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#35 - Precision Medicine

Robot Ops

The da Vinci surgical robot (Courtesy of Intuitive Surgical)

Faster recovery time, reduced pain and minimal scarring—the benefits of robotic surgery have been recognized by the medical world for more than three decades. We talked to Dr. Roger Smith, chief technology officer at the Florida Hospital Nicholson Center, a pioneering hub for robotic surgery.


Nowadays, technology has come so far that robots are being used for complex operations in a wide range of fields. “Most robots are built to address one specific part of the body—the da Vinci and TransEnterix, for example, are meant to be laparoscopic or abdominal, carrying out operations in areas from the diaphragm to deep into the pelvis area,”  Dr. Roger Smith explained.

“Other robots are made for the throat: Medrobotics makes a flexible stem robot that can go down the throat and navigate some of the turns at the back that are usually difficult to get to. They are also using that same technology to do transanal surgery.” He added: “There is literally a robot made to do hair transplants and one for dental implants, and there are several built to assist with hip and knee replacements.”

Man and Machine

The 54,000 sq ft Florida Hospital Nicholson Center was established 13 years ago at a cost of US $50 million. It offers training on 50 surgical and clinical skills stations, all fitted with multi-specialty, state-of-the-art equipment; it also carries out research experiments on new robots. A robot is controlled by a surgeon and typically comprises miniaturized instruments mounted on robotic arms for precision, as well as 3D cameras to provide an enhanced view of the operating site.

“Most robots are built to address one specific part of the body.”

“For years, our trainees were mainly learning the da Vinci robot but because we developed a world class reputation we became one of the stopping points for any company creating a new robot,” said Dr. Smith.

“We are currently working with Titan Medical on their SPORT abdominal robot. The unique angle here is that they want to enter the abdomen through one port to do prostatectomies, hysterectomies and colorectal surgeries.”

“With the da Vinci, you have to make about four or five or six very small incisions and each of the five or six instruments enters through its own port and then works with an operating space that is maybe the size of the upper half of a soccer ball.”

TransEnterix robots (Courtesy of Nicholson Center)

“With the Titan robot, however, they make a port that is a little bigger and enter through the umbilicus area so the scar blends with the naval when finished.” All the instruments are clustered together in one shaft and go in through the single incision, he explained. “They then open up kind of like an umbrella. They separate, and can then reach, grab, cut and cauterize, working in an area inside the abdomen that is about the size of a softball.”

Silicone and Skin

Dr. Smith has also been involved in the development of the Fundamentals of Robotic Surgery (FRS) Dome, a portable, storable and reusable device that enables training and testing of core skills on synthetic skin. “We use different kinds of mock-ups of people to test the various robots we have here and to train the surgeons on,” he explained. “The most common is the cadaver because it is exactly like a real person—it just doesn’t breathe and pump blood in the same way—and it is also common to extract organs or tissue from animals.”

The Florida Hospital Nicholson Center (Courtesy of Nicholson Center)

One day he hopes developments in virtual reality will allow robotic practice to take place in a digitally simulated world. This could offer surgeons the opportunity to test run entire robotic operations in advance.

“It is a case of waiting for the computers to get faster and discovering the best algorithms mathematically to represent the person and the procedures,” he said. “We would also like the ability to scan a patient and input that data so the simulator is not just realistic anatomically but is also realistic to the very patient the surgeon is going to operate on robotically the next day. That is the holy grail.”


Read more about surgical robots on MedicalExpo website.


About the Author

Abigail Saltmarsh is a freelance journalist with 25 years’ experience for national magazines (The New York Times, International Herald Tribune).

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