Smarter surgical procedures

While technological advancements continue to grow and push the medical field forward, providing increasingly more customized, efficient, safe solutions, the industry is still met with questions about what’s next.

How can these tools continue to advance? How do we lessen the toll some instruments have on surgeons? How can costs be driven down while preserving benefits? How do we focus on these challenges while progressing in the evolving healthcare environment? Asensus Surgical, a medical device company based in Durham, North Carolina, is introducing a new type of minimally invasive robotic platform to help provide an answer.

The Senhance Surgical System laparoscopic platform digitizes the interface between the surgeon and patient, leveraging artificial intelligence (AI) and machine learning (ML) to reduce surgical variability and improve patient outcomes. The system has already received multiple U.S. Food and Drug Administration (FDA) clearances for its components, the most recent one being for expanded machine vision and measurement capabilities of its Intelligent Surgical Unit (ISU), improving automated camera control and image enhancement based on real-time data.

“By applying augmented intelligence and machine learning to surgical robotic technology, laparoscopic procedures have been effectively digitized and surgeons’ performance and patient outcomes have the potential to improve,” says Anthony Fernando, president and CEO of Asensus Surgical. “When surgeons are able to use critical, real-time information to help surgery become more instinctive and more focused, it reduces unintended and preventable complications,”

The ISU uses machine learning to recognize anatomy, convert image analytics into 3D virtual measurements in surgery, and become a virtual assistant to facilitate certain procedures in tandem with the surgeon. The technology understands how the surgeon performs or deviates based on dynamics of a patient’s anatomy, then applies learning algorithms for smarter surgeries.

The need for digital

For any procedure, the goal is always to ensure the best outcome possible for the patient and reduce recovery time and pain. However, limitations of traditional laparoscopy and operating rooms (ORs) bring challenges and can cause surgeons to make technical errors. As Fernando goes on to explain, traditional ORs have widespread inefficiencies, variability (surgeon and staff skill and fatigue), and workforce challenges, including:

• Reliance on an assistant to control camera

• Challenging ergonomics for the surgeon, staff who stand for long periods in awkward positions

• Imprecise instrument movement

• Torque at incision sites

Features incorporated into the Senhance system overcome these obstacles, providing a greater level of control and reduced variability.

“In terms of variability, surgical procedures are limited by human ability – surgery is an art that’s influenced by experience and thousands of hours of training. Skill variability and discrepancies across surgeons and facilities can lead to a wider gap in the surgical outcome,” Fernando adds. “And when you think about team dynamics in the OR, failures in situational awareness among surgeons and staff are associated with a higher rate of technical errors.”

To address variables that can occur due to team interactions, Senhance provides surgeons with the ability to control their visualization via an eye-tracking camera instead of having to provide verbal direction to a surgical assistant. This also frees the hands of surgical staff to perform other in-room activities. Senhance’s open- platform architecture improves surgeon-team communication. In addition, they can use and integrate other OR technologies to benefit from capital investments and support surgeon preferences. Standard reusable instruments also minimize costs, keeping overall cost and time similar to traditional laparoscopic procedures.

Typically, during surgery, the physician will stand in awkward positions for long periods of time, leading to physical and cognitive fatigue that can impact performance. With the Senhance system, the physician is seated in a comfortable, ergonomic position, which is an improvement from laparoscopy. And robotic-assisted arms eliminate the need for a surgeon to maintain awkward instrument positions and static stances. They can be paused, allowing the instruments and camera to remain stable and stationary while the surgeon changes position. The ISU provides digital assistance to address cognitive fatigue by supporting routine tasks performed by the surgeon and distributing them to the digital assistant, enabling the surgeon to focus on other critical tasks for the patient.

With the 3D measurement feature, surgeons can measure points in the abdominal cavity and receive instant measurements between those points, down to a few millimeters; whereas surgeons formerly relied on estimates or inserted sterile measuring tapes, which can provide inaccurate results, to map staple lines or surgical mesh sizes.

Digital tagging allows surgeons to highlight areas of interest within a patient’s anatomy, making it easier for them to keep track of those areas throughout a procedure. They can also use this feature as a teaching aide, marking images while guiding trainees through an operation.

Finally, for a greater level of control, the platform’s haptic feedback heightens the surgeon’s sensing of pressure or tension throughout the procedure. When pressure thresholds are reached, the system sends alerts as an added layer of security.

Value-added care

Backed by intelligent learning algorithms, the ISU can consistently learn across a variety of surgery indications, surgeon techniques, and facilities to deliver smarter surgeries and improved outcomes.

With digital laparoscopy, the integration of AI, use of 3mm instruments, and force-sensing at the incision site allows patients to benefit from smaller incision sites and faster recovery time. They can leave their procedures with a better overall experience.

Changing what’s possible

While patients’ needs are changing, their conditions are also growing more complex, due in large part to rising chronic conditions and an aging population. In turn, this is driving demand for more intuitive, connected solutions to thrive in today’s evolving healthcare landscape.

Reflecting on what could be possible as these capabilities advance, Fernando sees the technology already exists and is growing exponentially in other industries. Therefore, it seems most suitable to bring more of these smart solutions into surgery and encourage the critical need for adoption. More investment means that the benefits of robotics can reach more patients in more care settings.

“Next-level technology changes the idea of what’s possible. As technology enhances and changes the world we live in, the OR can move beyond inefficiency, unpredictability, and outdated technology,” Fernando says.

Continuing to digitize surgery and build ML algorithms and AI will allow surgeries to become even smarter and more instinctive, creating a shift toward better quality care and patient outcomes. Digital technology also can level the field in terms of surgeon skill and experience, leveraging the best outcomes and use anywhere.

Asensus Surgical Inc.
https://www.asensus.com

About the author: Michelle Jacobson is assistant editor of TMD. She can be reached at 216.393.0323 or mjacobson@gie.net.