REVO

Representative Director Yoonsik Kang says, “I will not hesitate to recommend the System to those medical teams who are considering adopting the system” … Easing relevant regulations is a top priority to revitalize the local market

by Lee Sang-chul | Report entered on 15 Mar. 2021 [08:36 a.m.]

[Whosaeng Shinbo] 

Gibbeum Hospital has added meerecompany’s ‘Revo-i,’ which is the first laparoscopic robotic surgery manufactured by the Korean company. Recently, the hospital has completed 100 robotic surgeries using Revo-i. Such results have been evaluated for excellent performance and stability because no surgical complications were found after performing 100 operations. It is meaningful because it guarantees the quality of technology. Hospital representatives think that the technology itself is strong enough that other university or large hospitals using laparoscopic surgical robots can consider adding the Revo-i system. Also, the price is another bonus. Patients are satisfied with the price as they can access to high quality medical services with half the price of other surgical robots. Customer service is a big differentiating factor because the company keeps improving the quality of the system based on surgeons’ feedback. Despite all these positives, PR activities for enhancing the brand visibility to patients and surgeon is something that should be improved.  

Hospital representatives advise the company to increase PR activities highlighting and featuring the excellence of Revo-i which ultimately would attract more patients and surgeons. Whosaeng newspaper interviewed Gibbeum Hospital Representative Director Yoonsik Kang and Robotic Surgery Division Manager Jinwoo Lee, who have added the Revo-i for the first time in Korea, on the significance of completing 100 operations using the system and the future expansion outlook.

▲ Division Manager Jinwoo Lee (left) and Representative Director Yoonsik Kang participate in interview with Whosaeng Newspaper

Q. Please tell us about Gibbeum Hospital.

A. Yoonsik Kang, Representative Director of Gibbeum Hospital, opened the hospital in December 2005. Back then, Seoul Surgical Clinic which specializes in hemorrhoids was located near the Express Bus Terminal, and has now expanded into Daehang Hospital. I opened Seoul Surgical Hospital with one of my colleagues. We worked together until 2005, then moved out to operate Gibbeum Hospital since last July and now the hospital is located near the Nambu Bus Terminal Station in Seoul.

COVID-19 has spread when interior work began as planned. The pandemic appeared by the time we needed to add devices and hire staffs.

Q. How many staffs are currently working in the hospital?

A. Yoonsik Kang: Around 170 staffs including 29 doctors.

▲ Representative Director Yoonsik Kang

Q. What do you want to highlight about [the hospital’s] equipment?

A. Yoonsik Kang: We currently have CT, ultrasound, and mammography devices. The performance of CT scanner in our hospital is more advanced than those in other hospitals because its radiation exposure is also relatively low. But, there are not so many university hospitals have that device that we are currently using.

Our CT scanner is manufactured by Siemens. We are the fourth hospital in the world and first in Korea having this device. However, patients are not aware of it, as every hospital says they have great equipment which is hard to check.

Personally, I don’t want to use any product when there is a better one out there. There is a reason for it.

In general, medical centers use low performance CT scanners, which results in poor quality of images and a high level of radiation exposure.

Of course, cancer patients need to pay attention to the radiation exposure, but I think healthy people should not be also harmed by the radiation exposure from CT scan. This is why I chose to obtain high-priced CT - safety is our top priority.

Our hospital has performed the most hernia repair operations in Korea and also developed a new surgical technique. In general, the technique for hernia repair is reinforcing the surgical area with mesh and this has been widely performed for more than 20 years, but, patients had high rates of complications including severe pain.

Our hospital performs mesh-free hernia repairs. The U.S. Food and Drug Administration (FDA) reclassified surgical mesh into class III, which is the highest risk medical device.  

Other countries conduct pre- and post-market surveillance of medical devices. In Australia, all patients having surgical mesh operations must now be given patient information leaflets, but we don’t have those requirements in Korea.

The ads with the phrase ‘mesh-free hernia repair’ is not allowed to use on the websites. It seems that doctors who supervise the medical advertisement do not want the phrase to be used as they perform mesh surgeries.

Q. Too much time is being spent for developing and commercializing local medical devices. It almost takes a whole year to undergo an audit and inspection by the NECA (National Evidence-Based Healthcare Collaborating Agency) for evaluating a new medical technology. But if the device falls in the same category, I think there must be a way to reduce time. To resolve this issue, the government is currently discussing with the party whether to let use the device first, then evaluate later. I believe that this will further develop the Korean medical device industry.

A. Yoonsik Kang: I agree. The current regulation is too strict.

Q. Are there many cases where many doctors develop new surgical techniques but not conducted?

A. Yoonsik Kang: Surgeons develop their own technique while performing surgeries. Other countries are facing with a similar situation regarding hernia repair.

