The Baxter robot hands off a cable to a human collaborator — an example of a co-robot in action. Photo credit: Aaron Bestick, UC Berkeley.

The key takeaway from Tuesday’s RobotLabNYC forum, on “Exploring The Autonomous Future,” was humans are the key to robot adoption. Dr. Howard Morgan of First Round Capital expressed to the audience of more than 100 innovators working within the automation ecosystem, the necessity of embracing “entrepreneurial marketing” to reach customers. Tom Ryden echoed Morgan’s sentiment in his presentation about Mass Robotics, conveying his startups’ frustrations with the pace of adoption. Dr. Eric Daimler, formerly of the Obama Administration, concluded the evening succinctly by exclaiming, “we only adopt what we trust.” Trust is key for crossing the chasm.

Intuitive Surgical this past year celebrated its 17 year of operations with close to a million robotic surgeries completed last year. According to a recent Gallup Poll, medical professionals are the most trusted individuals in our society, even more than one’s clergy. The fact that robot-assisted surgery has become so routine and accepted by doctors and their patients is proof positive that in some industries we have already crossed the trust threshold.

Photo credit: Robert Shields

Understanding how Intuitive’s Da Vinci robot built trust within the medical community could offer parallels to other areas of the automation industry. Robotic-assisted surgery or “telerobotics,” is the evolution of two modern technologies: 1) telepresence or telemanipulation; and 2) laparoscopic surgery. In 1987, French physician Dr. Philippe Mouret performed the first minimally invasive gallbladder surgery using an endoscope-like device to remotely guide his instruments via video to remove the damaged organ. By the 1990’s, laparoscopic surgery became commonplace, driving the demand for more precision through mechanics and computer-aided techniques. A decade later, Intuitive received FDA approval for its Da Vinci robot for general surgery, which has since been expanded for prostate, neurological, and thoracic procedures. Telerobotics evolved not just from the availability of advanced technologies, but from the demand for less invasive procedures by the most trusted people in America.

Last month, the FDA approved the Da Vinci Xi Systems, enabling Intuitive Surgical to market less expensive systems and gain marketshare with smaller medical institutions globally. “This new system enables access to Intuitive’s leading and proven robotic-assisted surgical technology at a lower price point. Customers around the globe have different needs from a clinical, cost and technology perspective; Intuitive’s goal is to meet those needs by providing a range of products and solutions: the da Vinci X System helps us continue to do so,” said CEO Dr. Gary Guthart.

According to the press release, Da Vinci X System is “a focused-quadrant surgery and features flexible port placement and 3D digital optics, while also including advanced instruments and accessories from its Xi system.” Another determining factor of Intuitive Surgical’s success is the interoperability of the instruments. Rather than just an endoscope that provides video feeds, Da Vinci is equipped with multiple end effectors that mimics traditional instruments guided by experienced surgeons telerobotically.

Patients trust the robot because it is simply augmenting their doctor’s skills with greater precision. This is reinforced by shorter recovery periods and better outcomes. Recently, Oxford published a research study which took place over a nine-year period that concluded patients who opted for robotic lobectomies had better lung cancer outcomes. As a new generation of surgeons embraces the robotic future, the market for abdominal surgical robots is expected to grow from $2.9 billion in 2017 to $12.9 billion by 2022.

Trusting robots with our bodies might seem like a difficult premise to uphold, but robots have been saving lives on the front lines since 1972. Bomb-defusing machines have been utilized in the most dangerous situations worldwide from Afghanistan to Jerusalem to New York City. Today, almost every police department and military have an arsenal of remote-controlled explosive removal devices.

Dr. Sethu Vijayakumar, director of the Edinburgh Centre for Robotics in the United Kingdom, explains, “One of the target areas, in terms of [the] use of robots, is for going into dangerous situations. Robots can go in, be operated from a safe distance, and, in a worst-case scenario, be sacrificed.”

Similar to robotic medicine, trust-based systems for the military are built by teleporting human expertise into dangerous situations. Pittsburgh-based RE2 Robotics took this concept to a new level with its Robotic Manipulation System announced last week. The RE2 System now enables users to actually use their limbs and hands to control the robot’s movements and grippers to quickly defuse explosives.

RE2 CEO explained the rationale for his new product, “Often times, you still need the human intellect to perform those tasks. But they’re dangerous, so the question is, how can we project that human capability remotely, so they’re still able to do their job and leverage the human intellect to solve a really big problem? That’s what we’re trying to do — keep the human safe, but allowing them to still do their job.”

While rover looks remarkably similar to Endeavor’s (formerly iRobot) Packbot that has been widely deployed by the US military in Iraq, Afghanistan and elsewhere, the control system is novel and more reliable in the high-pressure situations. Pedersen says, “If you’re going to project that human capability, the most human way to control it is to have it be as much like you as possible. That’s where we’ve come over the past decade, having true human-like capability. It’s no coincidence that these robots look like human torsos. These systems are a projection of you, remotely. It’s almost like an avatar, where you’re dealing with a threat out of harm’s way.”

While today the operator of RE2’s robot stands at a safe distance watching the video feed on a laptop, the company is developing a virtual reality headset accessory for the control system to enable the professional to completely immerse himself into the situation. Pedersen also plans to expand the use cases for his technology to civilian markets such as search & rescue, disaster recovery (like Fukushima) and medicine.

“Yes, people could use this technology for other means. But our charter is saving lives and extending it into new markets like health care, where we can do patient assist. [We can] help a person from a wheelchair to a bed or a wheelchair to a toilet, as the brawn for a caregiver,” touts Pedersen.

While we are years away from fully trusting autonomous systems with our lives, it appears from these two examples that the first step is enabling machines to augment our most trusted citizens. As yesterday was Father’s Day it is only appropriate I share with my readers my gift – GrillBot. The disclaimer on the box, however, does make me question when I plan to use it; fear of death is kind of a big deal!

Transcript below

In this episode, Audrow Nash interviews several companies from the International Conferences on Robotics and Automation (ICRA) showcase. The companies span the following applications: mobile robots for military and commercial uses, warehouse solutions, robotic arms and manipulators, and robotic systems to assist surgery.

Companies are listed in the order of their interview with a picture of their booth at ICRA 2015. All photos were taken by Robohub and can be found here.

American Robot Company (AMBOT) specializes in advanced electronics, unmanned systems, autonomous vehicle solutions and intelligent platforms for research, commercial and military robotic applications.

Fetch Robotics provides warehouse solutions.

Intuitive Surgical designs and builds the da Vinci Surgical System for robotically assisted minimally invasive surgery.

Kinova designs and manufactures robotics platforms and components that are simple and safe under two business units: Assistive Robotics for  people with disabilities and Service Robotics for humans and robots working in the same environments.

Applied Dexterity seeks to advance the field of robotically assisted surgery by creating a research surgical robot that can serve as a standard platform allowing researchers to share their software and improvements.

Interviewees

Jens Hurley is a Senior Roboticist at the American Robot Company.

Michael Ferguson is a Co-Founder and the Chief Technical Officer (CTO) of Fetch Robotics. Previously, Ferguson was the founder and CTO of Vanadium lab, developing low-cost education and hobby robot controllers, and a Software Engineer at Willow Garage.

