Health-care providers leverage next-generation technologies to treat patients

 

 

 

There are few things that seem more of-the-future than robots, particularly when robots start doing things previously performed by humans.

The da Vinci Si HD surgical robotic system is a new addition to the Hospital of Saint Raphael’s robotics department, having arrived just in December.

More than 1,000 robotic surgeries have been performed at the hospital since the program started in 2005, when robotic systems were used primarily by urologists. But their usage proliferated into other surgical disciplines, and now are used by 14 doctors in urological, gynecological, colorectal and thoracic surgeries.

The new da Vinci robot replaces the previous model formerly used by the hospital. But before anyone gets the wrong idea, it’s not that kind of robot. It doesn’t walk or move independently, speak, or have a face. It only operates remotely by the direct control of the surgeon’s own hands.

“The biggest thing patients worry about when they hear ‘robotics surgery,’ is that it’s R2D2; that it’s in some way automated. That I’m off drinking coffee while a robot is performing my surgery,” explains urologist Thomas Martin, MD, who heads the hospital’s Robotic Surgery Program. “But once you explain that it’s purely surgeon-driven, and the robot can’t do anything to them without the surgeon telling it exactly what to do, they’re fine with it.”

The new da Vinci machine features four arms, three of which hold and operate the small, flexible surgical tools, while on the fourth arm is mounted a high definition three-dimensional camera.

The surgeon sits away from the machine, using the images from the da Vinci camera to see, and uses small hand controllers to operate the robot. As a safety measure, the machine shuts off if the surgeon’s eyes leave the screen for a second, and the controls even have a threshold for any degree of tremor in a doctor’s hand movement, smoothing them out for added precision.

Martin says operating this way is accurate, and incredibly helpful in cutting down fatigue for the doctor, who otherwise would be standing for any potentially long surgical procedures. It also puts more control directly into the hands of the surgeon as opposed to assistants.

“In most surgeries, there are not a lot of hands in the wound, but instruments that are lengthy and precise,” says Martin. “But absence of tactile sensation with this is well-compensated and more than fairly exchanged for the degree to which the visibility is enhanced. I’m a tall guy, so having a 3D camera image right in front me versus having my eyes three and a half feet from where my hands are is a big difference.”

The new da Vinci robot also has a simulator, which trains surgeons on the machine’s functionality, and offers surgical practice scenarios. A far cry from Martin’s initial training, in which he practiced sewing tubes and pieces of cloth together to get the hang of the robot’s motions.

But most importantly, the machine is valuable to patients. Martin says the accuracy of the machine and the small, flexible tools it operates allow for fewer incisions to be made in the patient, and therefore reduces overall pain and recovery time. The comparison between robotic and non-robotic surgery, Martin says, is not even a fair one.

In a typical prostatectomy, the operation used to take roughly four hours, and the patient would remain in the hospital for up to four days, and had a 25-percent chance of requiring a blood transfusion. The patient was typically restricted from heavy exertion for a month, with three months elapsing before feeling back to “normal.”

With robotic surgery, Martin says operating time is cut to three hours, the patient has only a one-percent chance of requiring a blood transfusion, and is sent home after one overnight at the hospital. Heavy exertion is typically limited for just a week, and he says most patients are back to normal functionality in a month.

“It’s really a profound difference,” he says.

Martin says similarly beneficial results can be seen for the many surgeries the da Vinci performs, including hysterectomies, thymus removal, kidney and fibroid operations, and colon and bowel procedures.

The use of robotics in surgery, he says, is applicable across many disciplines, but not so much yet with cardiac or brain surgery, due to the high risks involved. But as technology further advances, and tools become more flexible, robots in the operating room could become even more common.

“Fifteen years ago, if somebody had described to me when I was a resident doing the surgery that we do now robotically, I’d laugh,” Martin says. “It would be stupid to even think of. And here we are.”

 

 

Kurt Roberts, MD knows a thing or two about minimally invasive surgery.

In fact, he’s pioneered procedures at Yale-New Haven Hospital that have patients back on their feet in almost no time.

Roberts is the only surgeon in Connecticut to practice Natural Orifice Translumenal Endoscopic Surgery (NOTES) in women, or, abdominal surgeries such as gall bladder removal, appendectomies, and hernia operations conducted trans-vaginally, with no external incisions in the patient’s body.

