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How Intuitive’s Innovative Technology Is Advancing Robotic-Assisted Surgery

Brian Miller

Brian Miller has been with Intuitive for 20 years and serves as our Chief Digital Officer.

I’ve been at Intuitive for more than two decades, and I can say for certain that there’s never been a more exciting time to work here. Why? Because we’re at this point where Intuitive’s robotic-assisted surgeries are considered the common approach for certain procedures, and our presence is growing throughout the world. And because our digital solutions impact a physician’s work before, during, and after a procedure, we have the opportunity to play a large role in helping build a strong robotics program that can deliver the most efficient and state-of-the-art care—and help deliver the best outcomes for patients, which is central to Intuitive’s mission.

Educating and empowering surgeons with data

We took our first step into digitally connecting our platforms in 2007. Prior to that, we had very capable systems sitting in operating rooms, but we were unable to monitor their use. Once our robotic systems began streaming data to the cloud, our eyes were opened to a wealth of information coming back to us in real time.

Fast forward to today, we’re marrying those data streams with state-of-the-art cloud computing to educate and help enable surgeons. Like anyone trying to be an expert in their field, surgeons need the ability to understand what they’ve done and where they have opportunities to improve. Using the data streams from the system created during a procedure, we’re able to personalize how the physicians interact with some of the other technology and services available post-procedure. We send the data through machine learning models to identify insights that can help surgeons perfect the craft of using our robotic technology. Plus, we enable those surgeons who might need to improve in various aspects of the procedure by providing data-driven insights. In those cases, we offer a personalized approach, which could include a virtual reality simulation to see how to do the procedure more efficiently. We can also connect them to a mentor through a remote presence technology. All of this is designed to enable better, more educated surgeons, and ultimately more consistent patient care.

For example, over the millions of anastomoses performed with the da Vinci, which involves connecting two parts of a vessel, we've been able to record how a surgeon uses the wristed instruments to complete the suturing task. Collectively, that data can show surgeons’ best practices—how to position the needle, for instance—to enable better outcomes.

Of course, the quality of these solutions is only as good as the quality of the data and timely delivery of insights—and that’s a massive challenge my team confronts every day. Everyone from our software engineers to our data engineers to our database experts focuses on delivering quality data—whether it’s generated by our own devices or from the hospital systems we’re connected to. A surgeon just finishing a procedure isn’t going to remember it three days later: They need to know how they did immediately so they can learn and improve for next time.

Digital in the operating room

Data-driven personalized learning is a huge focus for us right now, but my team is also building tools that will help physicians before and during a particular surgery—leveraging cloud computing to help them make more informed decisions at the point of care. For example, using existing pre-operative scans we can create a detailed 3D model that enables a surgeon to understand where a tumor is located relative to critical anatomy. The physician can use this model to plan the approach prior to the procedure, and then use it during the procedure for guidance.

We’ve also recorded thousands of hours of procedure video, and we’re programming the machines to know each procedure step by step, helping surgeons along the way. You can define a discrete number of steps for a prostatectomy, for example, and train a machine learning model to automatically identify when you transition from one step to another. In the future, once a surgeon arrives at a particular step, the system might prompt the surgeon, “OK, now is the time to inject the imaging agent.” Or, later on in the procedure, “Make sure you’re not coming into contact with a critical structure because that leads to complications.” That additional information—beyond what a surgeon sees through the endoscope—is going to be pretty valuable in the future in terms of helping surgeons through procedures and, potentially, helping them avoid complications.

There’s also potential gains to be made with efficiency: This technology could enable surgeons to complete procedures more quickly. It’s not that time in an OR is a measure of quality, but it is a matter of cost. And in the big picture, efficiency is an important contribution that moves healthcare forward.

Far from done

Even as we push the boundaries of technological development, one of my leadership priorities is to make sure my team is always connected to our core business—robotics-assisted minimally invasive procedures—and what it took over all these years for people to adopt it. We seek to deeply understand how the decisions we make will affect surgeons and their patients. If a software engineer has observed a da Vinci procedure in the operating room they will leverage that experience to make decisions as they are designing the next set of products. You cannot build technology that’s useful without the baseline mission of who we’re helping and what we’re trying to do.

And when you take that perspective, we’re just getting started. When I look back at the last 23 years, we have made substantial strides in being able to improve patient experience. With prostatectomies in the U.S. for instance, da Vinci has turned what used to be predominately an open procedure into a surgery that’s now consistently done with a minimally invasive approach. That is huge for that patient experience when you think about how they recover and get back to their normal life. But there are still complications for prostatectomies for too many people. So we’re far from done. We have the opportunity to harness the power of digital technology and robotics to transform patient care around the world.

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Brian Miller

Brian Miller has been with Intuitive for 20 years and serves as our Chief Digital Officer.

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