Simon DiMaio is a Senior Manager of Research and Advanced Systems Development at Intuitive Surgical. Previously, DiMaio was an Instructor of Radiology and Postdoctoral Research Fellow at Harvard Medical School.

François Boucher is the Vice President of Business Development at Kinova Inc. in Boisbriand, Canada. He received his MBA and a Bachelor degree in Physics Engineering from Laval University. After his graduation, he worked as the General Manager of a technology transfer and investment company before joining Kinova in its early days to develop the service robotics market. In 2014 and 2015, Kinova was listed as one of the 50 most influential public & private companies in the global robotics industry by the Robotics Business Review and one of the fastest-growing company by Profit 500 in Canada.

Andrew Lewis is a Roboticist at Applied Dexterity. Previously, Lewis was a mechanical engineering graduate student in the BioRobotics lab at the University of Washington. His work in the BioRobotics Lab focused on the development of surgical robots, dynamically evaluated gravity compensation, and electromyography controlled iRobot Roombas. Lewis earned his BS in Robotics Engineering from Worcester Polytechnic Institute in 2011. His interests include mechanical design, systems development, and ethics in robotics engineering.

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Transcript

Audrow Nash: Hi, can you introduce yourself.

Jens Hurley: My name is Jens Hurley. I’m a senior roboticist at AMBOT.

Audrow Nash: Can you tell me what you have set up at this booth?

Jens Hurley: Our booth is based on research mobility platforms. We’re doing a lot of ground robotics with a lot of autonomous function built into them.

Audrow Nash:This one right here, can you describe it a bit and then talk about its applications?

Jens Hurley: Absolutely, this guy is a ruggedized outdoor, high-speed, mobility platform. It weighs about 525 pounds. It can carry about 550 pounds, so it’s got a one-to-one payload ratio. It’s got four-wheel, steer independent suspension and four-wheel drive so it’s highly manipulative which makes it great for research applications. It also served in the military for a light and load application and medical evac. It has high-powered lithium ion batteries and a 8-10 hour runtime over difficult terrain.

Audrow Nash: How large is it and how tall?

Jens Hurley: Overall, I believe it’s about 52 inches long, about 42 inches wide and its ground clearance is about eight inches. The whole vehicle itself is about 19 inches from the ground.

Audrow Nash: It’s a large remote operated vehicle?

Jens Hurley: It can be. This particular one is set up for remote, a man in the loop. We also offer systems with autonomous functionality, like soldier following or vision based systems.

Audrow Nash: I see, and so it has these large carbon fibre capsules on its side. What do those do?

Jens Hurley: Those are actually our battery packs. They are quickly removable.

Audrow Nash: Why electric?

Jens Hurley: Silent operation, clean, quiet, overall a very nice function to have. A lot of applications in military require silent functionality.

Audrow Nash: What’s the max distance it could travel? Do you have an idea?

Jens Hurley: No, I couldn’t tell you the max distance. Runtime dependent about seven miles per hour for 10 hours, moving continuously.

Audrow Nash: 70 miles, okay. This vehicle looks like it has a very heavy suspension system.

Jens Hurley: It does.

Audrow Nash: Can you talk a bit about that?

Jens Hurley: Absolutely, it was developed to carry a high payload, heavy weight, under almost any conditions, so it’s got six inches of independent suspension at each corner which makes it contact with the ground. It’s very rugged, very durable.

Audrow Nash: How fast does it go?

Jens Hurley: This particular model has a top speed of about 40 miles per hour.

Audrow Nash: At those speeds why is good suspension valuable?

Jens Hurley: It’s key. If the payload’s too high – high centre of gravity – it’s just not a good thing to have at high speeds. The active suspension keeps the payload low, very stable, it’s physics.

Audrow Nash: Yes. Are there governments interested in this or are there other applications?

Jens Hurley: This particular robot here was developed for a military function, basically, to lighten the load of a soldier. The European space agency is using it for teleop, and universities such like John Hopkins and the Applied Physics Laboratory, are using it.

Audrow Nash: What do you mean by teleop?

Jens Hurley: It’s basically a man in the loop. So they’ll be operating from miles away to perform some sort of action.

Audrow Nash: Okay, so teleop and research applications. What about agriculture?

Jens Hurley: It’s something we’re looking into. There’s been a lot of interest here in agricultural purposes.

Audrow Nash: I see. What’s the purpose of the buttons?

Jens Hurley: It’s pretty standard that every robot comes with an emergency shut off: the red buttons. The rest of these are there for easy setup and control when you get it out of the package. A lot of the customers, when they get it up and going, move the onboard control system because they’re going to be controlling it from a distance.

Audrow Nash: I don’t really see how you put a payload on it, so describe it a little bit more. The wheels are a little bit taller than the body and the battery packs are a little higher than the body. Do you mount some sort of platform on it and then use the payload that way?

Jens Hurley: It depends on the application. A lot of payloads are being used just with manipulative arms and torsos and they do fit on the current payload space. If it’s something larger, like a palette size, we do offer mounting. There are hard mounting points located at each corner of the vehicle where we mount racks to elevate it up and off.

Audrow Nash: What about repair in the field?

Jens Hurley: Depending on what exactly has just broken down, it’s a very simple platform. Everything is open architecture, so it’s easy to get into, easy to repair. It’s a very straightforward, simple machine.

Audrow Nash: Are there standards in creating this? Do you use, for instance, one single size screw for accessing almost everything, or is there one tool to take apart most of it? Is there any modularity built in, so that you can quickly replace components?

Jens Hurley: Definitely. Most of the stuff is done in two metric sizes, M6 and M5, so it’s pretty much built together with the same hardware.

Audrow Nash: Thank you.

Jens Hurley: No problem.

Audrow Nash: Hi, can you introduce yourself.

Michael Ferguson: Yes, I’m Michael Ferguson. I’m the chief technology officer at Fetch Robotics.

Audrow Nash: Can you tell me about what you have set up at your booth?

Michael Ferguson: This week we are showing our new robot platform, Fetch. We’re letting people get up close and see the robot in person. Most people here at this show are particularly interested in the research edition of Fetch.

Audrow Nash: Can you tell me a bit about the robot and describe it.

Michael Ferguson: Sure. So, Fetch is a mobile manipulation platform, it has a mobile base that can drive around with a scanning laser in it to give it a view of the world and keep it localized. It has a torso that can rise up and down and attached to that we have a seven degrees of freedom arm. The gripper is a modularity point. Currently, we have a simple two-finger pincher on here.

Audrow Nash: What do you mean by modularity point, can you swap it?

Michael Ferguson: You can swap it, yeah. We have a standard specification on this, an ISO standard.

Audrow Nash: International Standards Organization?

Michael Ferguson: Yes. There are a number of vendors here at the show with really cool grippers that have, you know, sensors and all sorts of other stuff in them. And many of those will fit on our robot.

And then, lastly, the robot has a pan and tilt head, so that you can look in different directions, that’s carrying an RGB-D sensor. Colour and depth data are in 3D so you can see the whole world around you.

Audrow Nash: It’s a Microsoft Kinect or very similar?

Michael Ferguson: It’s a prime sense sensor, yeah, similar.

Audrow Nash: The robot has a wider base and that’s how it moves around. Then it has the centre part, that has the robotic arm and then above that is the vision, the depth sensor. What’s at the very base?

Michael Ferguson: It’s a scanning laser range finder.

