This is a great write-up Adu, very thorough analysis and very balanced.
Do you have any thoughts on the potential of Intuitive being a key enabler of remote surgery, allowing expert supervision or perhaps true telesurgery in developing nations, crisis situations, or even just driving more widespread high-specialism surgeries in the developed world?
Thanks for the feedback. This question harkens to the founding of ISRG with Darpa's dreams of remote surgery.
There are a couple things to consider: 1) As you pointed out, remote surgery could enable greater specialization where every surgeon has one surgery that they are extremely good at. There would still be general surgeons but people could have access to better surgeons if need be. However, one consideration is that surgical outcomes for most surgery are generally good and getting a marginally better surgeon isn't worth the risks of telesurgery. It opens the tech up to cybersecurity issues and possible connection issues. It requires onsite supervision in case of emergency so it would cost a lot more. The value proposition isn't there because surgical outcomes aren't that different.
This paper outlines the potential limitations of telesurgery and one key point are the minimal latency times needed (<100 ms) and how such latency times can only be achieved with teams of 40 people and dedicated fiber optic infrastructure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067812/
With regards to developing nations, the infrastructure simply isn't there to perform remote surgery. Many places don't even have X-Rays.
It could be a limit of my imagination but I couldn't see remote surgery playing a large part in surgery (>.1% share) in the next 15 years.
Good analysis and don't disagree Adu. However the world has moved forwards since that 2018 publication. 40ms latency is common these days, and will be available even in the most remote locations now that Starlink is deploying. Nano-X have a prototype xray device that they're planning to sell through a SaaS like model to developing nations.
Totally hear you on the surgical outcomes comment. I realise my line of challenge is very much an edge case.
This has come down a lot since Adu. How are you feeling now about it?
This is a great write-up Adu, very thorough analysis and very balanced.
Do you have any thoughts on the potential of Intuitive being a key enabler of remote surgery, allowing expert supervision or perhaps true telesurgery in developing nations, crisis situations, or even just driving more widespread high-specialism surgeries in the developed world?
Luke
Thanks for the feedback. This question harkens to the founding of ISRG with Darpa's dreams of remote surgery.
There are a couple things to consider: 1) As you pointed out, remote surgery could enable greater specialization where every surgeon has one surgery that they are extremely good at. There would still be general surgeons but people could have access to better surgeons if need be. However, one consideration is that surgical outcomes for most surgery are generally good and getting a marginally better surgeon isn't worth the risks of telesurgery. It opens the tech up to cybersecurity issues and possible connection issues. It requires onsite supervision in case of emergency so it would cost a lot more. The value proposition isn't there because surgical outcomes aren't that different.
This paper outlines the potential limitations of telesurgery and one key point are the minimal latency times needed (<100 ms) and how such latency times can only be achieved with teams of 40 people and dedicated fiber optic infrastructure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067812/
With regards to developing nations, the infrastructure simply isn't there to perform remote surgery. Many places don't even have X-Rays.
It could be a limit of my imagination but I couldn't see remote surgery playing a large part in surgery (>.1% share) in the next 15 years.
Good analysis and don't disagree Adu. However the world has moved forwards since that 2018 publication. 40ms latency is common these days, and will be available even in the most remote locations now that Starlink is deploying. Nano-X have a prototype xray device that they're planning to sell through a SaaS like model to developing nations.
Totally hear you on the surgical outcomes comment. I realise my line of challenge is very much an edge case.