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The Quest for Minimally Invasive Surgical Devices and Robotics

Mon, 08/12/2013 - 2:02pm
Melissa Barnes, Associate Editor, MDT

The demand for less invasive devices is persistently growing, putting the pressure on engineers to put forth quality, innovative products, all while staying ahead of the competition. ER and surgical robotics and minimally invasive devices are currently holding the spotlight, seeing some of the most promising growth and innovation. These technologies are best able to overcome the challenges of performing quality, quick, and non-invasive procedures. However, with significant success comes significant controversy, as there are many complex industry challenges involved in adopting new products. Surgical robotic devices are seeing particular controversy at the moment, but companies show their growth to be steadily increasing as new products and technologies become more widely accessible and accepted.

Industry Outlook for Non-Invasive Innovation
The lasting effects and uncertainty involved with the new healthcare regulations and ever-increasing production, marketing, and funding protocols makes for an uncertain market. Paired with increasing global competition, the future growth of the sector looks to be quite a complex one. This tumultuous environment has put a damper on the advancement of new device technologies. Many highly-innovative surgical and ER technologies never make it to market, and those that do have an even tougher road ahead as far as acceptance and implementation goes. With profit models under pressure and an eroding customer value proposition, medical equipment organizations are at the crossroads of a highly disruptive market. 

“Given the degree of concurrent changes impacting business models in the industry, it is fascinating to track the varied strategies being enacted,” says Frost & Sullivan’s Industry Manager, Venkat Rajan. “Market participants are working to better align themselves with this new market paradigm.”

Rajan and other market experts agree that though non-invasive innovation is met with severe challenges, the industry is seeing some of the most promising change. The key to this sudden increase in acceptance is due to the improving cost and time of procedures, which would not have been made possible without the very devices that allow them in the first place. As cost, time, and access improves, more opportunities and demand is the welcomed result.

Specific surgical device sectors currently receiving the most demand include single-site instrumentation and comprehensive, multi-treatment systems. With procedures becoming less invasive, the tools are becoming more intuitive and all-purpose driven. Surgical robotics is perhaps the most exciting area to keep an eye on, as the technology becomes more widely accepted and accessible in the medical community.

Minimally-Invasive, Multi-Tasking Devices
The greatest success stories involving the implementation of minimally-invasive surgical devices encompass instruments that are the most user friendly and multipurposed. Devices that are used endoscopically, or through one or few incision portals, experience the highest demand. Many of these successful, cutting edge devices are considered multipurpose, as they integrate multiple instruments and tasks into one device. Some instruments are so all-inclusive that they seamlessly integrate such components as retractors, cauterizers, and other typically separate instruments into a comprehensive design. The SPIDER Surgical System, for instance, is a flexible laparoscopic platform that allows multiple instruments to be used through one incision.

With the growth of minimally invasive procedures, it is not only the tools that must keep up with the needs, but also environmental aspects as well. As incision sites become smaller, particularly in breast and spinal surgeries, surgeons have greater difficulties with illuminating dark cavities. Since traditional OR lighting typically comes in the form of overhead lighting and fiber optic-enabled instruments, interior incision illumination is a problem. What’s more, this kind of traditional lighting often causes intense glare when blood and internal tissue is present. Some companies are working to solve this problem, such as Invuity, with their groundbreaking Eigr technology.

Eigr guides light through an advanced optical polymer and extracts it using hundreds of micron-sized structures. Through this method, Eigr delivers precise, high-definition illumination deep inside an incision, while virtually eliminating shadows and glare. This low profile solution does not interfere with other surgical instruments and delivers cool and directed illumination.

Surgical Robotics
According to Robotic Surgery Equipment Manufacturing, the surgical robotic industry revenue is projected to increase at an average annual rate of 14.9% to $4.2 billion through 2016. Several companies have put forth new robotic technologies that are garnering some well-deserved attention, particularly Intuitive Surgical, Titan Medical, and MAKO Surgical. The Clinical Robotic Surgical Association (CRSA) is one of the foremost organizations providing up-to-date information on the industry and the latest innovations in robotics. Many surgeons and engineers are finding the association to be a valuable source for gaining necessary technological and market know-how.

Some of the most common procedures involving the use of surgical robotics include gynecological, prostatectomies, and orthopedics. Orthopedics procedures are made increasingly non-invasive through the use of hand-held robotics. One example is the MAKOplasty from MAKO Surgical, which makes use of a tactile, intelligent robotic arm and 3D visualization of the surgical area.

Perhaps one of the most talked-about surgical robotic technologies comes from Intuitive Surgical, with their da Vinci Surgical System. As with most robotic systems, the purpose of the da Vinci is to perform complicated procedures as simply, precisely, and quickly as possible. The da Vinci does this through the use of a main console, which is operated by the surgeon. In short, the da Vinci is a sort of extension of the surgeon himself, with what is claimed to be better maneuverability. Surgeons control the robot, which operates through a few small incisions where the da Vinci gives a magnified 3D high-definition view. Equipped with tiny wristed instruments that bend and rotate further than the human wrist, the robot enables the surgeon to operate with enhanced vision, precision, dexterity, and control.

Though Intuitive Surgical has boasted over 2,500 da Vinci systems worldwide to date, the system is experiencing lasting controversy. Some doctors and patients are hesitant to turn to such a new and uncertain technology. However, the majority of the medical community who would like to take advantage of the technology is unable to gain access, as the system can cost upwards of two million dollars to implement.

Another similar surgical robotic system is the Titan, which also allows a 3D endoscopic view through a single incision. The Titan is also operated much like the da Vinci—through interactive micro-instruments that are activated from a main user console.

Complex Industry Challenges
At the heart of the industry challenges facing minimally invasive and robotic product design is the issue of accessibility. Since many of the best technologies are simply too costly, they are not as widely integrated and, therefore, not as highly proven or acknowledged. It is important to increase accessibility of technology already in existence so that both patients and medical professionals can reap the benefits.

Broader integration must be made for cooperative procedures and image guidance capabilities. “Greater connectivity and networking between physicians is needed. The ability to offer valuable guidance and long-distance ‘tele-surgery’ may be a long way off yet, but it may be the future key to successful implementation and education of new technologies and procedures,” says Rajan.

This technology would allow physicians who are experienced with a new device technology to offer long-distance guidance during initial procedures. Perhaps this approach would help to improve the challenges of implementation, for it is only through successfully educating a user to a new technology that the technology becomes widely accepted. In such a highly regulated industry, engineers face considerable design challenges as it is. Now they must further consider the challenge of how to design cost-efficient devices that are minimally invasive, as well as more intuitive and user-friendly.

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