Audrow Nash: Laser range finder? Is it only on a plane?

Michael Ferguson: It is on a plane, yeah. That’s actually manufactured by SIC.

Audrow Nash: Why seven degrees of freedom?

Michael Ferguson: Seven degrees of freedom give you really good dextrous manipulation. If you’re just picking things up off a table top, you probably don’t need a really dextrous arm, but if you want to reach into things, if you’ve got a complex cluttered environment, you really need the extra degrees of freedom there.

Audrow Nash: I see, and so it only has one arm and the arm is at the centre of the robot. Why this configuration? Is this so you can reach things?

Michael Ferguson: Yeah, there are two aspects to it. One is that two arms would make this robot significantly larger, heavier and bulkier. You want to navigate around human environments. We have skinny doors and things like that. The other is that very few applications really require two arms and, in many cases, if you did need a second arm, you just have a second robot come up and help and they can coordinate with each other. As far as the centre, really that’s for stability. There’s a very nice little tuck configuration for the arm that makes the platform extremely stable as the robot’s driving around – so that you can move quickly in the environment and not have to worry about your robot falling over.

Audrow Nash: So will this, primarily, be used for warehouse solutions to pick up products and put them into boxes to be shipped off somewhere? Is that what this has been designed for?

Michael Ferguson: We’re really designing to go into the logistics space, warehouse automation, pick and pack for items. There are videos on our website where you can see the robots doing those sorts of tasks.

Audrow Nash: If I’m not mistaken, the whole robot can rise up. Its spine kind of grows longer and that allows it to reach higher?

Michael Ferguson: Yes.

Audrow Nash: Okay, and how tall can it be?

Michael Ferguson: It gets up to about 1.7 meters or so. The exact specs are on our website. When you extend the arm all the way up you can still have some dextrous manipulability at about six foot.

Audrow Nash: You also mentioned that this could be a research platform. Can you tell me a bit about that?

Michael Ferguson: Yeah, we need a stable robot platform built on a operating system or ROS. We’re now making available our research edition, which has the robot hardware plus the open source side of navigation and some manipulation software, so that university labs can get a real jump-start. They don’t have to build robots by bringing pieces together. They have something that’s designed for mobile manipulation from the get go.

Audrow Nash: Thank you.

Michael Ferguson: Well you’re welcome.

Audrow Nash: Hi, can you introduce yourself.

Simon DiMaio: Sure, my name is Simon DiMaio. I work in our R&D group at Intuitive Surgical.

Audrow Nash: Now, can you tell me a bit about what you have set up at this booth?

Simon DiMaio: Sure, so this is called the Da Vinci Surgical system. It’s a system for minimally invasive surgery, for assisting surgeons to perform in a minimally invasive way. It does that by allowing the surgeons to control instruments inside the patient’s body from what we call a surgeon console. They can get very dextrous manipulation of surgical instruments while minimizing the invasiveness of the procedure for the patients. They fit these instruments through very small incisions in the patient’s abdomen, but still allow the surgeon to have control and dexterity.

To see the field in 3D, we have a stereo endoscope that allows the surgeon to see the inside, with very high quality HD images to control surgical instruments, like graspers and forceps and cutting instruments and electric quarter instruments, in a very natural way, almost as if they were inside the patient.

Audrow Nash: Now can you describe the Da Vinci a little bit.

Simon DiMaio: Absolutely, so there are really two main components in the Da Vinci. There’s the part that’s at the patient and this is where there are robotic manipulators for instruments that are inserted inside the patient. And that is a cart. It’s a mobile cart that carries four robotic arms. Usually, one of those arms carries the camera and the surgeon can control the pointing direction and the view that the camera sees. Then there are three additional arms that are usually used to manipulate instruments. Those can be for cutting, grasping, suturing and things like that.

Then, the other main piece is where the surgeon sits. They sit in an ergonomic console. You can think of it as kind of like a surgeon’s cockpit where they see the images from inside the patient. They see information from the system and they can interact and control by moving some really fancy joysticks, to control the movement of the instruments. They can interact with tissue from the other side of the room. Usually, the console is in the same room, connected to the rest of the system through a cable, but the surgeon controls the system from it.

Audrow Nash: The patient and cart, it kind of looks like a large hang man.

Simon DiMaio: Yeah.

Audrow Nash: It’s high, high above with the arms coming down.

Simon DiMaio: Correct.

Audrow Nash: It has four arms and each has a large tube that is inserted into the patient and that’s where the manipulators are and the camera.

Simon DiMaio: That’s right and that tube is called a trocar or a cannula and that’s the point of entry into the patient’s body. In order to create space for the surgeon to work in, the abdomen, or whichever cavity within the anatomy the surgeon is working on, would be inflated using carbon dioxide gas to create kind of a bubble. Those tubes that you referred to, the trocars or cannulas, have a seal on them, so that the carbon dioxide is trapped inside and maintained and so the instruments pass in and out of the body through that cannula, or trocar, through a seal.

Audrow Nash: I see, and so if they want different attachments, do they remove the inserted part from the arm and then swap in a new one?

Simon DiMaio: That’s correct. Yeah. They’re surgical articulated instruments that have wrists on them to mimic what the surgeon would want to do inside the body. Then there are a variety of end effectors or jaws that the instruments have. Some of them are for grasping tissue, like bowel, liver or kidney. Some of them are for cutting. Some of them are for suturing, so for handling needles. Those instruments are interchangeable on the system so they can be removed and replaced with different instruments depending on the task.

So, if the beginning of the procedure is a dissection, where you’re trying to expose tissues of interest, then you’ve got to remove some tissue and suture things back together. In each of those stages you would potentially use a different combination of instruments. So the system allows you to swap instruments during the procedure very quickly.

Audrow Nash: Is that the purpose of the fourth arm?

Simon DiMaio: The fourth arm could be managing retraction, for example, so it could be holding some tissue out of the way. You might be working underneath a liver or you might be working in an area where there is bowel and you might need to hold the bowel out of the way. It could be what’s called a suction irrigation instrument, that flushes the field with saline and then vacuums it out to manage blood and to keep the field dry and visibility good.
There are a variety of different things that you could use the fourth arm for. It could be used to manipulate an ultrasound probe. If the surgeon is looking at ultrasound images of the tissue and trying to see beyond visible surfaces in the endoscopic image, they might insert an ultrasound probe and manipulate that with the fourth arm. So it’s kind of an auxiliary arm that’s used for many different things.

Audrow Nash: I see.

Simon DiMaio: It can also be controlled from a second console so you can connect two consoles to the robot and have two surgeons.

Audrow Nash: When is that useful? Why?

Simon DiMaio: Training in one instance, if you have a proctor that’s training a mentor, a mentor that’s training a mentee, the proctor might be on one console and the trainee might be on the other. They can virtually swap instruments back and forth. So, a mentor might demonstrate a technique and then give control of the instruments to the trainee who can replicate those motions.

Another instance is if you have two experienced surgeons and they’re collaborating on a complex case, so that you can have all of the arms operating at the same time.

Audrow Nash: I see. How do you manage collisions between the arms? Does that happen?

Simon DiMaio: It does happen, the arm is working in very close proximity. Part of the design was to make the arms as skinny as possible so that they can work closer together. They’re pretty robust, so they can collide and they shouldn’t break.

