Medtronic has been a key player in the minimally invasive surgery space for the last few decades, and has made great strides more recently in robotic surgery with last year’s acquisition of Digital Surgery. As a quick reference point: despite the many benefits of robotic-assisted surgery (RAS), only 3% of surgeries around the world are done with the help of robots. Medtronic is aiming to shatter the barriers currently thwarting the adoption of this important technology.
We were able to connect with Tracy Accardi, VP of R&D for Surgical Robotics at Medtronic to catch a sneak peek of what the industry can expect over the next six months and dive into how Medtronic is innovating to solve some major shortcomings in the RAS space. The Medtronic surgical robotics team is putting focus on the impact that digitizing surgery can make on the healthcare ecosystem for clinicians and patients alike.
Alice Ferng, Medgadget: Tell us about your background and what ultimately brought you to your current role at Medtronic.
Tracy Accardi, Vice President of R&D for Surgical Robotics at Medtronic: Nice to meet you too. I lead the R&D group for the surgical robotics team at Medtronic. I built my first robot with my dad when I was about eight, and it was a really simple device that we built to feed the dogs – but as a result, it’s just been an area of fascination for me since then. I also had a very influential advisor in college, who went on to establish the robotics program at Carnegie Mellon. So robotics has always been kind of my area of interest.
Very early in my career, I was part of the medical device space with GE Healthcare first, then Philips, then Johnson & Johnson, and then Covidien. And healthcare is – or I should say medical device development – is really my special spot. It’s where I love the connection between innovative medical technology. And putting the ‘tech’ in ‘med tech’ and making a difference in patient outcomes is really what I’m all about. So I lead a team of extremely talented scientists and engineers, and we are working on the introduction of the Hugo robotic-assisted surgery (RAS) system, which will be a soft tissue robot from Medtronic that is modular and mobile with an open console. We are kind of spread around the world in four different locations, but all working towards that same goal of putting the tech in med tech and making meaningful surgical robotics technology that can really bring quality care to more patients in more places.
Our mission at Medtronic is to alleviate pain, restore health, and extend life. And it’s really, really easy to see the connection between that mission and what we’re trying to do with the surgical robot. So I’m just in a great spot to be able to help make a difference.
Medgadget: Robotics is an exciting category in the field of healthcare and medical technology. What drew you to this work and why is working on soft tissue robotics is something of interest? Why is it challenging?
Ms. Accardi: I’m very much driven by doing things that some people think aren’t possible. And I look for a challenge in any opportunity that I go after because I get a lot of satisfaction in making challenging things happen. I came into the surgical robotics team about two years ago, and I think through every opportunity very carefully, and it was just really compelling to me to think about Medtronic with its strengths in the instrumentation side for laparoscopy. Combining that knowledge with customer relationships in a soft tissue robot could meet some of the needs that are not being met by other soft tissue robots in the space today. So it was all about the opportunity and the challenge for me with something that I knew would be hard to accomplish and take a lot of work, but that would have a big impact.
Medgadget: I also love those seemingly impossible problems – those are always the most fun to tackle and solve. Can you elaborate on some of the biggest challenges that people think can’t be conquered in soft tissue robotics?
Ms. Accardi: Well, if you look at robotic surgery today, we have less than 3% of surgeries around the world being done with the assistance of robots. And digging into why that’s true, you come out with some very clear challenges and opportunities around Cost of Ownership, around modularity or flexibility, ability to swap rooms, or ability to quickly turn rooms over so that robots can have a higher level of utilization. And I think those two barriers (modularity and flexibility) were things that we set out from the very beginning to accomplish as a part of our design.
On average, we think that hospitals use the robotic system about once a day, and we set out from the very beginning to design a robot that would enable more value and ability to help patients. So we’re very excited about what our modular design will bring to that equation for cost, access, and ability to utilize the equipment. And then we’re building on a really strong reputation and customer satisfaction that we’ve experienced on the instrumentation side to make our instruments in the robotic space a very comfortable transition for someone who’s used us in lap.
Medgadget: How do you pick which modules you’re going to build and how do you prioritize that? What’s your design process like?
