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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)