Wednesday, November 26, 2008
Advantages of Robotic Surgery
In today's operating rooms, you'll find two or three surgeons, an anesthesiologist and several nurses, all needed for even the simplest of surgeries. Most surgeries require nearly a dozen people in the room. As with all automation, surgical robots will eventually eliminate the need for some personnel. Taking a glimpse into the future, surgery may require only one surgeon, an anesthesiologist and one or two nurses. In this nearly empty operating room, the doctor sits at a computer console, either in or outside the operating room, using the surgical robot to accomplish what it once took a crowd of people to perform.
The use of a computer console to perform operations from a distance opens up the idea of telesurgery, which would involve a doctor performing delicate surgery miles away from the patient. If the doctor doesn't have to stand over the patient to perform the surgery, and can control the robotic arms from a computer station just a few feet away from the patient, the next step would be performing surgery from locations that are even farther away. If it were possible to use the computer console to move the robotic arms in real-time, then it would be possible for a doctor in California to operate on a patient in New York. A major obstacle in telesurgery has been latency -- the time delay between the doctor moving his or her hands to the robotic arms responding to those movements. Currently, the doctor must be in the room with the patient for robotic systems to react instantly to the doctor's hand movements.
Is Robotic Surgery Better? Or Just Marketing?
Why the U.S. healthcare system (if you want to call it a system, which it isn't) is a mess is obvious. It's mostly because of bureaucratic, inefficient, denial-fixated health insurers—chop out the waste, and escalating costs will come back into line. Considering this albatross as well as various other handicaps, it's amazing that the quality of our healthcare is really good.
Myths, both. Administrative expenses are a relatively small driver of healthcare costs. And the quality of U.S. care not only fails in many respects to measure up to the care delivered in other countries but swings between extremes depending on where you live, the caregiver you see, and the hospital you use. Shannon Brownlee, a visiting scholar at the National Institutes of Health Clinical Center (and a former U.S. News colleague), and oncologist Ezekiel Emanuel, chairman of the center's bioethics department, busted those two myths and three other widespread misconceptions in a well-argued piece in Sunday's Washington Post that is well worth reading.
In their discussion of what is to blame for high and rising costs, they cite technology, among other things, meaning new drugs, new gizmos, new procedures. "Unfortunately," they write, "only a fraction of all that new stuff offers dramatically better outcomes."
That reminded me of a striking admission from Paul Levy, president of Beth Israel Deaconess Medical Center in Boston, who last Friday stated publicly on his blog that the hospital is buying a da Vinci surgical robot for marketing reasons. It costs well over $1 million, not counting its expensive annual care and feeding with new tools and software. All of the hospital's Boston competitors have the robot, and they are drawing referrals away from Beth Israel, which doesn't. "So there you have it," he wrote, his own sentiments clear. "It is an illustrative story of the healthcare system in which we operate."
I'm not sure this is a perfect allegorical example of a pricey technology purchased just because it is new and therefore represents a competitive advantage or, if a hospital doesn't have the technology, the loss of one. It is quite true that the da Vinci robot—which allows a surgeon sitting at a control station to manipulate tiny surgical tools and thus is no more of a "robot" than is a car being driven by a person—has not been shown, with the possible exception of a few specific procedures, to be clinically superior to conventional surgery.
But let's suppose an expensive gadget has been introduced that might be able to do one or more of the following: reduce deaths or complications (saving lives and money), get patients out of the hospital faster (saving money), and get patients back on their feet sooner (making them happier and reducing lost work time). Turning that hypothetical "might" into "yes, it can" or "no, it can't" requires that the gadget be put to use, doesn't it? How can a technology be evaluated without putting hands on, making comparisons with the usual ways, and so on?
Where I have a problem with the Beth Israel situation is that our system is very much driven by marketing. Referring physicians are clients, patients are customers, and every hospital competes for market share. That can mean feeling pressured to have the latest CT scanner or radio-beam therapy or surgical robot. If there aren't enough patients to keep a gadget in use enough to be profitable, get more by hyping the benefits (remember the temporary boom in whole-body scanning a few years ago) or luring patients from other hospitals. Does every hospital in Boston truly need a surgical robot system? Can't expensive technology be pooled?