Audrow Nash: Do they collide during surgery?

Simon DiMaio: They can collide during surgery and usually that happens when the surgeon’s trying to get the instruments very close together through a very narrow entryway. Some of the forces that occur during collisions are fed back into the console, so surgeons can feel some of them on the outside of the robot.

Audrow Nash: So there is some haptics.

Simon DiMaio: So there is some haptics. They don’t feel the very delicate interactions with tissue, but they can feel external collisions between the arms or perhaps with some rigid object. They get some feedback and they stop and investigate. There’s usually an assistant or nursing staff at the patient’s side that can warn them. But it happens quite often, and instruments work very closely together, it’s almost like if we were to stand side by side and our elbows were to knock against each other. It’s not a big deal, you keep going and that’s the nature of working in a confined space.

Audrow Nash: Now, can you tell me about the demo that you have set up at the booth?

Simon DiMaio: So we have a full Da Vinci system here and people are able to test-drive it. We’ve got a mannequin that has a simple plastic environment people can interact with. We’ve got some elastic bands so that they can get a sense of the intuitiveness of the motion of the arms. We also have a virtual reality-based simulator that’s used for training, basically a skills simulator that surgeons can use to learn how to tie knots and suture. They learn how to control the camera and the various instruments, and so are able to repeat the same skills and drills over and over again to develop muscle memory and familiarity with the system in a way that doesn’t require them to operate on patients or animals.

It’s a convenient way for people to use virtual reality models to hone their skills or to warm up before a procedure. So there are some surgeons that use the simulator like an athlete would do before a game. They might warm up and they might do some practice.

Audrow Nash: Interesting. Is there a certification procedure for doctors that are using the Da Vinci system in operations?

Simon DiMaio: There is a training path. I’m less familiar with that side of things but there is some training. I don’t believe that Intuitive directly certifies surgeons for using the system at their hospitals. That’s the responsibility of the hospital. But we provide some training, but we don’t train them on how to perform surgery, that’s something that they learn in med school, but we teach them how to use the tool and then hospitals decide how to certify.

Audrow Nash: What kind of feedback have you received from surgeons on the Da Vinci?

Simon DiMaio: Well, a variety of feedback. Obviously, there’s lots of interest in what they can do with it and what they can offer their patients. It’s a way of allowing surgeons to offer their patients an option for minimally invasive procedure where sometimes that’s not available. We get feedback related to the kinds of procedures that they can perform and the value of those procedures.

We also get feedback on the ergonomics of the system. For them, it’s being able to sit at a console in a fairly comfortable posture versus sometimes working in fairly awkward poses and configurations at the operating room table.
Obviously, there are lots of features that surgeons would like and so we get feedback on things that they’d like to see. It’s a work in progress, so we’re always interested in feedback; things that work well, things that they would like improved.

Audrow Nash: Thank you.

Simon DiMaio: You’re welcome.

Audrow Nash: Hi can you introduce yourself.

François Boucher: François Boucher, VP Business Development for Kinova Robotics.

Audrow Nash: Can you tell me what we have at the booth here?

François Boucher: Lighter, smooth, compact, efficient sets of service robotic arms. We have two different models, JACO and MICO with different ranges and size and weight.

Audrow Nash: First, what do you mean by service robotic arm?

François Boucher: Basically, it’s the opposite of industrial robotics. We’re not extremely fast and extremely precise, but we’re good at working around humans, in collaboration with them or with a human in the loop.

Audrow Nash: That means that they’re compliant to being touched, so if they bash into a human when it’s moving, it won’t hurt the human?

François Boucher: Yeah, exactly, but the arms are on top of all the features that we added: software and sensors. The arm itself weighs only five kilograms, including gripper control, so it won’t hurt anyone at that speed and that weight.

Audrow Nash: Very light, very cool. So how do you make them compliant? Is there a spring in them, like with Baxter?

François Boucher: No, it’s sensors in every actuator.

Audrow Nash: It generates a small electrical signal when you have force on the arm and it’s in the opposite direction?

François Boucher: Exactly.

Audrow Nash: How come you have a different approach? What’s the advantage to doing that over having like a spring in series with the actuator or pillow action?

François Boucher: Well, the fork gives us a safety feature but it also gives us a whole new range of applications, since the arm can now be speech controlled and not only just position controlled. With this whole new field of service robotics, that’s the kind of control that will be needed.

Audrow Nash: You mentioned two robots. What are they? Can you introduce me?

François Boucher: Yeah, it’s JACO and MICO. We started a company for assistive robotics, to mount robots on a wheelchair so that people can eat, drink, open doors, all by themselves. JACO was our first product five years ago.

Audrow Nash: How did you get its name?

François Boucher: It’s the name of the uncle of the founder of the company. He, himself, had muscular dystrophy. So, basically, you’re in a power wheelchair and you have limited motion in your arms. He was an inventor and he developed and built some sort of mechanical arm, with a cable from bicycle brakes and a motor from a windshield washer. It was our inspiration to start the company. His nickname was Jaco, so that’s why the robot’s named after him.

Audrow Nash: I see, and how did MICO get his name?

François Boucher: That’s an easy one. It’s a contraction of Mini and JACO so it turns out to be MICO.

Audrow Nash: Very cool. Can you tell me a bit about the grip and endefactors on these robotic arms?

François Boucher: Yeah, so for the assistive robotics purpose, we had to figure out how we could grip hundreds of different objects of different size and weight. We had to find a really versatile solution. We went with an under actuated gripper.

Audrow Nash: Tell me a bit about how it’s under actuated.

François Boucher: Basically, there’s one actuator per finger and, if you imagine, two tendons links with a spring.

Audrow Nash: I see. Okay.

François Boucher: So the great advantage with this gripper is that they are mechanically intelligent. We don’t have to worry much about which force we’re going to apply, how we’re going to grasp the object, since the flexible gripper adapts to its shape. So, with the precise force needed, we can grab an egg like we can grab a bottle of water.

Audrow Nash: You can grab an egg?

François Boucher: Yeah, exactly.

Audrow Nash: Surprising, that’s great. So, to grab an egg, do you have to tell it that it’s a soft object?

François Boucher: No, it’s really just a great mix of mechanical design and force imitation based on current. Sometimes people try to overdo things. We keep it simple and it works pretty well.

Audrow Nash: That’s interesting. Can you talk a bit more about that or is that IP?

François Boucher: It’s more experience than IP, I would say.

Audrow Nash: That’s kind of mind blowing for me. All right. So some of these don’t have any hands, robotic arms or graspers. What are you demonstrating there?

François Boucher: A lot of our arms are used in maintenance logistics, inspections or replacing a tool, a sensor or a camera. So the arm’s not only used for manipulation, but it can also be combined with a mobile mount platform to perform inspection and probing.

Audrow Nash: I see. Thank you.

Audrow Nash: Hi, could you introduce yourself.

Andrew Lewis: Sure, my name is Andrew Lewis and I’m a roboticist with Applied Dexterity and I’m here representing the Raven II and the Surgical Cockpit.

Audrow Nash: Tell me about the Raven II.

Andrew Lewis: The Raven II is an open source surgical robotics research platform. It was developed here at the University of Washington and then spun out into our start-up company, Applied Dexterity. We’ve helped to ship it around the world. Now there are about 18 or 19 labs around the world using Raven, or something similar.

