News & Trends - Medical Technology

The future of surgical robotics: An Asia Pacific perspective

Health Industry Hub | August 23, 2021 |
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MedTech News: Robotic assisted healthcare interventions offer improved procedural precision, standardisation, protection from radiation hazards and a future of remote patient care.

Dr Paul Ong, an interventional cardiologist at Mount Elizabeth Novena Hospital in Singapore, and Rajat Nag, Head Asia Pacific, Corindus Vascular Robotics at Siemens Healthineers, discussed the future of surgical robotics at a recent event organised by the Asia Pacific Medical Technology Association (APACMed).

Rajat said “What we have seen more recently is that COVID-19 has accelerated the adoption of technology to protect patients and frontline healthcare staff.

“In taking a peek into the future, we want to see how robotics and artificial intelligence (AI) will play a key role in augmenting human intelligence and improving quality of life. Imagine a time when losing a limb may no longer be limiting but may be deemed as an enhanced capability with bionic prosthetics that are mind controlled.”

In 2001, the first transatlantic operation was conducted by surgeons in New York on a patient in France. Remote robotic surgery and interventions can expand telehealth or procedural treatment instead of just consultation and diagnosis, as we see mostly today. This can truly democratise healthcare delivery and bring expert healthcare to patients when and where they need it.

Siemens’ Corindus endovascular image guided robotics aims to tackle the ongoing challenges of access to care, procedural complexity, increased need for efficiency of labs and protection of patients and surgeons from the hazardous environment of radiation.

Rajat continued “The Corindus robotic system is able to provide 95% radiation protection to the primary operator the physician and almost 20% to the patient. In terms of precision, the robot is able to move the balloons and stents within sub-millimetre and place them within one millimetre accuracy.

“The automation helps to pull together the expert international skills as algorithms for any operator to use them when they call upon those particular automation skills to be deployed.”

Dr Paul Ong, an interventional cardiologist at Mount Elizabeth Novena Hospital in Singapore, said “We were one of the first countries in Southeast Asia to perform robotic assisted angioplasty. The chance of placing the balloon and stent in exactly the right place and not missing the narrowing is very easy with robotics assisted surgery.

“When you talk about technology, you cannot avoid topics like artificial intelligence, ultra-navigations and remote capabilities.”

Remote angioplasty, as a proof of concept, first occurred in India in 2018. The patient was located in the operating room in the hospital and the surgeon was 30 kilometres away. With faster 5G technology, one can imagine a surgeon sitting at home and performing the procedure on the patient in the hospital, or be located in the hospital and operate on patient in a remote village in the Asia Pacific region.

Dr Ong added “Stroke is also a very big burden to the healthcare system due to difficulty with healthcare access. The patient should be at the hospital within six hours. Can you imagine in a country like Malaysia or Philippines where the patient may be in the remote island? Remote capabilities to deliver healthcare in vast areas is very attractive. This doesn’t just apply to Southeast Asia. You can easily imagine its use in countries like Australia where the landscape is much larger.”

Rajat continued “Time to treatment is critical for ischemic stroke and coronary artery disease. In stroke, every one and a half hours of delayed treatment means one year of life lost for that patient. Our image guided endovascular robotics will address three different areas with remote robotics, image and robotic technology integration, and specialised capabilities to improve access to patient care.”

A significant challenge is that access to expert specialists who perform these procedures is limited and a significant global problem. Remote robotics will help create a mesh network where theoretically any hospital with internet access can be connected. It means that smaller hospitals may receive the benefit of working with multiple specialties on demand. Remote robotic assisted intervention could be the first opportunity to use telehealth for treatment rather than for just diagnosis and consultations.

“By using multimodality imaging and algorithms combined with precision robotic control, we hope to further the possibility of improving patient outcomes. The fluoroscopic imaging will be driving the robot and the device to the targeted lesion and the blockages, without the physician having to manually drive the robot. We could leverage machine learning algorithms derived from large population data sets to enable an integrated image guided robotic system to deliver any procedure treatment plans that may further improve patient safety,” said Rajat.

Dr Ong discussed the key benefit of using surgical robotics for patients, doctors and the hospitals who invest in the novel technology.

Patient benefits:

  • Precision
  • Remote access
  • Cross site operation during COVID-19

Surgeon benefits:

  • Significant reduction in radiation dose for surgeons and nurses (including female surgeons/nurses who are pregnant)
  • Prolonged practice life with reduction in back pain
  • Remote patient care
  • Remote surgical training

Hospital benefits:

  • Reputation gain
  • Technology theme to differentiate services
  • Reduction in cross contamination due to patient procedures or hospital transfers during COVID-19
  • Remote patient care

Investment in robotics differs across the Asia Pacific region. Rajat noted “In countries which are mostly driven by private insurance payments, the challenge is a lesser one because people want to go for a safer treatment, a treatment which exposes them to lower radiation, places the stent more accurately so that they have less adverse outcomes. In those countries we have a solution because people who are going for some of these complex treatments are already paying for the extra sophistication in that procedural treatment.

“Looking at reimbursement-based countries, it takes a little while longer but eventually most governments and most healthcare institutions want to bring down their cost of operations in terms of workflow efficiency, smart automation and timely access to expert care.”

Dr Ong concluded “By being the early adopter of robotics, you have some say into the technology as it advances. You can contribute your knowledge, help set the standard, be involved with the early R&D and get access to those novel technologies faster.”

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