Roberts, an assistant professor of gastrointestinal surgery at the Yale School of Medicine, says this is far more beneficial to the patient in terms of recovery; he says the only incision made is on the uppermost section of the vagina to access abdominal organs.

“There are no scars, less pain, and faster recovery. All the pain fibers are in the muscles, and when you go through them, that’s when it hurts,” Roberts says. “The recovery is faster because you have no pain to bother you, so you can go back to regular activity.

“One of my first patients had the surgery on a Friday, she was at home vacuuming for guests on Saturday, and went to a parade on Sunday with no issues. That wouldn’t have been possible with a regular operation.”

The procedure is still relatively rare in the U.S. — Roberts says there are between 300 and 400 NOTES procedures performed each year, and he’s done 88 of them — but is more common in Europe. He saw this first-hand since he grew up in Germany, and went to medical school in Austria. He went on to residencies in Baltimore and Seattle before coming to Yale in 2005.

He said his NOTES procedures are slowing gaining ground, with about 75 percent of patients offered the surgery accepting it.

But since he doesn’t want to be a “one-man show” in Connecticut, Roberts is teaching a CME course in May to train other surgeons on the procedure, and is a program chair at this year’s International NOTES Summit, organized by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), in July.

Roberts’ research in minimally invasive surgery, such as single-port access surgery, in which doctors can operate via a single incision by the patient’s navel, led to the founding of a medical device startup, Science Park-based NovaTract Surgical, in 2010.

The company is expecting to have its first product, an as-yet unnamed surgical retraction device, in use this year. Roberts explains that the device uses strings and a pulley system to move organs inside a surgical cavity, requiring fewer incisions and therefore less pain for the patient.

“Usually you make four incisions — one for a camera, one for cutting and other fine work, and two others for holding organs aside. You can say you won’t need those two anymore,” Roberts explains. “It works on an internal pulley system with strings that go through the first two ports, and we can pull and retract like a puppeteer with a marionette to move things around.”

NovaTract founder and CEO Eleanor Tandler says the device is currently going through final design stages, with early adopters using them in humans by the fall, and commercial availability by the end of the calendar year. The target, she says, is for gynecological and abdominal surgeries, including gall bladder, appendectomies, hysterectomies, bariatric surgery and colorectal surgery.

“There are still many multi-port surgeries in the U.S.,” she says. “We see this as a tool in helping patients have surgery with fewer incisions, and faster recovery, and less post-op pain.”

She says NovaTract sees big opportunities for distribution in Europe and Japan further down the line.

 

Meanwhile, Yale pediatric surgeon Christopher Breuer, MD is in the process of conducting Food & Drug Administration-approved clinical trials on children with congenital heart defects to build new vascular grafts using cells from the patient, eliminating the need for synthetic materials.

And more so, since the new tissues are made of living cells from the patient’s body, they have potential to grow.

“Children can outgrow a graft like they outgrow shoes,” Breuer says. “So putting in a graft that can grow is the distinct advantage for use in children.”

To get blood vessels 15 years ago, Breuer says, he would make a biopsy to extract cells, then use a culture to grow more, at which point they would be ceded to a biodegradable scaffold before being used in the body. But in searching for an alternative, he found that nearly enough cells can be gained from a single bone marrow harvest from the hip bone.

The cells can be harvested, attached to a scaffold and implanted in the patient in a single procedure.

The procedure is currently in the investigative stage and is being measured for safety. (The initial application to conduct the procedures is 3,000 pages long and took five years to complete. “The FDA sets a pretty high bar,” he says.)

His first operation, and the first in the U.S., was performed on a three-year-old child last August. There are two more operations slated for this year, and the new grafts will be monitored for growth activity.

Because of the experimental nature of the procedure, Breuer says he had to standardize the patients; in this case all are afflicted with single-ventrical cardiac anomalies, in which the child is born with one functioning heart ventrical. He says successful tissue growth has been observed in animal tests.

Breuer is also working on creating a disposable system that would allow surgeons to inject bone marrow directly into an apparatus that cedes blood cells to a biodegradable scaffold, avoiding the need for expensive laboratory facilities to do the same thing. He says that product is currently in pre-clinical testing on large animals.