Audrow Nash: Now, what stands out to me is open source surgical. Can you explain that a bit?

Andrew Lewis: Sure. So all the software is open source. It’s up on GitHub if you want to fork it and play around with it; throw it in your own version of Raven, if you’re that brave. The tooler face is also open source. We have a team, one of the original Raven teams that developed a Da Vinci adapter, and now we can use clinical Da Vinci tools on our robot and have access to their 150 plus tools without having to make them all ourselves.

Audrow Nash: Is most of the value you get from open sourcing this technology in low level parts of the software?

Andrew Lewis: Right. We’ve done all the low level parts and we’ve opened it all up so that researchers can look at anything they want. If they want to implement their own impedance control, or some other control techniques, they’re welcome to dive deep into the PID loops and what have you. You can just use some automation software, with some python scripts in ROS and, since all the source code is available to you, if something’s not working quite right you can change it yourself, or you shoot me an email and I’ll tell you how to change it, or change it for you.

Then, with the common platform, all of the schools or labs that have this robot can really lean on each other for advice on how to approach a problem.
If they’re having technical difficulties, they can check the forums and see that “oh yeah Harvard dealt with it a few years ago and they just unplugged this other thing.”

Audrow Nash: Is it largely research communities that are benefitting from this being open source?
Andrew Lewis: Yeah, so far we’ve distributed just to research labs to help us get in touch with hospitals about using this for research or training. But that would probably be a tighter, ready to roll, don’t-need-to-play-with-the-code version.

Audrow Nash: When we spoke about this a little bit ago, you mentioned that it’s not FDA approved.

Andrew Lewis: Right.

Audrow Nash: Can you talk a bit about what that means in term of its application for surgical, is it just a robot that is used in surgery first of all?

Andrew Lewis: The original version, the Raven I was used for Cholecystectomy, about a decade ago I guess.

Audrow Nash: I don’t know what that is.

Andrew Lewis: It’s gall bladder removal in a pig, and it was successful and I think that’s been the only real life surgery that’s been done with the robot. Harvard has started doing some work with it on time delay and tele-operation.
Since it’s not FDA approved, it means that, when a lab is looking to do some research with the platform that’s ready to go, they’re not paying for that FDA approval. The Da Vinci or another clinical systems is going run into millions of dollars because they’ve had to put time and a lot of effort into getting it approved.

Audrow Nash: That’s the advantage of it, the cost is kept down because it’s not FDA approved.

Andrew Lewis: Right.

Audrow Nash: I see. What’s kind of the goal do you have, where is the company heading?

Andrew Lewis: Our slogan is: “pushing the boundaries of surgical robotics.” The idea is to be able to make this platform available to research labs that are really pushing the boundaries and to support them wherever we can. Then we can make a lot of great connections in all these great labs.

And maybe try to license back some of the technologies that are coming out of the research community. And certainly learn a lot by just being around everyone, so we keep developing either surgical or tele-operated or autonomous systems, and gain huge advantages by being familiar with all these research topics.

Audrow Nash: Thank you.

Andrew Lewis: Sure.

Intuitive Surgical offers funding for technology research grants for projects in 2016. Researchers at non-profit institutions world wide can apply. LOIs can be submitted until June 5.

Overview: The purpose of these grants is to support technology research in the field of surgical robotics, or related fields. Successful proposals will address clinically-relevant technology development. Grants will be awarded to researchers at non-profit academic institutions worldwide. Awards will be conferred on a competitive basis by submission of a grant application.

Available Grants: Applicants may apply for $10,000 to $50,000 of funding per project (US Dollars, total costs). The grant monies can be used to fund salaries, equipment, supplies and/or travel required to support the proposed research project for a period of up to one year.

Selection Process:  Applicants must first submit a Letter of Intent to propose (LOI), as detailed below. Grant LOIs will be reviewed and ranked by an internal selection committee. Those pre-proposals meeting a predetermined scoring threshold will be invited to submit a full grant application (not exceeding 10 pages, excluding bibliography and references). All invited full grant applications will be reviewed and scored based on the following criteria:

* Clarity of research goals and objectives.
* Novelty and innovation.
* Clinical relevance and value.
* Evidence of feasibility.
* Strength of evaluation methods and measures.
* Availability of required resources.

Letters of intent and full grant proposals will be handled in a confidential manner and will not be distributed beyond the grant selection committee at Intuitive Surgical. Due to the expected volume of proposals, we regret that the committee will not be able to provide detailed individualized feedback for unsuccessful proposals.

Letter of Intent Guidelines: A two-page letter of intent to propose should be submitted by all grant applicants. Submissions will consist of 5 parts:

* Summary: one or two sentence proposal overview.
* Description of Problem/Background.
* Purpose, Hypothesis and Methods of research (not more than 500 words) for the project.
* Capabilities: Indicate the identities, capabilities and credentials of investigators as well as any participating institution. Include contact information for applicant principle investigator.
* Budget: Include a rough project budget that includes estimated costs for staff, equipment, consumables, and other direct costs. Applicants can request up to $50,000 in total costs, with no more than 20% of this total constituting indirect costs.

Click here to submit a letter of intent on-line for the Technology Research Grant.

Deadlines:

* We are asking interested applicants to submit a Letter of Intent by June 5, 2015. Invitations to submit full grant applications will be sent by July 2, 2015 (this invite will include proposal guidelines and forms).
* The deadline for submitting a full, invited grant application is September 11, 2015. Only complete application packets will be considered. Awardees will be notified by October 16, 2015. Grant monies must be used to support research expenses during the 2016 calendar year.

Grant Conditions:

* Intuitive strongly encourages institutions who have not previously received funding from the company to apply.
* Multiple grants will not be funded simultaneously to any Principal Investigator.
* Multiple grants to the same institution for different principal investigators will be considered.
* Awards must be used to fund research at academic institutions. Grants are not to be used to fund for-profit activities.
* Grant monies must be used to support research expenses during the 2016 calendar year only.
* Total costs may include no more than 20% indirect costs and the total budget, including both direct costs, indirect costs and any applicable taxes, should not exceed $50,000 USD.
* In the case of technology development, IP terms and conditions may require a negotiated agreement.
* Grantees will be invited to present their work at our headquarters in Sunnyvale, CA (travel costs covered by Intuitive Surgical).
* All applicants selected to receive a grant are required to submit a one-page mid-year progress report, as well as a final status report that details study results and conclusions. If the funded project does not take place, all monies awarded will be refunded to Intuitive Surgical. If the project is terminated early then a partial refund, with an accounting of the funds expended up to the termination date, will be provided by the Principal Investigator. Any unused funds as of 31 December 2016 will be refunded to Intuitive Surgical.

To submit a letter of intent, use our on-line application process 
Click here to submit a letter of intent on-line for the Technology Research Grant.

Please email grants@intusurg.com, with questions regarding the grant process. If you do not have email access, please send a hardcopy of your letter of intent to:

Dale Bergman
Research Coordinator
Intuitive Surgical, Inc.
1266 Kifer Road
Sunnyvale, CA,
U.S.A.  94086

– See more at: http://intuitivesurgical.com/company/educational-grants/technology_grants.html#sthash.CjqcBHOH.dpuf

Proof of the success of their efforts came the other day when they won a $430 million contract from the U.S. Department of Defense. It’s a five-year deal to supply da Vinci robots, tools and spares to Army, Navy, Air Force and Marine Corps hospitals.