SAIC's RTR-4® X-ray imaging systems are fully portable and compact, designed to rapidly perform X-ray based inspections in the field. The RTR-4N™ configuration consists of a portable X-ray source, an integrated digital imager, and powerful notebook computer. It is used for both Explosive Ordnance Disposal and Non-Destructive Inspection applications.
RTR-4 systems are the only fully-digital portable X-ray systems with ground level imaging available to Explosive Ordnance Disposal (EOD) professionals, meeting the intended purpose of enhancing the safety margin for EOD technicians and innocent civilians. The RTR-4N imaging system with its optional integrated wireless feature is the world's most popular portable digital x-ray system, and provides the ability to quickly and efficiently search for weapons, drugs, and contraband in areas too difficult or time-consuming to search by hand.
The RTR-4N digital X-ray system is compact, rugged, and portable, which allows it to be useful in a number of scenarios. A few examples of RTR-4 applications include:
Improvised Explosive Device (IED) evaluation and disposal. Bomb technicians from a variety of law enforcement, military, and airport security organizations use RTR-4 systems to investigate suspicious packages for the presence of IEDs.
Unexploded Ordnance (UXO) disposal personnel employ the RTR-4N system with Large Area Imager to evaluate unexploded ordnance and determine fusing condition.
Mail and package evaluation in a mailroom scenario, as well as point-of-entry examination of personal belongings at special events.
Customs personnel utilize the RTR-4N system to x-ray and investigate private vehicles and other odd-shaped objects not appropriate for an x-ray baggage scanner.
Non-Destructive Evaluation/Testing/Inspection (NDE/NDT/NDI) for process control of component assembly, honeycomb aerospace structures and wood building structures.
Portable Notebook Control Unit: The lightweight and powerful notebook computer possesses all the capabilities necessary to acquire and process images, enabling rapid threat assessment.
Powerful and Fast Processor: Notebook computer with Pentium® IV processor provides rapid processing of acquired data.
Large Display for Image Evaluation: The notebook computer display is large, with additional pixels to allow easy image evaluation and enhancement.
Image Analysis Software: Software includes full image analysis methods, such as smoothing, contrast stretch, subtracting, embossing, etc.
High-Capacity Hard Disk, Increased Memory, Built-in CD/RW and USB Ports: Some of the many notebook features that increase the effectiveness and productivity of the user.
Single Case for Transport and Storage: All components are conveniently stored in one hardened foam-lined case for easy, safe, efficient transport and storage.
Wireless Capability: A new integrated wireless option provides a digital and encrypted wireless connection from the Control Unit to the Imager and X-Ray Source with no add-on boxes. The operator, as well as other personnel and property, remain a safe distance from the potentially dangerous item being evaluated.
Upgrades: Several available options allow easy upgrade from the RTR-4/ARS system to the RTR-4N Notebook computer based system, creating an all-in-one case design.
The RTR-4N system is a small, lightweight, and durable portable x-ray imaging system that produces better image quality, less noise, and more contrast than typical analog systems. The RTR-4N system's digital transmission means no image degradation. The RTR-4N system operates without film— images are instantly displayed and can be saved in an industry-standard format.
Data is immediately available after the X-ray image is acquired and can be processed and reviewed as the inspection is being completed.
This product is available for purchase on the General Services Administration Law Enforcement and Security Equipment Contract GS-07F-0210J. Visit GSA Advantage for more information on purchasing.
More News On portable Device
A new portable X-ray system, which can generate instant images and which allows for state-of-the-art dentistry to occur anywhere, will be making the rounds at area schools this season, according to the Augusta Regional Dental Clinic.
A $2,500 gift from the Augusta Health Care (AHC) Community Health Foundation helped the regional clinic purchase the portable X-ray system. Donations from the Staunton/Augusta Rotary Club and the American Dental Association also contributed to the program, which required about $20,000 to launch.
The system will be traveling to elementary schools in Staunton, Waynesboro, and Augusta County over the next few months. Any student can be screened for oral health issues and given a dental assessment including free X-rays, sealants, and recommendations for follow-up treatment, said Margaret Hersh, executive director of the Augusta Regional Free Clinic, in a press release sent out by the AHC Community Health Foundation.
Parents at the school were given prior notice of the services available on site and asked if they wanted their child to participate, she explained.