That’s why many patients visit our hospital. We perform high-quality mesh-free surgeries.

When surgical meshes are used in the repair of hernia, the recurrence rate is 5-10%, and the complication rate is 10-20%. Also, removing the mesh is extremely difficult.

The mesh-free surgery, however, the recurrence rate is below one percent with a very rare complication. It’s also a simple surgery with fast recovery.

In the aspect of better health care, I think mesh-free surgeries should be widely performed but many doctors don’t seem to agree with this.

Q. What is your goal or vision for the hospital?

A. Yoonsik Kang: The hospital seems to be operating just fine, but we are facing a deficit. Our long-term goal is to make a good hospital.

We can’t pay much attention to business rationalization because it’s hard to pursue profitable growth opportunities under the current health system in Korea.

But our hospital has grown so much that we have hired 23 new doctors. We are one of the hospitals that perform hernia repair, appendectomy, and gallbladder surgeries the most. We are making efforts to offer the best treatment in these cases. This is why we have adopted the robotic surgical system.

Q. You have performed 100 surgeries using Revo-i, the robotic surgical system for laparoscopy manufactured by meerecompany. Why did you pick Revo-i?

A. Yoonsik Kang: It is recognized that laparoscopic robot surgeries are mostly performed in University Hospitals.

Then I heard at the conference of the Korean Surgical Society that Revo-i has been developed for laparoscopic surgeries in our country. I thought the price might be a little cheaper because the system is manufactured in Korea so I was like, ‘Why not adding it in our hospital?’ I reached out to meerecompany first because I also thought that we should use more local medical devices.

▲ Division Manager Jinwoo Lee

Q. I heard that you have conducted 100 operations using Revo-i. It would have been difficult to do so if the system’s performance was poor. Tell us your thoughts on this.

A. Jinwoo Lee: Gallbladder disease is on the rise. Robotic surgeries are widely performed at hospitals including University Hospitals. Our hospital is a secondary hospital but we have adopted the robotic surgical system for laparoscopic surgery relatively fast.

It is never easy for small and medium-sized hospitals to perform robot-assisted laparoscopic surgeries to patients. We have adopted Revo-i and completed 100 surgeries. If there was a serious issue with Revo-i, we would not be able to use the device. But the result was amazing that no surgical complications were reported – until now. It means a lot that we have been using the device without any issues.

Q. Up until now, the surgical robotic market was dominated by one brand. It is significant that the Korean device is developed under these circumstances. As far as I know, one particular company has generated high revenue by offering device accessories. Also, I was told that many university hospitals are not satisfied with this. When the department of gynecology had a cadaver lab by using Revo-i on ‘Revo Day’ last year, their feedback was pretty good. Is gallbladder surgery the most conducted surgery at the hospital, using Revo-i?

A. Jinwoo Lee: That’s correct.

Q. Is there any surgery type that you think it can be performed with Revo-i?

A. Yoonsik Kang: Maybe gynecology surgery, but we are not performing it yet. However, it can be used for appendectomy. Appendix surgery is included within the Korean Case Payment System (KCPS), so we were not able to charge patients even if we performed a laparoscopic robotic surgery. But the regulation has been changed since July last year, so it can be charged if patients agree with it. We are planning to perform more robotic surgeries.

Q. After adopting Revo-i, what percentage of laparoscopic surgeries are robotic?

A. Jinwoo Lee: As the robotic surgery costs more, only some patients with an insurance have robotic surgeries. I think around 20% are robotic surgeries.

Q. What are the feedback from people about Revo-i?

A. Jinwoo Lee: As the result of post-surgery is good, there are no complaints coming from patients. Most of them are satisfied with the robotic surgery.

A. Yoonsik Kang: We are not delivering PR activities to reach the widest range of possible patients. I think it will be great to let patients know about our robotic surgery results. We also offer robotic surgeries at a cheaper price than University Hospitals.

Q. I heard that the price is around half that of other devices, which put less burden on patients. Recently, even an OB/GYN hospital in Busan has adopted the device. Also, well-known college professors have a great interest in the system. Honestly speaking, most medical college students graduate with no experience performing surgeries. In this aspect, the Revo-i can be of great help. What is the differentiator that sets Revo-i apart from the competitors?

A. Jinwoo Lee: The overall benefits of robotic surgeries are equal to Revo-i’s. It is hard to say Revo-i has this specific benefit that da Vinci doesn’t have. As the robotic system provides highly magnified images that are much sharper in resolution than those a surgeon would see with their own eyes, I think this is the greatest benefit of using it.

