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.”