The benefits of robotic surgery are clear. Simply put, it can make surgeons better. It can help patients recover more quickly. And two Western University graduates, Dr. Reiza Rayman, BSc’85, MSc’91, PhD’09, and Stephen Randall, BA’72, are on the cutting-edge of this emerging technology with their groundbreaking firm, Titan Medical Inc. of Toronto.
In 1999, Dr. Reiza Rayman was part of the team that performed the world’s first robotic heart bypass surgery at University Hospital in London, Ont. Dr. Rayman along with Dr. Doug Boyd, operated using the ZEUS® Robotic surgical system. The procedure took eight hours, double the standard four hours. But, for Rayman, it was a glimpse into his future.
“The patient benefit was the dramatically improved primary recovery time that was much less than traditional cardiac surgery with an open chest,” explains Rayman, a former assistant professor in the Department of Surgery at Western University. “This was three 10 mm incisions, no heart-lung machines. Months of recovery time were reduced for the patient. Robotics was early then, but it was clear the technology was powerful enough to continue to improve.”
Dr. Rayman holds a PhD in Telesurgery from Western University in addition to an MSc in Medical Biophysics from Western University and an MD from the University of Toronto. He is also a Clinical Associate, Cardiac Surgery at London Health Sciences Centre (LHSC).
In 2006, with hundreds of robotic operations already to his credit, Dr. Rayman helped found Titan with the goal of carving out their own niche in a marketplace that at the time included just one firm, Intuitive Surgical Inc., working in robotic surgery technology. And it is a healthy and growing market that Titan estimates will be worth $5 billion by 2015 for robotic surgery with potential demand for 6,000 systems worldwide.
According to Titan CFO Randall, the SPORT® (Single Port Orifice Robotic Technology) will sell for less than $1 million.
“The really amazing thing with a robotic surgical device is that it allows surgeons to extend their hands and eyes like they’ve never done before in open surgery,” says Rayman. “Surgeons can use the technology to augment vision and to augment natural manual dexterity. The robotic camera offers a high definition true 3D view at 10 times magnification of the inside of the body that sometimes you’d never be able to see.
“Robots don’t have tremors,” he continues. “They don’t get tired standing on their feet, and they have multiple arms that can hold several instruments at once and come loaded with databases of thousands of similar surgeries.”
And now, he’s on the cusp of a breakthrough with a new robotic surgery system dubbed SPORT®, or Single Port Orifice Robotic Technology. What makes the new Titan technology — licensed from Columbia and Vanderbilt universities — unique is that the surgery is done through a single incision made below the belly button, as opposed to multiple incisions in other models including the current standard: the da Vinci®.
“SPORT is even more next generation,” says Randall, who explains that the SPORT technology is now being refined through tissue testing underway in Providence, Rhode Island.
“Tissue testing will continue for probably the next eight or nine months. The testing can vary from simply testing instruments by passing a needle through real tissue to an intended procedure, gall bladder surgery,” says Rayman. “We are testing with robotic surgeons in the field using several key opinion leaders.” The goal is to get their machines into operating rooms by 2015.
“We expect in approximately one year to begin initial human pilot studies, human clinical trials, probably outside the United States first,” says Randall. “Europe and Canada are also prime areas for testing the device. All testing will be approved through the regional regulatory bodies that exist right down to the particular hospital and the surgeon.”
The potential is thrilling. Robotic surgery can save lives in remote locations, on battlefields and rare expertise can be shared from around the world.
“We are at the Kitty Hawk stage of robotic surgery right now, in terms of where the platform is,” says Rayman. “There will be more sophistication, more diversity in the types of robots applied to not just one platform in many different areas.”
According to Rayman, the Da Vinci robot performs two main procedures: prostatectomy and hysterectomy, and is most widely used in the United States. The SPORT would concentrate on gall bladder surgery.
There are approximately 20 da Vinci systems in Canada and close to 2,800 in the United States. Currently, less than 10 per cent of such operations are done with robotics. But, in 10 to 20 years Rayman expects that number to increase to at least 50 per cent if not 80. But the human element should remain.
“Patients are so diverse, and the anatomy varies so much, and there is so much judgment,” says Rayman, who still performs surgery one day per week. “Some say there is art involved in surgery, and to take the human out of the surgery loop would be quite difficult. It’s like painting, in a lot of ways. You’re moving instruments through tissue, placing instruments precisely, moving tissue in a precise way.”
Titan Medical Inc. of Toronto is a publicly traded company on the TSX and the OTCQX.
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