Also, the system has the same movement capacity as the human wrist and this allow surgeons perform more delicate and elaborate surgeries.

Q. Jinwoo Lee has also used the da Vinci system when he was working at the university hospital. Are there any differences in customer service between Revo-i and da Vinci?

A. Jinwoo Lee: There are big differences in the aspect of customer service. The manufacturer pays more attention to our hospital because we have firstly adopted the system in South Korea. When we asked to resolve the issues or improve the system, they immediately settled them. I also heard there are great benefits in terms of price.

Q. When surgeons requested to resolve the issues of Revo-i, did they instantly provide feedback?

A. Yoonsik Kang: Yes, they did.

Q. Is it very different from the Da Vinci in terms of the way the system functions?

A. Jinwoo Lee: They are practically the same. There is no big difference.

Q. Do you feel the difference in terms of the technology aspect?

A. Jinwoo Lee: It is hard to say that Revo-i is completely on the same level as that of the da Vinci, but it is does not fall behind the da Vinci in terms of technology. It has some issues to be settled but we don’t have any difficulties in using it for surgeries.

Q. Which market do you think Revo-i should focus on?

A. Yoonsik Kang: I told the manufacturer that they shouldn’t try to compete with the da Vinci when we adopted the system. The da Vinci has already accumulated expertise in the area and was installed by university hospitals earlier. The doctors who is accustomed to using the da Vinci prefers to stay with the system that they are currently using.

Therefore, Revo-i should compete with laparoscopic devices not with the da Vinci. If the manufacturer makes the system more accessible to hospitals who are using laparoscopic instruments, the business will be expanded as the years go on. I think this will be a good opportunity for the company.

The da Vinci is too expensive for secondary hospitals to consider adopting it and hard to afford the cost of accessories. So it may be better for Revo-i to target small and medium-sized hospitals. In order to be installed at those hospitals, the system needs to compete with laparoscopic devices. And it also needs to target university hospitals at the same time.

A. Jinwoo Lee: I heard some university hospitals consider Revo-i as the first option when they discuss whether to add additional laparoscopic surgical robots, so ultimately, Revo-i will compete with the da Vinci.

Q. It would be ideal to have better technology and price in the market and highlight that it is manufactured by the Korean company.

A. Yoonsik Kang: To achieve that goal, it has to become a widely sold system. It also needs to approach and interact with secondary hospitals that are not easily accessible to the da Vinci system.

Q. Do you think it seems helpful to develop educational programs for future users including medical students?

A. Yoonsik Kang: If meerecompany can do it, why not? I was told that one medical device company provides training and education opportunities to students and residents. It will be great if meerecompany can provide these opportunities such as animal labs.

Q. I heard that Korean companies are hard to grow in the robotic surgery market as many surgeons prefer staying with the system that they are currently using. Tell us what you think about the future of the robotic laparoscopic surgery market in Korea.

A. Yoonsik Kang: When I was a resident, even the laparoscopic surgery was not widely spread. One day the laparoscopic surgery was introduced, and the robotic surgery has recently developed. I believe that the use of robotic surgery will increase.

Q. We expect that there will be some movements within the market as Revo-i launched by meerecompany. Do you have any advice or suggestion that you want to recommend to the Korean government on revitalizing the development of Korean medical devices?

A. Yoonsik Kang: If government provides generous subsidies for surgical robot purchases, it will help revitalizing the development of Korean medical robot. The quality of Korean healthcare has been ranked as being among the world’s best, but the medical device market still has limitations. Compared with the domestic clinical medical level, the equipment level is still too low. It is my hope that the government can at least ease the relevant regulations.

Q. There are too many steps to complete for the equipment to move forward from the development process to commercialization.

A. Yoonsik Kang: The OnePrep, which is a colonoscopy prep drink that I developed, is approved by the MFDS and currently it is on the market. The dose is only half that of the existing products, which allows us to get good feedback. The foreign-developed medicines easily get an approval based on their safety and effectiveness data, but the medicines which were developed within the country need to go through a very strict process. Also, it takes even five to six years to get approved. When we asked to ease the regulations, the MFDS just answered that it is not an agency for industrial revitalization but an agency for regulations.

Q. As you have frequently used Revo-i, are you willing to recommend the system to other hospitals?

A. Jinwoo Lee: We can definitely recommend it to those who are considering whether to purchase Revo-i or not. Our divisions of OB/GYN and urology haven’t used the system yet. One of the benefits and features of the laparoscopic robotic surgery is that it is much easier to perform the suture of the abdomen than a laparoscopic surgery. The OB/GYNs and urologists will need this and I think the system can be used for these surgeries.

Article : http://www.whosaeng.com/125399