The DoD contract comes shortly after the company successfully received FDA approval for two of its new surgical systems last year – the da Vinci Xi, a gantry-style upgrade to their basic system that includes a higher definition vision system, better consoles and controls (and in some cases two sets of controls and consoles) and a general upgrade of everything else, and the new da Vinci SP (single port) system. The SP system squeezes a 3D high-def camera and three fully articulating instruments through its 25 mm cannula (single thin tube containing the arms and end-of-arm tools; the tube goes through a single hole in the body).

Intuitive’s 2014 revenue was $2.1 billion and the number of procedures performed using da vinci products grew 9% year over year to almost 600,000. Quoting from Intuitive’s Annual Report about 2015:

“In 2015, our focus will be on accomplishing the following objectives: First, we will focus on the expanded use of da Vinci in general surgery, particularly colorectal surgery and hernia repair. Second, we will work to complete our launch and new product introductions of the da Vinci Xi Surgical System in key markets globally. Third, we will continue to develop our organizational capabilities and markets in Europe and Asia. Finally, we plan to build da Vinci SP prototypes that are compatible with our da Vinci Xi system and initiate customer evaluations.”

 

In spite of this success, or perhaps because of it, Google and Johnson & Johnson announced a collaboration to produce a competing line of products to use robots to assist surgeons. The announcement of this strategic pooling of resources didn’t include a price tag or investment amount.

According to the San Jose Mercury News, “Google stressed that the life sciences team at Google X will only be providing software and sensors for the proposed systems, with J&J’s Ethicon unithandling the rest of work. The Mountain View company’s robotics arm – Google acquired robotics firm Boston Dynamics in late 2013 – will not be involved.”

“We think we can use some of our machine vision and image analysis software to help surgeons see better as they operate (e.g. to highlight blood vessels) or make it easier for them to see information that’s relevant to the surgery at just the right time,” a Google spokeswoman said.

An Intuitive Surgical spokeswoman said that the effort by Google and Ethicon was a validation of Intuitive Surgical’s work.

“This announcement is just the latest confirmation that computer-assisted surgery continues to grow to the point that others can no longer sit on the sidelines. Computer-assisted surgery will continue to flourish around the globe and competitors have been expected.”

Mini-tender offer:

TRC Capital Corp, a private firm founded by a Canadian securities lawyer, has made a mini-tender offer to purchase 250,000 shares of Intuitive Surgical stock at a price slightly below the current market price.

Mini-tender offers, because they are offers to purchase less than 5% of the company’s securities, are not governed by the Securities Exchange Act and don’t need to comply with the disclosures that are in place for larger tender offers. Intuitive Surgical announced today that it does not endorse the offer and recommends that stockholders reject it by not tendering their shares.

In the professional and business journals:

Perhaps a reason for the recent upward swing of Intuitive’s stock is that a recent issue of the journal Obstetrics & Gynecology (January, 2014, volume 123, Number 1) from the American College of Obstetricians and Gynecologists (ACOG) included four articles dealing with robotic surgery. Bottom line is that bumps along the way with regulatory regimes and technology adoption should be expected with new technology surgical devices. In one of the four articles, Milestones to Optimal Adoption of Robotic Technology in Gynecology, the abstract said:

Minimally invasive technology, especially robotics, is gaining widespread acceptance and is becoming the standard approach for the treatment of both benign and malignant gynecologic conditions in centers across the country. However, there are challenges on a systems-based level to the implementation of a robotic program. Prominent among the concerns is the length of the learning curve, team-building, quality of life, and financial and various organizational challenges.

Dating from a story in the WSJ on January 9th, Intuitive’s stock has risen 14.5% even after reporting reduced revenues (see below). The article showed that, in the case of prostate procedures, a large population-based study showed that robotic-assisted prostatectomy procedures resulted in shorter hospital stays and lower overall complication rates compared to open surgery. Other findings in the article were that as surgeons completed more robotic-assisted surgeries, there were decreases in overall surgery time, with less experienced surgeons averaging 5.0 hours for a case and more experienced surgeons averaging 3.9 hours thus contributing to the ACOG finding that surgeons improve with use over time.

[Intuitive got some bad press after the WSJ article because Intuitive paid for the researchers to have access to the databases used in the study, also paid for travel, and one of the authors of the report (which appeared in the December 18 electronic edition of the Journal of Endourology) was an employee of Intuitive Surgical.]

Q4 and Year-end Earnings:

On January 16th, Intuitive Surgical announced that it expects revenues for the fourth quarter to be down 5% from 2012. Full year revenues of $2.265 billion are up 4% from 2012. The consensus is that lower revenues from the sale of systems were attributable to slowed procedure growth in benign gynecology, and also changing hospital capital spending priorities associated with the implementation of the Affordable Care Act. But these declines were partially offset by higher international systems sales, particularly in Japan.

Intuitive’s business model is to sell systems and then support them with service contracts, instruments and accessories. Even with reduced gynecological procedures, the overall number of procedures increased 16% for the year to 523,000. Consequently as the number of surgical procedures rose, tools and accessories was up 6%, and services was up 16% for the year.

The Troubles:

Trouble started brewing for Intuitive investors earlier in the year when an article appearing in the Journal of the American Medical Association called into question the prudence and metrics of using daVinci for a large portion of hysterectomies. At the same time was a wrongful death suit and a series of posturings by class action law firms.

Later, Intuitive announced slow sales of daVinci units in the United States. After years of growth, hospital spending on new machines was much lower than expected. Many attributed this to cash flow uncertainty in the face of new regulations from the new Obamacare Affordable Care Act. About the same time the FDA sent out a query about possible non-reported incidents which ended up in a partial recall. Later still there was another recall of a part that could cause injury during a procedure.

With hospitals unwilling to pay for new machines until the fiscal picture clears up, one hedge fund manager, Stephen Mandel, decided not to stick it out and instructed his Lone Pine Capital fund to sell a big chunk of Intuitive’s stock. The sale of 1,161,068 shares was made during Q3 and was valued at approximately $430 million. Source: SEC 13F-HR Largest Eliminations.

If you liked this article, you may also be interested in:

• All eyes on Intuitive Surgical suit
• A flurry of bad publicity for Intuitive Surgical
• Jury finds Intuitive Surgical’s training practices NOT at fault
• Intuitive Surgical stock takes another big hit
• MAKO Surgical sells to Stryker for $1.65 billion

See all the latest robotics news on Robohub, or sign up for our weekly newsletter.

Often funding sources – the groups taking the risk – are not the beneficiaries of the rewards of the venture. Intuitive Surgical is an example.

NSF, DARPA and NASA funded a project to solve a very real problem: providing medical attention to Americans in remote places such as space, war or scientific expeditions. The initial concept was to be a telepresence project but with no known solution. That was the high-risk research project funded by the three agencies.

During the development phase, two enterprising team members, Frederic Moll and Robert Younge, concluded that true remote-presence surgery couldn’t be achieved with then-current technology but could be achieved within a controlled network,and by so doing there would be many benefits to the surgeons and patients involved. The two wrote a business plan, got venture money and proceeded to develop the system now known as the da Vinci Surgical System within a company subsequently named www.