Ms. Accardi: It starts with interviewing hundreds and hundreds of physicians and hospital executives to understand what their challenges are. And then we kind of break it down into questions such as: “What’s driving the wrong behaviors today?” “Why is it so difficult to change a room over between patients?” “How could you look at ways to make that process better?” So we go into detail in each of the areas that we identified through the interviews, and it all starts with a very customer centric design process.
We’ve made sure to talk to people that use robotics today, and those that haven’t yet. And we have asked ones that haven’t yet: why not yet and what are the obstacles that you perceive? And we came out with a few key design elements. One was around flexibility; we wanted a design that would be modular – when I say modular, I mean, components within the system that can be used or exchanged with other components. For example, we have four robotic arm carts that can be used in any combination. And they can be used in both robotically assisted surgeries as well as laparoscopic surgeries, which we thought was really important. It’s a system that can be upgraded over time, so that you know that you are buying something that will continue to add value over time.
And then we heard loud and clearly that we needed to stay compatible with the trusted surgical instrumentation portfolio that we already offer. We also heard from a lot of surgeons about the cognitive loading that happens in robotic surgery, the amount of energy that a surgeon has to put into understanding everything that’s going on. So we’ve looked at ways to incorporate analytics that can inform decision making for them and make it easier for them to provide a standard of care that’s consistent between surgeons and surgeries, so that access to quality care is possible for all the patients involved. Then we also heard very strongly that hospitals and physicians were looking for partnerships here, and not to be a vendor-supplier kind of relationship, but instead, to really get in and understand how they can optimize system utilization and how we can help them with ongoing training. Whether it’s training at the beginning, or ongoing with different staff members going in and out of the operating room (OR), so we’ve built a team with a dedicated field engineer as well as systems specialists that will really be there to partner with the surgeons and use the robot.
Medgadget: I’m curious to learn how you managed the cognitive load of surgeons and how you reduced that load – are there metrics that you use? How do you model these issues?
Ms. Accardi: So a large part of this comes in through the work that we’re doing with our Digital Surgery teammates – Digital Surgery being a company that we acquired about a year ago that I’ve integrated into the surgical robotics team.
They understand an awful lot about how procedure steps flow, and different amounts of times that different users might bend in different steps, and potentially even different orders that surgeons might do procedural steps in. They’re then able to use that information to help surgeons understand how they could be potentially more efficient by looking at how others are doing the same procedure.
And with sharing the information that the surgeons are gathering in each of their surgeries, they can compare notes with each other and drive some conversations about that. We see the ability to use analytics to do things like indicating critical structures. Don’t go here, there’s a large nerve bundle there, or make sure you’re seeing everything within your field of view. And even using some general coaching through the robot to help avoid putting instruments where they shouldn’t be, you’re having them be energized when they shouldn’t be in the surgical field. So there are a lot of ways to just use the multitude of information that’s available, and understand which procedure sets have the best outcomes.
Medgadget: It’s pretty clear AI will play a big role in RAS and the future of med tech – can you elaborate more on this from your perspective?
Ms. Accardi: Yes, AI has a major role in robotic assisted surgery. I think a robotic system without AI obviously has value on its own, but when you can combine the AI with the robotic system, it’s really a force multiplier. I get really excited about solutions that can provide information that’s either not visible currently or knowable even to the user that could reduce or eliminate unwarranted variability or human error, and over time on it, maybe even automate certain decisions or tasks so that there’s less for the surgeon to have to think about. We think, at Medtronic, that data analytics and AI will continue to help streamline our processes for clinicians and standardize the quality of care. Like I mentioned, we see this already with the touch surgery enterprise platform that we launched last year with Digital Surgery. And I think you’ll see us continue to share digital and AI technologies with both our laparoscopic and future robotic solutions. The goal is to lower per procedure costs, while increasing patient access to care and reducing variability – those three things just fit really well when you have all the data that the digital Touch Surgery Enterprise platform can combine along with the algorithms that we’re developing.
Medgadget: Can you please tell me more about the surgery enterprise system?