He cites congenital heart disease is an example of an orphan disease, otherwise known simply as a rare disease, that which affects a small percentage of people (fewer than 200,000 people, according to the Rare Diseases Act of 2002). Breuer says the system currently in development qualifies as an orphan drug. The Orphan Drug Act of 1983 eases some restrictions, allowing an orphan drug to be produced faster. The act urges pharmaceutical companies to produce products for such rare diseases, since they ultimately will be less profitable.

“The end goal is to create a better vascular graft that is both safe and has growth potential,” Breuer says. “Most drug and device companies make products based on profitability, and as a result there are a number of problems that don’t get much attention. This makes it easier to bring something from the bench to the clinic.”

 NEW HAVEN — Six local startups have been selected to receive $25,000 each in funding from Connecticut Innovations Inc.’s (CII) TechStart Fund, while taking part in a 10-week accelerator pilot program.

Applivate, MeritBooster, Red Ox Technologies, Scaled Liquid Systems and Seldera, all of New Haven, and Hamden-based Snippet were among the nine entrepreneurial teams selected from a larger pool of 33 teams.

Applivate and MeritBooster (the latter of which was developed by a father-and-son team) were formed in November during Startup Weekend New Haven, where they took home first- and second-place honors, respectively.

Applivate created ShugaTrak, a mobile app for parents and diabetic teens that allows them to connect glucose meters to their smart phones, alerting parents that their children are checking — or not checking — their levels. MeritBooster is a website that allows students to post video pitches as a means of raising money for class trips and projects, as an alternative to selling gifts or candy.

The TechStart Fund was launched in January to spur innovation and business formation in the state. The nine teams selected — which also include Dealizio of Niantic, eBrevia of Stamford, and My Luck Club of New Canaan — will take part in a ten-week program starting March 5 that provides professional business resources, and will give the opportunity in mid-May to pitch to professional investors.

 EAST HARTFORD — Several local women were given top honors from the Connecticut Technology Council as part of its annual Women of Innovation awards program March 1.

The ten winners were pared down from 53 finalists across nine categories in the technology, science and engineering fields.

Two New Haven teachers received Academic Innovation and Leadership awards. Susan Brown is teacher of applied technology at Mauro Sheridan Magnet School, teaching science, technology and robotics to middle school students. The other winner, Joan Feigenbaum, is the Grace Murray Hopper Professor of Computer Science at Yale University. She conducts research on algorithms, Internet security and the interplay of economics and computation.

Elizabeth Garypie, chief Black Hawk engineer at Sikorsky Aircraft in Stratford, won an award for Large Business Innovation and Leadership. Garypie provides technical oversight for development of Black Hawk helicopter models.

 The U.S. Commerce Department’s Connecticut office and the Connecticut District Export Council planned to send a trade delegation to China from March 25 to 31 to promote Chinese investment in Connecticut.

The delegation was set to go to the wealthy provinces of Liaoning and Shandong. Connecticut companies, particularly those in alternative energy biotech, new-generation information technology, manufacturing, fuel-efficient cars, and green technology, were invited to provide information for a shot at Chinese investment.

 FAIRFIELD — The U.S. Court of Appeals ordered Mitsubishi Heavy Industries to pay $169 million to General Electric (GE) for violating a wind turbine patent.

The court’s ruling relates to a GE patent that helps wind turbines remain connected to the electricity grid, even when voltage drops to zero.

The lawsuit was filed in 2010 after GE lost a case in January of that year wherein the U.S. International Trade Commission ruled in Mitsubishi’s favor.

 SHELTON — Solar company Opel Technologies has announced its 36th patent for thyristor semiconductor devices that can determine the angle-of-arrival of an incident laser beam with high angular resolution (a “harlid”).

The core patent was issued in December, and additional development is expected.

The company is also dispelling various Internet rumors suggesting it fast-tracked an agreement for funds with NASA under the Small Business Innovation Research (SBIR) program without submitting required information in accordance with securities laws and regulations in the U.S. and Canada.

Opel says it is still in negotiations with NASA, and will make an official statement when any agreements are finalized.

 WALLINGFORD — Enterprise streaming video company VBrick Systems will have its video software and hardware products sold through Avaya, a global provider of business systems and software.

The VBrick products are being sold through the Avaya Select Product Program, and will provide Avaya customers with live meeting and event broadcast capabilities to corporations, educational institutions, health-care facilities and government entities.

 SOUTH GLASTONBURY — Streaming music platform Raditaz is getting a $150,000 boost from Connecticut Innovations Inc. (CII) to advance development and marketing.

