Robotic surgery's advantages include less pain, fewer side effects and less blood loss because the instruments add a level of preciseness that human hands can't deliver. But the danger of robotic surgery is that it's only as good as the operator. Training surgeons poses inherent problems as well as an opportunity for a new device: the Robotic Surgical Simulator (RoSS), which works like a flight simulator for robotic surgery.
Intuitive Surgical's (Sunnyvale, California) da Vinci Surgical System is the only FDA-cleared robotic surgery device and is the focus of RoSS.
“The training-related problems with da Vinci are multiple; it's very expensive and any institution that has it wants to maximize the use,“ Khurshid Guru, MD, director of the Center for Robotic Surgery and attending surgeon in the Department of Urology, Roswell Park Cancer Institute (RPCI; Buffalo, New York), told Medical Device Daily. Because the da Vinci costs almost $2 million, most hospitals choose to use it as much as possible, leaving little time for surgical training. Typically, surgeons learn their skills by shadowing a veteran, but it's difficult when it comes to robotic surgery.
That's why RPCI has collaborated with the University at Buffalo (UB) School of Engineering and Applied Sciences to develop RoSS, a da Vinci simulator that closely approximates the touch and feel of the mostly widely used robotic surgical system. With a price tag of $125,000, RoSS offers institutions a cost-effective means to train more surgeons, Guru said.
The Research Foundationof the State University of New York and Health Research (Buffalo, New York), the technology transfer arm of Roswell Park, jointly licensed the RoSS technology to a new spin-out company, Simulated Surgical Systems (also Buffalo). The company employs several engineers who are skilled in developing virtual simulation software for surgical applications. It plans to begin selling the RoSS by the end of 2010. Guru is the chief medical officer.
For now, RoSS is being taken for a test drive at five institutions in order to tweak the system and ready it for commercial launch. The participating institutions include RPCI, Robert Wood Johnson Medical School (New Brunswick, New Jersey), Albany Medical Center (Albany, New York), Henry Ford Health System (Detroit) and a fifth, yet-to-be-disclosed location.
RoSS uses virtual reality to introduce the user to the operation and feel of a robotic surgical console. It comes with a curriculum to train for the motor and cognitive skills required to operate a surgical robot. RoSS also has a suite of simulated surgical procedures for a fellow or resident to follow, and recreate the surgical steps of an expert surgeon.
“When I first sat down on a da Vinci, I didn't know what a clutch was or how to respond to visual cues,“ Guru said. “You have to learn to trust your eyes. Our modules are made in a way that there is no tactile feedback. That's a big thing. You are operating from a distance and you have to trust visual cues. You also have to learn to operate in a 3-D system. It's not like open surgery where you can hold somebody's hand. It's remote-based training.
Guru said that in order for a surgeon to develop a basic skill set on da Vinci, 80 hours of training are needed on RoSS, which has a head-mounted system and two hand-mounted controls. Clutches and blades control the arms and instruments. When surgeons peer inside, they step into a virtual environment.
At least 70% of all prostate surgeries in the U.S. are performed using robotic surgical systems. At RPCI, it's closer to 100% both in prostate and bladder surgeries. Robotic surgical systems are increasingly being used for gynecologic, gastrointestinal, cardiothoracic, pediatric and other urologic surgeries.
“The RoSS will have a major impact on improving surgical outcomes,“ said Donald Trump, MD, president/CEO, RPCI. “The product's relevance will grow in direct proportion to the acceptance and application of robot-assisted surgery as a best practice around the world. The training that RoSS provides will eventually translate into better quality of life for thousands of patients.“
UB's Virtual Reality Lab is focused on developing haptic technologies – technologies that bring a sense of touch to virtual reality.
In addition to learning skills such as tissue cutting, knot tying, needle driving and manipulation, suturing and vessel clipping, RoSS includes specific surgical modules for radical prostatectomy, hysterectomy and cystectomy.
Lynn Yoffee, 770-361-4789;