Ms. Accardi: As a high-level explanation, I should say is that it’s a very easy to use our surgical video capture solution that’s paired with a computer and then connected to the cloud. And it automatically generates the data and analytics about procedure time. It takes account of the instruments the surgeon uses and offers valuable insights with built in AI that anonymizes any sensitive frames so you don’t have to worry about that. And it gives surgeons at the office the ability to upload surgical videos automatically broken down into the procedure, and then they can either put that directly on their phone or into their computer in minutes. It was developed by the team at Digital Surgery, and by participation in cooperation with a number of surgeons that were trying to do it the old fashioned way, if you want to say it that way, you know, they either recorded the whole video and then had to break it down and anonymize it themselves, or they had to find some convoluted USB drive way to move it from one place to another, and all that that entails. So this has been on the market now since around September and the early adopters of Touch Surgery Enterprise tells us it’s transformational, that it’s really helping them to improve or efficiency and is very valuable in training. It’s actually even a patient engagement opportunity, because patients can see what the surgery that they’re going to be experienced could look like ahead of time, and for some people, that’s really reassuring. For me, that’s the kind of thing I like to be able to see before, but not everybody might want to do that. But it’s just really great to see the training and patient engagement impacts with that.
Medgadget: What is your vision for Medtronic’s long-term future in surgical robotics? What’s possible?
Ms. Accardi: I personally very much believe in the concept that an ideal robot can be thought of today with an eye toward an ideal robot of tomorrow. So in other words, I feel like it’s going to be a big transition – an evolution that we make. It’s really critical to design systems that can add value and solve the problems we have now. And while we’re doing that, getting that in the hands of our surgeons and being used on patients around the world that will be gathering information and learning from the machine – the non-clinical data, the clinical data, and all the things that we’ll be able to leverage for future solutions. So I think we’ll see a progression through different levels of automation on non-clinical tasks taking place during and around the surgery, while automation of clinical tasks at any level will probably take a little bit longer and coming along and will be highly dependent on both the rate at which the necessary surgical data can be collected and repetitiveness of the task. I think as long as we keep an eye on those and continue to collect the data that will help us improve the algorithms, then I think that the whole future of surgical robotics will be very much driven by the surgeons and the patient needs and the confidence that they develop in this kind of solution. So, I think that surgical robotics will continue to enable access to better care, and I mostly think about that by reducing variability and having better outcomes. Ultimately, it can be at a lower overall total cost of ownership. But I think, you know, bottom line, one day we won’t say robotic surgery, we’ll just say “surgery,” and it won’t seem like a big divide between the two spaces. I look forward to that day.
Medgadget: Let’s say in the next 10 years we solve the issues you’ve highlighted and perfect the robotic solutions – what do you envision the role of the surgeon being then?
Ms. Accardi: You know, I think that’s a great question. And I get that question a lot. I think that first, I think it’s a much longer timeframe than 10 years. So we’re at “Nirvana” – but I also think that it will be: we’ll have done it right when everything we can do to simplify the process for the patient and the physician has been accomplished and outcomes are really strong. I personally believe there will always be a surgeon paired with a robot, and I think there will always be a role for the surgeon to account for the variability between patients, the things that can happen that haven’t happened before and need an immediate kind of triage to make better. I do not see in any way a replacement in the soft tissue space of surgeons, I just think that it’ll always be a very strong partnership.
Medgadget: Is there anything else you’d like to add or emphasize?
Ms. Accardi: I want to go back to the comment that I made at the very beginning when I was talking about even why I decided to join Medtronic on this mission. Medtronic has been the global leader in minimally invasive surgery for a long time for decades. I had other opportunities, I’ll just say, and I couldn’t be at another company when there exists so strongly the critical part Medtronic plays on the instrumentation side and a new offering that includes resources for the mission to do a robot in parallel. I’m super excited about bringing all of that together in the surgical robotics space and expanding quality care. So I just wanted to stress that again, because it’s why I get excited about what I do every day.
Link: Medtronic’s White Paper on Robotic Assisted Surgery (RAS)