“Robotic surgery... the future is here.” Dr Andrew Vovenberg My...

“Robotic surgery... the future is here.”

Dr Andrew Vovenberg

My friends,

Tiresias has seen the development of surgery from the first introduction of laparoscopic, or so-called keyhole surgery, to now, robotic surgery. On his last survey of robotic surgery, he was aware that over 20 major companies, medical industrial giants such as Medtronic and Johnson and Johnson, and new rising companies and many startups, are vying in this space. Thus far, robotic surgery has relied on and mainly justified by providing a better alternative to the traditional surgery and laparoscopic surgery which was not feasible with unacceptable morbidity and post-operative deficits. The best-known current application of so called “robotic surgery” today, is “robotic radical prostatectomy”. As Tiresias has previously indicated, these surgeries are not truly robotic, though they have certainly extended an improved surgical outcome for what was previously a very difficult and bloody operation with significant postoperative morbidity and significant postoperative unacceptable outcomes. With this application showing the feasibility of “robotic surgery”, the race has started, and it is now growing rapidly. There is now considerable competitive tension amongst the leaders and majors as well as the many smaller companies vying and jostling for a cut of the growing action, and the Mayo Clinic has just upped the ante.

Tiresias is certain that Mayo Clinic has not entered the joint venture with Optiscan because it wants to manufacture surgical robots with Optiscan’s CLE microscopic eye. The Mayo brothers were not only skilled surgeons, but they were also entrepreneurs, promoters, and businessmen. They will want the surgical equipment manufacturers, with whom they have very close ties already, to come to them. They will have already spoken to the preferred surgical equipment providers about their new venture. The Clinic will make sure that there will be competitive tension between the majors and the upstarts in the new field they have just staked out. You see, the current robotic surgery enables minimal or so-called keyhole surgery to be performed in inaccessible sites. It uses 3D imaging procedures to localise the lesion to be excised or biopsied. It does not enable direct visualisation of the actual tissue being thus excised or biopsied. It is just an extension of the surgeon's hands still operated though stabilised by the machinery involved. The “robotic arm” is still guided by hand with under medical imaging, andnot tissue or cellular level visualisation. Our Mayo partners will not have to mentionthe immediate possible obsolescence of the current and developing, veryexpensive, surgical “robots”. The most exciting and compelling potential application, and the field that so many are scrambling in, of our new venture with the Mayo Clinic, is cancer surgery on solid organs such as the breast, the brain, liver, in a different way the lung, but most compellingly and most urgently the breast. You see my friends, the cutting by the surgeon, whether under direct vision or with some magnification, the surgeon can only see at the gross tissue level and not at the cellular level. As a result, the surgery, whether it be by scalpel or any other instrument, no matter how fine and well controlled, the surgeon cannot tell whether he’s cutting normal tissue or cancer tissue and cannot tell if he is leaving cancer behind. Taking repeated frozen section biopsies, a Mayo innovation, has served for 120 years, and the problems and shortcomings are well known, and understood by Mayo Clinic, and Tiresias does not need to repeat them. Suffice it to say, therein lies the problem of all cancer surgery, malignant cells and malignant tissue is almost always left behind. This is the problem of current cancer surgery, and this is where Optiscan has combined with the Mayo Clinic to address and revolutionise. The eyes will be upon us!

So why does Tiresias think this is such a big deal. At the risk of repetition, as he is want to these days, Tiresias would like to expand on this just a little further. Tiresias sees how this combines the steadiness and accuracy of the robotic instruments with microscopic eye on the tissue being operated on with instantaneous real-life pathology on that tissue. The microscopic examination in real time and AI-identification of malignant cells enables the removal of malignant cells, cell by cell if necessary. But, of course, this is not all. To Tiresias, who looks forward, the Opiscan real time confocal laser endomicroscope makes autonomous microsurgery feasible, and in Tiresias’s opinion, inevitable, and for the first time, true robotic surgery, a reality. The surgeon will no longer have to have his eyes peeled on the spot and looking at it, cell by cell. The computer operating the arm will now have vision at microscopic level. The technology is all in place and it just must be put together. It is not surprising that Mayo Clinic has indicated that it will take equity in Optiscan as part of this collaboration. As indicated, Mayo Clinic will not be a manufacturer of CLE-guided (Optiscan Inside) Autonomous surgical robots. Of the 20 plus major robotic companies, once they see what is happening, will rush to do anything they can to be involved with this Mayor Clinic venture. Medtronic, Johnson and Johnson et al, cannot afford to sit on their hands and watch and wait and be left behind. Tiresias expects some competitive tension from and their focus onto Optiscan.

Until next week…….