Shortly before going public, and before getting FDA approval, Intuitive Surgical was sued for patent infringement by Computer Motion, Inc., which had its own system, the ZEUS Robotic Surgical System – a system which was already approved for use in Europe.

The litigation was resolved in 2003 when the two companies agreed to merge, thus ending the litigation. The ZEUS system was ultimately phased out in favor of the da Vinci system. The litigation created an active depository of intellectual properties – hundreds of patents and trade marks – that Intuitive Surgical has vigorously defended in a way that has created a competitive void in the commercialization of similar devices and systems.

Consequently Intuitive Surgical has grown to be a growth company with large profits and is listed on the NASDAQ stock exchange (NASDAQ:ISRG). But it didn’t exactly happen with the high-risk / high-reward formula. Intuitive Surgical and it’s VC backers got the reward and NSF, DARPA and NASA are still searching for their solution.

SRI and Stanford University did get money for licenses to use the technologies they developed, but not the huge rewards stemming from the successes of Intuitive Surgical.

As is often the case in startups, the solutions and products that finally emerge in the marketplace are ones that are different from those that initiated the startup. Sometimes this involves changes in funders, partners and ownership and those that reap the final rewards are often removed from the originating project.

High risk takers are most often governmental agencies with a strategic social/political issue to resolve. Corporate R&D departments also invest in future scenarios but to a lesser extent – they most often pragmatically acquire the technology they need and rework it to fit their specific requirements.

Hence the dilemma: does the initial risk taker expect to get the double reward of (1) product solution and (2) profits from their sale, or just the altruistic reward of seeing that their initial problem, for which they are risking their money, is being addressed in the broader marketplace solving the original problem, reward or not?

One of robotics’ biggest stars, Intuitive Surgical (NASDAQ:ISRG), and their da Vinci robotic surgical systems, is receiving a lot of unfavorable media attention – including a 4-part “exposé” by MSNBC – because:

PLAINTIVE: That Intuitive Surgical designed a watered down training program to make it easier for them to sell systems to hospitals thereby compromising surgical quality which, in this case, led to complications which caused the man to die. They further claim that the lack of training and steep learning curve caused mistakes which led to kidney failure, brain damage, permanent incontinence, the need to wear a colostomy bag, and ultimately, heart failure and death.

DEFENDENT: That injuries suffered by the obese and medically-troubled patient occurred after the robotic systems was unplugged and not in use; the injuries happened after the robotic surgery was completed. That training, supervision and case selection warnings are and were adequate but in this case not heeded.

UPDATE 5-6-2013:
As Intuitive begins to defend itself in the Taylor case, witnesses testified that heart disease, not a failed robotic procedure, killed the patient. Further, Taylor’s arteries were 50 to 90% blocked and he had bypass surgery. Another witness testified that Taylor’s health risks prior to the prostate surgery – diabetes, high blood pressure, high cholesterol, bypass surgery, and his obesity (280# on a 5’8″ frame) – ultimately caused his heart to stop.


UPDATE 5-14-2013:
Intuitive sends note out to customers about a scissor instrument known as Hot Shears saying the instrument could develop small, invisible cracks, which can potentially cause a leak of electricity that can burn patients. It describes precautions to take before using the instrument but also says an additional message will be sent once a replacement instrument is available.

Three additional law firms (Ryan & Maniskas, Rigrodsky and Long, and Hagens Berman Sobol Shapiro) filed class action suits alleging that ISRG issued a series of false or misleading statements to investors and thereby failed to fully disclose to investors the financial impact of safety problems with its da Vinci Surgical System.

In December my colleagues and I produced a valuation of Intuitive Surgical.  Below is a representation of our model of the asset structure of Intuitive Surgical in our forecast.  Whether you agree with our estimate of a 31% return on economic assets or not (though the stock market roughly seems to), this chart is very instructive to look at what the economic assets of a successful robotics firm are.

And hey, guess what?!  Intuitive looks more like a software company than a traditional manufacturer.  Strike another blow for the case that robotics companies – at least successful ones – are capital efficient!

Moreover, if I was critiquing the model in the valuation I would say that we hadn’t adequately valued the intangible assets of Intuitive Surgical.  The intangible assets of the firm probably have a market value of 2-8 times what we estimate.  Even with our conservatism, look at what you’re buying into when you buy a share of Intuitive:  A $2Bn stack of cash, a multi-billion dollar IP portfolio, and a smallish medical device manufacturing company.

[How to read this chart:  Black is our estimate of “R&D assets” in $K so starting balance is just shy of $2Bn.  Red is GAAP non-financial assets, otherwise know as real stuff, like buildings, inventory, and accounts receivable.  Grey is our estimate of financial assets with the current dividend policy–this model posits that Intuitive will be sitting on $4Bn in cash or the like in 2016 and an IP portfolio equally as large and valuable.Return on economic assets was estimated using our income forecast over capitalized R&D spending in the R&D account plus assets less cash and securities.  The model has a depreciation factor for R&D each year to account for obsolescence and expiration.  We went back several years to estimate an appropriate R&D account starting balance for the projection.]

The stock market assigns a $20Bn valuation to Intuitive.  It recognizes that Intuitive’s control of  intangible assets is very valuable. The graph of the model here only scratches the surface of intangible assets.  We assumed that the only off balance sheet economic asset was an R&D account.  Clearly, this is not the case as Intuitive Surgical also has unique and valuable organizational processes, sales relationships, and employment relationships with talented employees but those are much harder to find information about in SEC disclosures.    Similarly, we also marked R&D at cost–with a portfolio as valuable as Intuitive’s the market is probably going to value the R&D output at more than Intuitive paid to develop the R&D assets.

Even with all this, Intuitive Surgical looks like lean, mean, capital efficient, IP intensive, knowledge economy company.  Can anyone tell me why we let people talk about robotics like it is capital intensive?

I’d like to gratefully acknowledge my co-authors of this report who have given me permission to publish it: Avinash Belur, Naohiro Furuta, Masayuki Minato, Kohei Mutoh, & Dashampreet Sidhu.  Analysis available by request.

I watched the video wherein Mohr pointed out that most of the new robotic-assisted surgical procedures, including those provided by her company’s da Vinci Surgical System, are simply improved versions of surgeries that have long been done through open or laparoscopic access — and that’s not disruptive.

She felt that new technologies are poised to profoundly disrupt the field of surgery … new methods that will enable the body’s own immune system to fight off problems, or new systems that will enable doctors to implant medicines in just the right spot to fight a disease without corrupting other nearby organs.

Aeon Scientific’s magnetic catheter steering system.

Last week I had the good fortune to visit the Institute of Robotics and Intelligent Systems (IRIS) Labs at the Swiss Federal Institute of Technology (ETH) in Zurich, Switzerland. I saw some products in their final stages of development that fit the disruptive aspect of what Mohr was talking about. Headed by Professor Bradley Nelson and his team of 40 researchers, Masters and PhD students, and postdocs, the ETH IRIS lab is (amongst its many projects) in the process of spinning-off a medical device company that is developing a new type of robotic catheter steering system which uses patented technology for electromagnetic manipulation.

