SIU 2018: New Robotic Devices

Seoul, South-Korea ( John Davis, MD gave a summary of the new robotic devices that are in development and will be available in the next few years. Dr. Davis began with a description of how the robotic system has integrated with the health system. In the US, there is an emphasis on volume growth, shorter hospital stays, and improved quality metrics for high volume cases. However, in other countries, the patient might need to pay the difference, the government at a time pays the difference, and some cost pressure can lead to using older models or persistence with laparoscopy instead of using the robot. In the US the practice patterns have resulted in many surgeons becoming “obligate” robotic surgeons, vs. part-time robotic surgeons.

Dr. Davis continued to discuss the future of robotics and where will the added value be found. The overall quality of the next robots will need to match the high quality of the Intuitive robots. The cost will need to be lowered either through capital or instruments. Ideally, the robot will be customized for specific procedures with a high enough volume to justify it. Reducing the cost may enable to acquire a large fleet of robots, as most hospitals struggle with how to allocate this limited resource.

Some data from MD Anderson Cancer Center was next shown. This date showed the rising volume of robotic cases per year with a stable 5.3% increase in the volume of cases, and the allocation of the robot among the various medical specialties. This was shown as one possible model that should be adopted by other centers. This model demonstrates a growing need for more robots and how despite the significant costs associated with it, robotic surgery can still be cost-effective.

The robot platform a center has will have an impact on the specific procedure that is performed in that center. The older Si model was launched in 2009 and was the first robot that added the dual console. It is very sharp, with manual focus vision, and a 12 mm fixed camera port, and a 1080 HD upgrade. It was the first robot that was approved for head and neck surgery and increased the utilization by thoracic surgeons. The Si platform is preferred by most pelvic surgeons, and it is the only robot approved for head and neck surgery. The newer Xi model was launched in 2014 and added the hopping camera port, which has a 30-degree toggle for up or down. In this model, the console control has been enhanced. It also has a multi-quadrant boom and a multi-quadrant surgical access and introduced the robotic stapler. The Xi model has been a real game changer for colorectal surgery, and the only robot that thoracic surgeons use. For urologists, it is mainly useful in upper tract surgery and retroperitoneal lymph node dissection.

Intuitive has additional robots planned. The first one that we will see soon is the single port robot. It has four flexible arms through a 2.5-inch single port. It integrates with Xi vision tower. The indications for the usage of this robot will be small space surgery such as perineal prostatectomy, head and neck surgery, trans-anal surgery and ample room for new indications. Another robot planned to be released by intuitive is the DaVinci X, which is already FDA approved. It is approximately 1 million dollars cheaper than the Xi robot. It uses the Si tower platform but has Xi type arms, with all Xi instruments being compatible with the X robot. The plan is to replace all aging Si robots with this cheaper model (as shown in figure 1).

 UroToday SIU2018 The Xi and X Intuitive robotic platforms
Figure 1 – The Xi and X Intuitive robotic platforms

Additional developments that Intuitive are planning include vision enhancements  -Firefly and future vision enhancing agents. Additionally, there will be significant simulation updates enabling surgeons to practice on completing a whole simulated procedure, as opposed to task-based learning. Telemedicine will be expanded as well enabling the surgeon to consult, advise and assist around the world. Lastly, table motion will be developed as well.

In the last segment of his presentation, Dr. Davis mentioned some of the new robots that are entering into the market. These include the Transenterix robotic system, which is the next generation robotic surgical system, with the advantage of haptic feedback, and reduced cost. This system enables broad reusable instruments with minimal disposables. Other companies include the Mazor robotic guidance systems, Titan Medical single port robotic surgery, and the Korean robotic platform (REVOI-I) which according to its developers, its characteristics are identical to that of the Intuitive robots.

Dr. Davis provided a small summary table for the various robots, shown in Figure 2, and concluded his talk stating that the addition of all these new robots will add a variety of robotic platforms to choose from, and the competition will drive the cost down. In the end, newer improved robots will result in better optics, articulation, and improvement in patient outcomes.

UroToday SIU2018 various upcoming robotic systems
Figure 2 – Summary of the various upcoming robotic systems

Presented by: John Davis, MD Anderson Cancer Center, Houston, Texas, USA

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre  Twitter: @GoldbergHanan at the 38th Congress of the Society of International Urology - October 4- 7, 2018 - Seoul, South Korea 

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