Raditaz currently has a Web-based platform and an app available for smart phones. The service allows users to integrate with social networking sites and utilizes a map function to let listeners see which artists are trending in their area and throughout the country. That same information can be used to recommend music to users based on those nearby with similar taste.

The company also boasts having more music than the popular Pandora streaming service — 14 million songs, versus the latter’s 900,000.

As a startup, Raditaz appeared at the Innovation and Entrepreneurship Summit at the Omni Hotel last October.

Raditaz’s CII funding comes through the Pre-Seed Fund, which supports Connecticut-based startup companies.

 CHESHIRE — Pharmaceutical company Alexion is seeing progress in the development of its HPP medication.

Asfotase Alfa, a targeted enzyme replacement therapy, was shown to improve skeletal abnormalities, pulmonary and physical function, and cognitive development in a Phase 2 study in infants and young children with hypophosphatasia (HPP).

HPP patients face life-threatening enzyme deficiency, which can lead to damage to vital organs, destruction of bones, muscle weakness, seizures and respiratory failure.

ORANGE — Tangoe Inc. has launched a new telecom expense-management product: The Tangoe Real-Time Telecom Expense Management (Tangoe rTEM), a portfolio of capabilities designed to eliminate “bill shock” resulting from unexpected mobile device charges.

The proliferation of mobile devices and related applications continues to complicate mobile cost containment efforts of organizations around the world. Governments have been debating regulations mandating that service providers offer bill shock prevention to their customers. The implications of bill shock negatively affect all parties involved: individuals, businesses, and carriers.

 

According to its maker Tangoe rTEM can help users reduce costs by proactively monitoring, reporting and analyzing mobile data, voice, SMS, and roaming consumption across multiple device operating systems and carrier networks. In addition to real-time capabilities, Tangoe rTEM provides predictive analysis, visibility and control over mobility usage and associated costs. This helps individuals and businesses avoid excessive charges before they are incurred, the company says.

$6.5 million engineering facility to promote multidisciplinary collaboration

NEW HAVEN — The Yale School of Engineering & Applied Science has begun construction of a versatile innovation and design studio to encourage the invention and prototyping of new, socially beneficial technologies — from robotics and medical devices to renewable energy systems and other innovations not yet conceived.

The $6.5 million, 8,500-square-foot Center for Engineering Innovation and Design will promote collaborative technology development among students in a wide range of scientific disciplines. It is scheduled to open in September.

“The establishment of this center underscores Yale’s surging commitment to engineering and technical innovation,” said T. Kyle Vanderlick, dean of the School of Engineering & Applied Science (SEAS), which will host the center. “It will foster a culture of engineering at Yale, and by catalyzing collaboration and hands-on design experience, we will produce more ‘Y-shaped’ engineers — engineers whose intellectual depth and breadth allows them to innovate with purpose.”

Located on the ground floor of the Becton Center on Prospect Street, the new facility is the latest manifestation of Yale’s focus on engineering. The Cesar Pelli-designed Malone Engineering Center opened in 2005, and SEAS is in the process of hiring nearly a dozen additional faculty members, supported by last year’s additional $50 million gift from John Malone (Yale College ’63), chairman of Liberty Media.

SEAS mechanical engineering professor John Morrell, a former director of systems engineering for Segway, will direct the new design center. He also brings a background in medical-device development to his new role.

“The center will capitalize on Yale students’ intense desire to create something of purpose,” Morrell said. “While many projects can easily satisfy the criteria of being ‘engineered,’ the projects at the innovation and design center will be driven and supported by the real challenges that face society — energy, health, poverty and climate, to name a few.”

The courses and projects affiliated with the center will require the application of a broad array of engineering principles and will serve the interests of students and faculty in all of Yale’s engineering majors: biomedical, electrical, mechanical, chemical and environmental engineering. The center will be open to students in all majors for both academic and extracurricular projects.

“Innovation occurs when we get ideas from seemingly unconnected areas,” Morrell said.

Designed to make collaboration easy, the center will offer group work areas, meeting rooms, and fabrication facilities for metal, plastics, wood, biomedical materials and electronic devices.

 

“With the addition of the center,” Vanderlick said, “SEAS will deliver a unique engineering experience that prepares students for the daunting but inspiring challenges of technical leadership.”