Tuesday, December 12, 2006


Dr.'s Jeffrey and Lee Ponsky lead this afternoon's forum about innovation taking place in the health care industry.

When Robots Become Surgeons

Lee Ponsky provides a glimpse of where surgery has been and where it is going.

The Institute of Surgery Innovations (ISI) is a new Center to provide an opportunity to exchange information about applications in new technologies.

In the past, the theory was, the bigger the incision the better. Now, the theory is to be less invasive - this was promoted by gynecological, arthroscopic and other areas of surgery which generated the laproscopic Olympics: there is little we do laproscopically. Even kidneys are removed laproscopically.

It is important to consider innovations and the relationship to what is the advantage for patients.

There are two perspectives that must be considered:

1) The physician's perspective: focused on the aliment, which may not be the perspective of the
2) Patient, who may not have the physician's considerations in mind but other priorities.

Laparoscopic surgery involves only a couple of tiny incisions.

Robotic surgery is something that has been talked about for quite some time. Often today, the surgeon sits at a separate counsel with 3D visualization guiding the robot activity.

The robot gives 6 degrees of freedom to do the fine stitching that is necessary.

Da Vinci Surgical System robot is the mechanism used. You can read more about it here and the company Intuitive surgical here.

Applications for distance surgery are in place.

New technologies:
Cryotherapy - freezes tumors with nearly no invasion
Radio frequency ablation
High intensity focused ultrasound

Cryotherapy: High intensity ultrasound - destroys tissues within extreme close and precise. Surgery requires ultra high sound waves to destroy specific tissue; because of the level of precision, we can preserve tissues and nerves.

What is in the future?

ViaCath System is a portable device that expands endoVia Medical's software and robotic technology platform. The compact system, which includes a user interface and instrument control platform, allows the endoscopist or surgeon to precisely manipulate catheter instruments deep inside the patient.

Battlefield robotic applications can assess and treat remotely. You can read more here.

Tele-robotic rounding allows a resident/physican to visit patients remotely. Once the robot enters the door, a barcode of informaiton is read and uploaded.

You can read about telerobotic surgery here.

Non-invasive surgery - "Novalis" - allows the ability to treat patients without any invasion at all. Currently, use laser treatment revolutionizing the ability to treat kidney stones and may be used for tumors in the future. Read more about shaped beam surgery here. The division of laser beams can be pin pointed to exact locations to deliver heat or radiation.

Jeffery Ponsky: Surgery of the Future

Here are three evolving areas of surgery today:

The Medical Image Group practices image guided surgery.
Endoluminal - the University of Virginia practices endoluminal repair of aneurysms. Read more here.
Transluminal surgery technique is used in cardiac treatment. You can read more here.

Surgeon's have been exploring non-invasive surgery for a long time. Their performance has been hindered by the inability to provide the support team needed in surgery. With the technological advance of coupling the video camera to the surgery taking place, immediately others could support the surgeon and approach could be leveraged.

Areas of evolution

A sewing machine can devise stapling

Where are we going in the future?

There is a need to develop a system of tools to accelerate new techniques.

This has caused tremendous debate - how do you practice and train? The approach of "See One, Do One, Teach One" no longer works. The way we have taught in the past no longer works.

How will we train people for the future to do this? The VA has a simulator for training and this is a new way of learning.

How will you train? Through simulations, then on to animals, then on to patients.

Innovative therapy - modification of the existing technique.

Surgeons must look at many different implications for human cases.

If you are not living on the edge you are taking up too much space!

Surgical education needs to change.

What drives you to do what you do?

Since the laproscopic (removal of the gall bladder) and the advent of the stones crusher...the technology makes a huge difference in how events take place. New energy sources are used.

People have started to use their imaginations. When new courses are offered for training, courses fill up immediately.

Most of the talks with industry -

Leverage the simulation opportunities to accelerate innovations.

The medical community is just beginning to realize the benefits of collaborations.

The Center for Advanced Surgical and Interventional Technology studies haptic feedback for surgery in robotics. You can read more here.


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