Developing Seamless Surgical Robotics Workflows

When adopting a new piece of technology, it can take surgeons time to adapt. On Episode 4 of Season 2 of The Surgibots Podcast I was joined by Edvardas Satkauskas, the CEO and Co-Founder of Inovatyvi Medicina, to talk about the process of developing a seamless clinical workflow through innovative surgical robotic technology.  

Here are his insights:  

What makes the Sentante platform so ambitious? 

There are two key things about Santana. One is that we designed it to perform entire procedures robotically. That is a big contrast from robotically assisted technology, where physicians are still required to be in the room in order to do the procedure. We designed Santana in such a way that you could do an entire procedure using robots. What that means is that you have the ability to use any endovascular devices or instruments during the procedure, and we are compatible with most standard, off the shelf vascular devices, so physicians can use any devices they are used to during the procedure, but now they can manipulate three devices at a time. So we haven’t changed devices or the clinical workflow - the same people are responsible for doing the same things, except that we have taken the physician out of the operating theatre.  

We haven’t even changed how the physician operates on their own. Santana works because the interface between physician and the robot is the same as the methods they are trained to use. Physicians have an interface with the robot that includes the devices, guide, wire catheter and diagnostic. Whatever the physician does in the cockpit, the robot senses all the movements with linear or rotational movement and translates the exact same movement to the patient side. If there's resistance from the patient, the surgeon can actually feel it in the cockpit through real time haptic force feedback. In that sense, the most ambitious part is that the physician has to retain the ability to feel the resistance of the devices in real time, not just rely on X-ray imaging. That feedback is part of information that doctors base their decisions on while doing the procedure.  

Given that we have to be compatible with a wide range of devices, the system is very dynamic. We have very thin guide wire, which is very sensitive, whereas if you take a very stiff guide wire, where you would use brutal force to get through calcification, those are very different conditions to work in. The system has to be compatible with both of them. It has to provide that haptic force feedback as well as the ability to manipulate the devices as they would be manipulated during medical procedure. Ours is a system that seamlessly integrates into clinical workflow, because physicians can use their existing skills alongside the system after as little as 10 minutes. They don't lose anything, but they gain so much more. 

Is there anything that people haven't liked about Sentante? 

Absolutely. There was some feedback that suggested some improvements, which is actually very difficult in our situation, because we are trying to build a system for endovascular interventions. You can do peripheral interventions, coronary interventions, neuro interventions, and each of those would have very different requirements and very different devices, workflows, and people. Technically, the device can be used in any of those interventions, but our first clinical indication is peripheral vascular, because that's got the shortest time to market for us, and we want to demonstrate the system in a real clinical setting.  

However, we also work with clinicians to demonstrate the system for clinicians that work with neuro indication. For example, with stroke management or aneurysm closing, there are different requirements. There were some very experienced people who initially said, ‘I would probably need more sensitivity, or extreme accuracy,’ and technologically that's absolutely possible, we just need to go that development pathway. The funny thing is that many of the clinicians are usually rather sceptical initially because they see so many technologies every day, but after some time passes, if you demonstrate the system, they come back and say, ‘I thought about it, it's great. That would absolutely work,’ and then we have a great discussion about how we could apply it to their specific field for their specific indication. 

Have you ever had to pivot based on feedback, to the point that you’ve had to change your route or methods? 

We’ve never lost our North Star. We constantly work towards the same requirements that we set at the very beginning, but sometimes we may alter them. We did make some changes to create a better usability. From an engineering standpoint, you can adapt the system or tweak it according to your needs. We could have an equaliser system which would adapt to a particular physicians’ habits for example, but that is a dangerous road to go down, because then you risk making a super complicated system that would need dramatically adjusting to customise it. For some people that would be helpful, but it probably wouldn’t work for everyone. Bringing such a sophisticated system to a clinical work has to be as simple as possible, as easy to use as possible and as safe as possible. We have no room for error. The feedback we collected went into the requirements of the system rather than defining what we’re trying to build.  

To learn more about the Santana system and Edvardas’s work, tune into Season 2, Episode 4 of The Surgibots Podcast.