New Device Takes Robotics in Smaller, Simpler Instructions

We’ve caught a glimpse of robotic surgery’s potential future, and it’s not much bigger than a bread box.

The miniaturized in vivo robotic assistant (MIRA), which weighs less than two pounds and is roughly the proportions of a human hand, can be inserted into a patient’s belly through a single 2.5–3 cm umbilical incision. The robot and a camera have a combined length of less than 24 inches.

According to Dmitry Oleynikov, MD, the co-founder and chief medical officer of Virtual Incision, a medical device company that develops miniaturized robotic support systems, it was initially believed that the current iteration of robotic surgery—the very large and pricey da Vinci system [Intuitive Surgical]—was probably not the best way to go about it. The technology featured in today’s watches and iPhones is comparable to the mainframe computers from the 1970s and 1980s as an analogy.

The MIRA has two compatible instruments and a robotically controlled articulating scope which fits into the robot’s center channel. It is made to triangulate the camera and instruments for clear visibility and to lessen the possibility of accidents during surgery. The surgeon can rotate the device once it has been inserted through the gel port to view all four quadrants.

The bedside assistant is capable of helping if the device needs to be improved or withdrawn, according to Dr. Oleynikov, who is also the head of surgery at Monmouth Medical Center and a clinical associate professor of surgery at the Robert Wood Johnson Medical School of Rutgers University in New Brunswick, New Jersey.

The miniaturized in vivo robot assistant (MIRA) comprises a surgeon console (above and below) and an adjustable scope with two miniature arms (bottom right).

Dr. Oleynikov predicts that, subject to FDA approval, the MIRA will be utilized for general surgical procedures such as colon resection, cholecystectomy, sleeve gastrectomy, and hernia repair. The instrument is still in the experimental stage and is not yet for commercialization in the United States.

Two years ago, under stringent study guidelines, Dr. Oleynikov and his associates used a slightly older version to complete two colon resections in Paraguay. “Both patients were successfully discharged from the hospital in just a couple of days with no problems or issues,” he claimed.

Due to its compact size, the MIRA does not need a specific area, infrastructure, or setup personnel, which could provide it an advantage over other robotic platforms already on the market. The system is made to be used at university medical centers, community hospitals, and ambulatory surgical centers—anywhere general surgery is performed.

It is hoped that the MIRA will greatly expand access to robotic surgery. Virtual Incision is targeted at the over 80% of the market that is underserved and requires a more compact and straightforward solution, according to Dr. Oleynikov.

He noted that reports of simplicity of use from robotic and laparoscopic surgeons had been encouraging. Laparoscopic colectomy has a learning curve of about 55 instances. Robotics has lowered the learning curve for a colectomy to 15 to 25. The learning curve is anticipated to be further reduced by the MIRA to five to ten cases.

Two effectors, a bipolar grasper, monopolar scissors, and a surgeon-controlled camera make up the existing system. After sterilization, the robot itself can be employed up to 15 more times, while the camera can be employed up to 50 times. After the system has run all of its cycles, it is intended to recycle it, according to Dr. Oleynikov.

Although the business has not yet set a price for the device because it is still in enhancement, the expense of surgery with the MIRA is projected to be roughly equal to a laparoscopic operation.

Virtual Incision is collaborating with the FDA to obtain approval for its very first investigational equipment exemption trial, which will include Michael A. Jobst, MD as one of the principal researchers. He has worked with Virtual Incision on the MIRA for several years and has utilized it in a dry lab, pig models, and a cadaver.

“I think it’s awesome,” commented Dr. Jobst of Surgical Associates, PC in Lincoln, Nebraska. He goes even further explaining that other surgeons complain that it lacks a vascular sealer and stapling capacity, however the da Vinci system lacked such features as well in 2010. At this point, the MIRA is a brilliant concept that is moving surgical robotics in a new direction. He believes it will be better in the end.

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