China's first robotic doctor looks to crack the cost of surgery

Without a long, deep knife edge, there are only five holes with a diameter of about 1cm and a very small amount of bleeding. In just over one hour, the robot “daughter” successfully removed the gallbladder from a piglet. Half an hour after the operation, gradually sober piglets have struggled on the operating table.

This is the scene of the first micro-invasive surgical robot “McroHand A” system held at the Tianjin University on July 3rd. Experts from the appraisal said that the "Skilled Hand A" system is a national 863 project. It has achieved major breakthroughs in key technologies such as mechanical design, master-slave control, and stereoscopic image and system integration of robotic systems. It is composed of 7 experts including the Chinese Academy of Sciences Xiong Youlun and other experts. The appraisal committee believes that it has filled the domestic gap and reached the international advanced level.

In fact, the overseas minimally invasive surgical robot "Da Vinci" was used in the operating room 10 years ago. The significance of the "Master A" lies in breaking the monopoly of Da Vinci to a large extent. .

Surgery enters the robot era

From traditional surgical operations to robotic surgery, humans have survived for nearly 3 centuries.

In the 1880s, Vienna surgeon Billroth first opened the patient's abdominal cavity and completed the first surgical operation. This traditional surgery is known as the first generation of surgery and has been used up to now. In the 1980s, the minimally invasive surgery marked by laparoscopic cholecystectomy achieved breakthrough progress and replaced traditional open surgery in many fields. It was called second-generation surgery. In the 21st century, surgical robots have been developed and quickly put into clinical use. They are considered to be a revolution in the history of surgical development, and also indicate the advent of the third generation of surgical operations.

According to Jiang Xueming, deputy chief physician of the General Surgery Department of General Hospital of Tianjin Medical University, who operates the "Hands-on A" system at the appraisal meeting, minimally invasive surgery has therapeutic effects, pain relief, recovery cycles, and medical costs compared with conventional surgery. obvious advantage. The medical assisted robotic system can be said to be another breakthrough in the field of surgery, greatly broadening the scope of minimally invasive surgery.

In 2000, the United States Food and Drug Administration (FDA) approved the DaVin-ci system as the first robotic system available in the operating room in the United States. "Da Vinci is currently the most advanced artificial intelligence surgical robot system. It has been widely used in urology, general surgery, orthopedic surgery and cardiothoracic surgery in recent years," said Jiang Xueming. It is reported that the system has advanced three-dimensional visual field, can simulate the flexible movement of human wrists and fingers, and overcome the limitations and shortcomings of many TV endoscopic surgery. For example, robotic surgery is not only more flexible than ordinary thoracoscopic surgery, but it also avoids the doctor's fatigue and wrist shiver caused by long-term surgery. Jiang Xueming told China Economic Weekly that with the help of robots, he could sit and perform surgery.

This reporter learned that as of March 31 this year, the Da Vinci system has sold 1,482 units worldwide. Since the introduction of the DaVinci system in the Department of Cardiology of General Hospital of the Chinese People's Liberation Army in 2006, a number of hospitals in China have introduced the system and successfully applied it. Before the appraisal, the “Master System A” has also begun trials at General Hospital of Tianjin Medical University, People’s Liberation Army Second Artillery General Hospital, and People’s Liberation Army 301 Hospital.

Cracking the high cost of surgery

The use of robots to perform surgical operations was once considered a distant and even risky event. However, with the development of science and technology, surgical robots have gradually become the main trend of minimally invasive surgery. Xu Xiang, a surgical expert at the People's Liberation Army 301 Hospital, told China Economic Weekly that their hospital had to arrange many such surgeries every day. “Some people are not even able to fit in.”

However, the costly use of surgical robots is still the biggest problem for hospitals and patients. This is mainly reflected in high acquisition costs, high surgical costs, and high maintenance costs. According to industry insiders, in the foreign countries, using surgical robots for conventional surgery, major surgery, and difficult surgery, the patients need to increase the cost of 1,000 US dollars, 1,500 US dollars to 2,500 US dollars, 3,000 US dollars to 4,000 US dollars. In China, although the Da Vinci system has been introduced, Robot-assisted minimally invasive surgery at the People's Liberation Army 301 Hospital can still only be charged according to traditional surgery.

"The introduction of a DaVinci system requires about 20 million yuan, and each time the startup cost reaches 60,000 to 70,000 yuan, the patient can't afford it at all." Ah Cheung said that although every surgery will have to be lost once, but in order to To master this technology, the People's Liberation Army 301 Hospital has been carrying out minimally invasive robotic surgery on the basis of the hospital’s many costs.

According to Wang Shuxin, dean of the "Master A" project and director of the Tianjin University of Mechanical Engineering, he introduced to the China Economic Weekly. "In addition to the high cost of purchase, the Da Vinci system is also very expensive for surgical supplies. For example, each time the tool is used 10 times Replacement, a preventive maintenance every 4 months, which makes the replacement of supplies and maintenance costs will reach about 40% of the cost of the robot system, a heavy burden on the hospital and the patient.”

In Wang Shuxin's view, the final cost of the domestic "self-developed" "Master A" system will be only 1/3 to 1/2 of that of foreign products. "Consumables will not be so fragile, and it will help reduce similar products in the future. The price and maintenance costs greatly reduce the cost of robotic surgery."

Surgery to the robot to worry?

Some patients worry that with the current technological conditions, can the surgery be delivered to robots with confidence?

"Robot surgery is actually a faithful restoration of the surgeon's intentions by the robot, so there is no need to worry about the robot will be indiscriminate surgery." Jiang Xueming said that because the system has set up multiple security mechanisms, and even some mistakes in the operation of prisoners. For example, the robot will automatically filter out some abnormal movements of the main surgeon during the operation, so as to avoid accidental injury to vital structures such as blood vessels and nerves. In addition, the magnification and clarity of the robotic viewing lens are much higher than those of ordinary mirrors, which is very helpful for fine operation in a narrow space. "At the same time, robotic surgery has also greatly reduced manpower."

In the current operating room, there are usually two to three surgeons, an anaesthetist and several nurses, and there are about ten individuals. In the future, surgery may only require one surgeon, one anaesthetist, and one or two nurses.

At present, more than 600,000 robotic surgeries have been successfully performed in 33 countries and more than 800 hospitals worldwide. The types of surgeries include urology, obstetrics and gynecology, cardiac surgery, thoracic surgery, hepatobiliary surgery, gastrointestinal surgery, and ENT surgery. Other disciplines.

It is reported that the "Master A" system has gone ahead of the Da Vinci system in many technical indicators. For example, for the first time, a small four-degrees-of-freedom surgical tool can be designed to perform complex suture knotting exercises. Through remote and distant transmission of signals, in the near future even Beijing doctors can treat patients in any conditional hospital in another place. Surgery is performed to greatly improve medical efficiency and reduce medical costs.

With the widespread use of robotic surgery, "some doctors may have to be unemployed," Jiang Xueming half-jokingly said.