Revolutionizing operating rooms with robots
Mar 22, 2022
Robotics will not replace the human surgeon, but will make them better than ever, explains Gary Guthart, CEO of healthtech giant Intuitive Surgical, developer of the da Vinci surgical system. In a special interview, he reveals how doctors can be persuaded to trust robots, and how Covid-19 accelerated their integration into operating rooms
"In future decades, a large part of medical treatment will be done with the assistance of computing, imaging and robotics," says Gary Guthart, CEO of robotic surgery giant Intuitive Surgical, when we meet in Tel Aviv. "Computed interventions will help reduce variability in operating rooms around the world, by making every surgeon's performance as good as the best. Will it be better than the best surgeon in the world? Hard to claim that. Can it improve the performance of the average surgeon? Absolutely. That's what robotics has done." Guthart, who is in Israel for the opening of Intuitive's new offices in Tel Aviv, is not overstating its importance. More than anything, the company's systems remind me of Sci-Fi movies. (צילום: אוראל כהן)
Intuitive's flagship system, called da Vinci, assists surgeons in performing surgical procedures using precision robotic arms that act with minimal invasion: the heart of the system is a console that presents the surgeons with a sharp, enlarged 3D display of the surgery area, in a way that helps them identify its structures and better understand its anatomical state. At the same time, the console interprets the surgeon's hand movements to robotic arms that perform the procedure through minimal incisions. The software even provides real time alerts, guidance and information that assist decision making in the operating room. In the end, Intuitive produces analytics of the system's performance that provide deeper understanding of the process as well as insights for the future. The company's technology is used by a number of hospitals in Israel, amongst them Rabin (Beilinson) Medical Center, Sheba (Tel-HaShomer), Sourasky (Ichilov), Soroka, Rambam and others. When asked if this technology doesn't threaten so called "senior surgeons", Guthart smiles. "Our products have been in clinical use since 1999, and the attitude towards them varies by country and surgical specialty. There are parts of the surgical community that see new technologies like ours as an opportunity to improve, and they are your first adopters, like urology or gynecology. But there are also well established surgeons in the field that resist and say: I don't need a robot, I'm the LeBron James of the field." What do you answer? "My argument to them is never 'you must use the robot', because it's not true. I will say 'you may be the LeBron James of your field, but not every basketball player is LeBron James'. I don’t disagree when they say 'I don't need it', but when they say 'nobody needs it', I present them with the data demonstrating the gap that exists in surgical performance, and prove that our products make a difference; they make the average surgeon as good as the best. That's the point." I assume it's not only surgeons, doctors and patients who are apprehensive about the robots, but regulators too. "The regulatory approach is not harmonized: the EU's approach is different from that in the United States, which is different from Japan's and China's, but I don’t remember a case where we weren’t somehow ultimately able to come to an agreement with regulators. It tends to be a discussion over the path and the method, rather than a 'yes or no' argument. "One of the biggest things driving the development of robotic-assisted surgery is the use of electronic medical records, a field in which Israel is quite advanced, because it makes it possible to answer more questions. We're finally at a point where hospitals can look at their own data, across their own patient population, across their own surgeon population, and assess the quality of surgery. This is the most powerful and influential thing that has happened in healthcare in the last decade, an amazing revolution really." "The market has a lot of opportunity. One company will not control it all"
This isn't Guthart's first visit to Israel. Two years ago Intuitive acquired Orpheus Medical, a start-up that developed a system for surgical video management. Over the last year, the company has deepened its local Research and Development activity and opened two R&D centers in Haifa and in Tel Aviv, with about 50 employees. What led you to invest in Israel out of all places? "The human capital. We were looking to compliment our team outside our headquarters in Silicon Valley, California. We were looking for diversification of our talents, specifically in machine learning in health care, and it is well known that many talented people are here. We were lucky to find Orpheus; it was a great match." Is the search related to the fact that you may lose your so-called "monopolistic" status in robotic-assisted surgery when giants like Alphabet (Google) and Johnson & Johnson enter the field? "I disagree with the definition of a monopoly," he laughs. "The process in which different players are interested in robotic-assisted surgery has been going on for a long time. The need for better healthcare and acute intervention is quite clear, and that's why more and more players enter that market. So the idea that 'all of a sudden a big player was coming in is not what happened." What is going to happen when people like Jeff Bezos and Elon Musk discover the untapped treasure called "health systems"? "There are many opportunities in the field, and they are really varied. I don’t think a single company will come in and dominate the market. One company won’t figure it all out. At Intuitive we made it our mission to make acute interventions in operating rooms much better for the patient and for the staff, and to lower the total cost of treatment as well. I don’t think Amazon or Google will run to the field as their first application, so I'm not concerned. On the contrary, it may be that they will build great tools that all of us can use." "When they started operating again, demand for minimally invasive procedures soared"
Today's hottest trend in technology is interdisciplinary: combining robots with artificial intelligence, machine learning and big data. Is that the next big challenge? "Hospitals today work to improve four parameters: treatment outcomes, patient experience, staff experience and lowering the cost of treatment. We supply technology that can help them achieve these goals. In the past I sold a client medical products – robotic scalpels, scissors or endoscopes – and he would know how to use them. Now we want to integrate this whole set of products and help the customer use it, in order to improve in all of those four parameters. “Of course, computing, AI and ML can make a vast difference, and still you have to touch the patient, the live tissue. We work a lot on the ways we can incorporate these technologies in our products and services. We've done a lot in the field of IoT, 'the Internet of Things': we are cloud-connected to robots in operating rooms for over a decade. If we start bringing data back, we can start looking at trends, we can help hospital efficiency with faster training, we can help change the operating room outcome for the better." Related articles: