

�� Still requiresStill requires

�� Multiple incisionsMultiple incisions

�� New problemsNew problems

�� CostCost

SizeSize�� SizeSize

�� Loss of tactile Loss of tactile

sensationsensation

�� Separation of the surgeon from the patientSeparation of the surgeon from the patient

��Adds to the cognition load of the surgeonAdds to the cognition load of the surgeon

�� Impact of the monopolyImpact of the monopoly

NeedsNeeds

�� Sensors Sensors

�� Better hardwareBetter hardware

�� Better softwareBetter software

Artificial intelligenceArtificial intelligence�� Artificial intelligenceArtificial intelligence

�� Human Machine InterfaceHuman Machine Interface

�� Brain Computer InterfaceBrain Computer Interface

Hardware and SensorsHardware and Sensors

�� HardwareHardware

�� Platform to reduce access traumaPlatform to reduce access trauma

�� Functional end effectorsFunctional end effectors

�� SensorsSensors�� SensorsSensors

�� Force feedbackForce feedback

��QuantifiedQuantified

�� UltrasoundUltrasound

�� Spectral imagingSpectral imaging

�� Optical imagingOptical imaging

Software and Surgeon InterfaceSoftware and Surgeon Interface

�� SoftwareSoftware

�� Process data stream from more sensorsProcess data stream from more sensors

�� Decision supportDecision support

�� AutomationAutomation�� AutomationAutomation

�� Surgeon Machine InterfaceSurgeon Machine Interface

�� Better display of informationBetter display of information

�� Better interface for controlling interventionBetter interface for controlling intervention

NextNext--Generation Robotic SurgeryGeneration Robotic Surgery

�� Goal: Goal: RemotizeRemotize sensors and effectors in the body sensors and effectors in the body cavity where they can perform surgical & imaging cavity where they can perform surgical & imaging tasks unfettered by traditional endoscopic tasks unfettered by traditional endoscopic instrument design. instrument design.

VisionVision

TeamsTeams of insertable robots performing of insertable robots performing

surgical tasks in the body under both surgical tasks in the body under both

surgeon & computer control.surgeon & computer control.

AutomationAutomation

New thrusts in computer & robotic technologies New thrusts in computer & robotic technologies

can make automated surgery, if not feasible, can make automated surgery, if not feasible,

an approachable goal.an approachable goal.

AgendaAgenda

�� Surgical RobotsSurgical Robots

�� The FutureThe Future

�� Current Cardiac Surgery OutcomesCurrent Cardiac Surgery Outcomes

�� Current Thoracic Surgery OutcomesCurrent Thoracic Surgery Outcomes�� Current Thoracic Surgery OutcomesCurrent Thoracic Surgery Outcomes

�� Other RobotsOther Robots

�� Rounding RobotRounding Robot

�� Hospital RobotsHospital Robots

�� Other Innovative Surgical TechnologyOther Innovative Surgical Technology