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Although Intuitive's robotic surgery technology has grown in popularity, especially among gynecological and urological surgeons, it has also come under increasing scrutiny. While it seems beneficial for the complex pediatric surgeries that Nguyen specializes in, it's not yet clear whether the robot improves outcomes for simpler surgeries that can be performed using more traditional laparoscopic procedures, such as hysterectomies. Other potential benefits of robotic surgery are more subtle and difficult to assess--whether it helps surgeons by making the procedure less physically demanding, or allows less experienced surgeons to do more complex surgeries. For example, Nguyen says only a few highly skilled surgeons could perform today's surgery laparoscopically.
Nguyen talked Children's Hospital into buying the latest version six months ago--for $2.5 million--after his analysis showed that the shorter hospital stays after robotic procedures would make up for the cost over time. (He receives no funding from Intuitive.) But he agrees that Intuitive's monopoly has stalled the field. "People are afraid to challenge Intuitive because they are such a big company," says Nguyen. "But now we're starting to see a rebellion from physicians on the price, especially in the context of the discussion on how to cut down costs. That will motivate more people to consider coming into the market."
Dennis Fowler, one of the surgeons in the audience at Nguyen's talk, has experienced this first-hand. His team developed a snake-like laparoscopic tool with two cameras, which provides stereoscopic vision like the da Vinci. But he says his tool doesn't require the large viewing console that Intuitive's does. "We learned after we developed the camera that Intuitive had 286 patent claims related to this type of device," says Fowler, a pioneer in laparoscopic surgeries who recently moved from Columbia University to CIMIT. "That's the major impediment. Right now it's an academic endeavor."
With funding from the National Institutes of Health, Fowler and collaborators are now working on adding grippers and cutters to the device. The tools are cleverly built into the same laparoscopic cord as the camera, making the assembly resemble a Swiss Army knife. This design would reduce the number of incisions required during surgery. Once inside the body, the device unfolds like a flower. But the device is still early in development; they have built a prototype, and Fowler is now applying for a grant to test it in animals.
It's too early to say how Fowler's robot would perform in comparison to the da Vinci or other robotic technologies, but "even the initial prototype has numerous advantages," Fowler says. "It will be less invasive, with one incision instead of three or four; it is vastly smaller; it will cost a small fraction of what da Vinci costs; and it will be much easier to maintain."
Johns Hopkins researchers have developed a feedback system for surgical robots, which lack subtle sensations.
Guest (aarontco)
I few points should be raised. Firstly, why is the cost of keeping a patient in a hospital after surgery so high? Rather than trying only to minimize hospital stay, how about technology that can allow people to stay in the hospital at a reduced cost? Automating some of the expensive tasks associated with hospital stays would seem to be where it's at in terms of controlling costs, if we are to believe this article.
Granted, I think it's great to develop as many minimally-invasive procedures as possible. However, it sounds like Da Vinci only produces better outcomes in a small number of specialized surgeries.
That brings me to the second point. According to the medical professionals interviewed in this article, they believe that they can get comparable performance to Da Vinci using far simpler, cheaper, more compact technology. This is particularly important for areas like the developing world who can't be throwing around $2.5 million for the latest gadget.
I will also add that, personally, I believe this highlights the need for reform in the current patent conventions. I am all for intellectual property, if it actually results in a useful product. I am not for the idea that you can buy up patents for the purpose of hoarding them and stopping the technology from being used. I also think we need to make patents far less broad, so it is harder to monopolize vast swathes of technology. I favor a "use it or lose it" standard. If others can show that a patent-holder is only producing a token amount of a product, or none at all, then it does not serve the public good, but rather harms it to grant them the privilege of exclusion. Classical economists made a similar observation about people who hoarded assets like food and would rather let them rot than allow starving people access to them. In such cases "usufructary rights", and eminent domain for that matter, have been invoked in the past, and could/should be in the case of intellectual property as well.
