“Innovating in Pediatric Surgery; The role of RoboticsSteven Rothenberg
Children Not Small Adults!
Issues for Pediatric SurgeonsSmaller workspace (Thoracoscopic TEF repair occurs in 2cm square area)Physiology differentOperate 500 gm to 100 + KgAbdominal and Thoracic procedures
Equipment
End affectors:What properties should they have?TENSILE STRENGTHDURABILITYINSULATEDROTATINGFINE MACHINED WORKING HEADSCOST PRACTICAL (No instrument can be bigger than the patient!)
Endoscopic Stapler & Clip
Endoscopic Stapler & Clip
9
Robotics : 2000
Mentoring Program
Conclusion•Too Big•Too expensive•Too much time•Limits access to smaller patients•No clinical advantage in majority of cases•Can’t go where I need it most
DiBerent opinions in way forward•Is there a worldwide need, is there a market ?•Are smaller instruments viable ?•Industry partners?•Can we improve of physician performance?•Changing surgeon skill sets. 15
Robotics 2024
Patient Story•REV•Hx of gallstones, treated medically for over a year•Chronic abdominal pain, weight loss, missed school, decreased activity•Needed gallbladder out
•Surgery with 3- 5mm ports•Docking time 10 minutes•Total operative time: 45 minutes•Discharged that afternoon.•Went to prom 2 days later •Show news story?
Innovations Shaping the Future of Surgery 19 *Products are under development and have NOT been submitted to or cleared by the US FDA, CE Mark or PMDA, and therefore are not yet available.Displaying for education purposes and not for promotional activity or sale.19 Preserving 3mm & 5mm InstrumentsEnhanced with TrueWrist ™ 5mm * Configurable & Modular Arm Design Patient Access and Bedside Workspace
Innovations Shaping the Future of Surgery 20 Performance-Guided Surgery (PGS)™Decision-support Digital Tools 20 Intelligent Surgical Unit™ Intra-operative Digital Tools Combining advanced robotic manipulation with real-time Augmented Intelligence digital surgery and machine learning to enhance intra-operative insights*Some products are under development and have NOT been submitted to or cleared by the US FDA, CE Mark or PMDA, and therefore are not yet available. Displaying for education purposes and not for promotional activity or sale. Informing surgical decisionsDigital measurements guiding surgeons and surgical maneuversAvoiding preventable errorsIden3fica3on of cri3cal anatomy to mi3gate risk of 3ssue damage*. Improving OR efficiencySurgeon camera control enables OR staff optimization. Enriching surgical education and trainingDigital tags and annotations* enhancing learnings, OR communication.
Seven Stages In The Evolution Of A Pediatric Robot1.Idea Stage :No one needs it, Can’t be built. Materials don’t exist2.Successful Laboratory Design Tests: Can’t be duplicated in a production model, won’t work in humans3.After Successful Animal Trial: Very Lucky!, Can’t get funding, Can’t mass produce4.After 4 or 5 Clinical Successes: Highly Experimental, Too Expensive, Too many Failures. I Understand They’ve Had A Number Of Deaths They’re Not Reporting.5.After 10-15 Patients: May succeed Occasionally But unreliable, Hospitals won’t buy it, And Surgeons Don’t Really Need it,
Seven Stages In The Evolution Of A Pediatric Instrument 6.After A Large Series Of Success: So-and So In Shangri-La Has Been Unable To Duplicate Their Results. Not Practical. Too Expensive, Only Experts Can USE It. 7.Final Stage: You Know, This Is A Very Fine Contribution! A Straightforward Solution To A Difficult Problem. We Had the Same Idea 20 Years Ago But The Market Just Didn’t Exist. There were no pediatric MIS surgeons at that time. Pediatric Instrumentation is a Great Advance not Only For Infants And Children, But For Adult Patients As Well
Disruptive Technology