Nelson is also a founder and member of the Board of Directors of Aeon Scientific. Aeon’s magnetic catheter steering system is initially set up to support electrophysiologists during catheter ablation procedures for the treatment of arrhythmias, such as atrial fibrillation. It allows them to move the ablation catheter within the heart of the patient using magnetic fields. The improved control leads to better outcomes and reduced treatment costs.

Note the little rectangle in image of eye retina. That’s what gets moved by magnetic steering device on left.

Aeon’s new technology is a platform with the potential for other medical applications such as gastroenterology, neurosurgery, ophthalmics, and targeted drug delivery. I saw an example of the targeted drug delivery as it relates to ophthalmics: moving a micron-sized object placed into the retina of an eye. The medical delivery system consists of the steering system (the magnetic coils and lens system on the left; a miniature of the fully-sculpted one shown in the human-sized cardiac system is shown above) and a computer station that allows the doctor to steer the little micron-sized rectangle (you can see the rectangle in the center of the photo on the right) to the exact right spot for it to deliver its therapeutic medicine.

This is exactly what Catherine Mohr was talking about: delivering medicine to the exact right spot so that it can safely do its job.

VGo Communications wins infringement lawsuit brought on by InTouch Health and also initiates a patent reexamination of four other InTouch patents.

InTouch Health, a company that has been providing remote presence services to the medical community for the past decade contacted VGo and suggested that they agree to a licensing agreement of InTouch patents. A suit followed and, in a Los Angeles Federal District courtroom yesterday, a jury found that VGo Communications did not infringe.

VGo requested that the US Patent Office re-examine four patents held by InTouch. VGo provided supporting documents on why those patents were invalid. To date, the US Patent Office has ruled on three of the re-examination requests and has rejected all of the claims within those patents previously granted to InTouch. The fourth patent is still in the re-examination process. This is just the beginning of what appears to be an ongoing round of claims and counter claims and appeals leading off to a decision – instead of by a jury – by patent experts at the Appeals Court.

In rhetoric typical of the best political spin doctor, Peter Vicars, CEO of VGo Communication said, “InTouch Health has been taking advantage of an overworked patent system in order to secure invalid patents that they then use to bleed competitors with frivolous lawsuits. New companies are producing competitive products at prices significantly less than what InTouch charges so InTouch is using teams of lawyers to maintain their exorbitant prices.”

Rhetoric aside, VGo’s low-cost two-way audio video communications combined with remote controlled mobility enables nurses, doctors and social workers to check on patients without having to be physically present. They feel better cared for and appreciate the extra effort. Recovery times are quicker and re-admissions are reduced. More time for the healthcare worker and lower costs for the healthcare organization.

The entry into the healthcare marketplace by VGo – a marketplace nurtured and developed by InTouch over the past decade – appears to be the root cause of the suit. InTouch trail-blazed the products, the FDA clearances, the marketplace and they want to protect their turf.

At a recent conference on remote presence telemedicine the most enlightening thing I saw was four hours of tightly-packed presentations by critical care doctors and hospital administrators, all users of InTouch Health’s remote presence robots, all portraying different aspects of why remote presence in health care is relevant, is saving lives and is necessary today and why it will continue to be in the future. InTouch has created a market that didn’t exist with products that weren’t being used in the way they are now. Certainly on a personal note one would think that there is room for more companies to assist in this very noble work.

But this is where patents kick in to protect that investment in market and product development which InTouch did. In fact, patents protect the holder for 17 years. Thus the courts decision is a bigger subject than just InTouch vs. VGo.

There has been a lot of gossip and more serious discussion within the healthcare devices industry about patents, their use in marketing strategy, their hindering product development, and their true value as intellectual property (IP).

Within the robotics healthcare community, much of that gossip has been focused on Intuitive Surgical and their da Vinci Surgical System. From the beginning, when Intuitive spun out from Stanford and SRI, they immediately had a legal battle with Computer Motion, the inventor of a similar system called Zeus. Since that time Intuitive has regularly contacted competitors to either get them to cease operations or license their patents. Many felt that this thwarted development of competing or better systems than the da Vinci. They have suggested that Intuitive Surgical has made a strategy of amassing large numbers of patents to try to protect their product and market share.

This is the essence of the arguments that people have used against Intuitive Surgical for the past 10 years. Except that no company has asked the Patent Office to reexamine their patents… yet.

In their suit with Computer Motion a decade ago, Intuitive won. But shortly thereafter, Computer Motion won their counter-suit. Stalemate. The two companies met outside of court and agreed to merge, shut down the Zeus operation, pay off the owners of Computer Motion with a small cash amount and 30% of Intuitive Surgical stock – a company that today has a net work of close to $21 billion. Thus the consequences of these patent battles are significant.

Yulan Wang, the founder of Computer Motion, moved on after the acquisition [of Computer Motion by Intuitive Surgical] to found InTouch Health, the very same company that just lost their battle with VGo.

New systems have proliferated in remote presence and robotic-assisted non-invasive surgeries but, in the case of surgical systems, none have yet to make it to market. RAVEN and SPRINT are two such systems presently in the news with reviews indicating that they are viable competitors to the da Vinci system.

The Raven operating system is helping the open-source community advance the state of the art in surgical robotics. In a joint venture between the University of Washington and UC Santa Cruz, the National Science Foundation funded the development of seven identical Raven II surgical robots. Each system has a two-armed surgical robot, a guiding video camera, and a surgeon-interface system built on top of ROS.These surgical robots are linked via the Internet so researchers can easily share new surgical robotics research and developments. Five Raven II robots have been given to major medical facilities at Harvard University, Johns Hopkins University, the University of Nebraska, UC Berkeley, and UCLA.

“SPRINT” is an EU-developed master-slave teleoperated robotic platform designed for bimanual interventions by means of a single access port. The system is composed by two main arms, a stereoscopic-camera, and additional devices, e.g. retractor or other assistive instruments that can be inserted through a central tube left free in the access port after the introduction. The surgeon console is composed of two master manipulators, a foot-switch and a 3D full-HD display.

Single-port surgical system by Intuitive Surgical.

Intuitive Surgical has recently announced their single-port surgical system, a competing concept to the SPRINT system. One can see another patent battle coming.

In the early years of automobile development, a group owned the rights to a two-cycle gasoline engine patent. By controlling this patent, they were able to monopolize the industry and force car manufacturers to adhere to their demands or risk a lawsuit. In 1911, independent automaker Henry Ford won a challenge to the patent. The result was that the patent became virtually worthless and a new association – which would eventually become the Motor Vehicle Manufacturers Association – was formed. The new association instituted a cross-licensing agreement among all U.S. auto manufacturers: although each company would develop technology and file patents, those patents were shared openly and without the exchange of money between all the manufacturers. By the time the U.S. entered WWII, 92 Ford patents and 515 patents from other companies were being shared between these manufacturers, without any exchange of money – or lawsuits. The best braking system was shared by all as was the best window wiper, and many, many other inventions passed freely from one car company to the others.

If something like this were to happen in the medical robotics arena, these wonderful new inventions would be available all over the world and patients, care-givers and healthcare systems would all share in the benefits and lives saved.

Perhaps there will be a time in the near future when new products like RAVEN and SPRINT will have a similar success as did VGo – maybe even without the costs and resources diverted from product development to fighting court cases.

Nevertheless, InTouch Health today filed an appeal of the verdict and also the patent reexaminations.