As for patent broadness, a patent basically is a legal monopoly on a certain type of product. Like all monopolies, they need to be carefully regulated, because they can often end up being abused and used as vehicles of extortion, far beyond any reasonable level of compensation for the fair value of the product. In the same way that we would not allow a single company to dominate a whole industry, or to have vertical holdings across many industries, we need to think about mechanisms to regulate this in the arena of intellectual property. Anti-competitive practices are regulated in other areas of business, and that needs to be the case in patent law, because competition is the only thing that keeps free enterprise honest. I tend to think that the "use it or lose it principle" could help here too, because a broad patent is less likely to be used in all its conceivable incarnations.
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fiberman
186 Comments
Is this part of the problem not the solution?
Isn't a $2.5 million gadget of questionable usefulness just another reason that medical costs are growing at a ridiculous pace? Im betting the for-profit medical business is the next big bubble - it's already unaffordable.
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pjduncan
20 Comments
Re: Is this part of the problem not the solution?
I think the economic usefulness would lie in reduced days in the hospital and fewer complications due to a less invasive procedure.
Having had non-laparoscopic abdominal surgery, I can also vouch for the significant cost to individuals in recovery time (and lost productivity) that can be saved by minimally invasive procedures. Only after being sliced open the old fashioned way can one really appreciate the advancement this represents.
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jhains2
17 Comments
Re: Is this part of the problem not the solution?
Is it part of the problem?
Let's say the robot is used for three surgeries per day and each patient has their hospital stay reduced automatically by 3 days. that is 9 days of hospitalization saved...generating huge healthcare savings.
Now, let's further postulate that using the old method, 1 out of 9 patients experienced a post-surgical infection and required another 5 days of hospitalization. If the da vinci simply cut that rate of infection in half, it is saving even more hospital days...
So, in sum, I think that this technology would not have been so widely adopted as it has been if it were not extremely cost effective.
Keep in mind, I made these statistics up for illustrative purposes only.
JH
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erbium
340 Comments
2.5million $ gadget expensive?
Advanced gadgets need to be expensive to begin with to finance development.
The real revolution in use of course comes after prices drop and you then are in awe of capabilities and value received by increased productivity.
To put it in the way of an 'expensive useless gadget', a prime example is cell phones.
For those of you not too busy uselessly texting friends in classes or while walking across against the walk signal at a light, you may remember cell phones were VERY EXPENSIVE, were the size of a brick (rent move 'atlantic city' for example of this) and had limited features, range, battery life, etc.
So as an addition to the them of 'scientific revolutions' book, I'd suggest that the real revolution occurs at the time people are least thinking it is a revolution. It occured for me with cell phones when they eventually came down in price below $40/month, lost the horrid low capacity batteries and reduced energy use thru years of refinement of microcircuitry.
THe real revolution in this case occured with a yawn rather than a bang! I even gave up my 'land line'. And when data prices come down a bit more I'll get a smart phone so I can see traffic when i leave somewhere on the other side of the universe to go home.
Many of my sci-fi stories (plus the common stuff like star wars attack of the clones) have automated medical devices and robotic surgery. As you mentioned it will have to get better and come down in price. By then it will be so common place we will accept it as standard.
I'm not plugging one way of funding medicine or the other but I have the feeling that the govt takeover of medicine will stifle innovation in this and some other areas. We americans seem to always want the best but now we are increasingly unwilling or unable to afford it. There are only so many $ which congress and the people demanding free handouts don't seem to realize.
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Guest (aarontco)
Re: 2.5million $ gadget expensive?
Is anyone fooled by the propaganda phrase "government takeover of health care"? How is asking private individuals to buy private insurance, from companies who then work with private hospitals and doctors a "government takeover" of anything? There is still no "public option", which seems strange, given that it is supposed to be a government takeover.
As far as your point on development of technology, the real question is what the most effective way of developing new technologies is. Experts I have talked to in management of technology (I know several PhDs in the field) hold that it is a total myth that "free enterprise" is the only way to develop advanced technology. Often times a government infusion of capital is the only way to get these super expensive technologies off the ground. Look at Apollo or the development of digital electronics in general. Without massive government money in the form of defense spending, computers never would have become cheap enough for everyone to own. IBM predicted that worldwide demand would be less than a dozen.
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