REVO

 “‘Revo-i’ competing on a par with Da Vinci”

Lee Jin Woo, General Manager at Gibbeum Hospital “Reasonable performance and quick AS would be its strengths” 

Installed at the end of 2018…74 cholecystectomy and appendectomy surgeries as of September

Reporter Moon Yeong Jung | Written on Sept. 17, 2020 [06:00]

【후생신보】 The robotics surgery market in Korea is dominated by American Intuitive Surgical’s ‘da Vinci’. The majority of large hospitals and tertiary general hospitals installed at least one to two systems, without exception, and some even installed close to 10. 

Of course, there are controversies but the satisfaction level of not only patients but also the medical staffs is high compared to laparoscopic surgery, so it is becoming more widely used at a fast speed.

The field of surgery is also becoming broader day-by-day. In the initial stage, robotic surgery was primarily applied to prostate cancer surgeries but now, there is hardly any surgery to which it cannot be applied to, such as stomach cancer, thyroid cancer, colorectal cancer, rectal cancer, renal cancer, uterine cancer, ovarian cancer, lung cancer, and esophageal cancer.

The advantage of robotic surgery is that it leaves smaller scars, ultimately leading to fast recovery. In addition, surgery can be performed by using 3D imaging that has been enlarged in high resolution and it can also prevent the fine hand trembling of the operating surgeon. 

Thanks to the robotic arm that moves freely, surgeries that used to be impossible are being performed without difficulty. The disadvantage is that docking and undocking the surgical robot require time. Furthermore, surgical robot is expensive to purchase and maintain. 

Capitalizing on these advantages, American Intuitive Surgical is dominating the domestic robotic surgery market. 100 systems of da Vinci have been sold in Korea to this point. Despite so, there are some tertiary general hospitals and large hospitals that still do not have surgical robots. 

In the Korean robotic surgery market that is dominated by da Vinci as such, Meerecompany’s ‘Revo-i’, designed and constructed with Korean technology, is gaining attention. 

Lee Jin Woo , General Manager at Gibbeum Hospital, who has performed close to 70 surgeries with Revo-i revealed that, “I think it can compete with da Vinci”. His assessment seems meaningful as he had used da Vinci in the past. 

General Manager Lee Jin Woo expressed his opinion by stating that “I have used da Vinci in past surgeries” and that “Currently, although I have only performed cholecystectomy and appendectomy surgeries with Revo-i, I believe that it would execute the role, equivalent to that of da Vinci, in various cancers in the future”. 

It seems that it would be possible for da Vinci and Revo-i to exist in one hospital. 

Moreover, Lee explains that the expensive cost and A/S aspect which are considered to be da Vinci’s biggest weaknesses, would not be able to supersede products ‘Made in Korea’.  

The following summarizes the interview with General Manager Lee Jin Woo. 

Q: What was the background for installing Korea’s first domestic surgical robot, ‘Revo-i’?

  - General Manager Lee Jin Woo (hereinafter referred to as Lee): It’s been over 20 years since surgical robot had been developed and in Korea, it was first installed by Severance Hospital in 2005. Since then, it is being used in various areas of diseases such as urology, obstetrics and gynecology. Meerecompany also launched a surgical robot in 2018. The biggest initiative was to adapt to the flow of era and the fact that a lot of robotic surgeries were being performed in university hospital played an important part.

Since its establishment, Gibbeum Hospital has focused on endoscopy and surgical operation, having performed the highest number of herniotomy and appendectomy. Following such, starting with robotic cholecystectomy (gallstone surgery), the scope of robotic surgery was gradually expanded, ultimately installing Revo-i in order to transform into a hospital specializing in robotic surgery in the future. 

Previously, because of the huge burden of installation and maintenance cost of surgical robots, robotic surgeries were performed centered on university hospitals or general hospitals so despite it being a better surgery for patients, it was difficult to provide medical benefits to many patients. By installing Revo-i at Gibbeum Hospital, we wanted to provide the opportunity for many patients to receive better surgeries at affordable cost through.

  Q: 65 surgeries have been performed from its installation until now. Please tell us about the detailed number of cases and the advantages of robotic surgery compared to laparoscopic surgery. 

  - Lee: There were 1 to 2 cases of appendectomy and the rest was all cholecystectomy. When we talk about robotic surgery, patients think that surgical robots perform the surgery but it is the doctor that controls the robotic arm for surgery. 

A general laparoscopic instrument is straight like a chopstick but a robotic arm has a structure equivalent to the joints of our hand and wrist. For instance, in a gall bladder surgery, there are many things to avoid, such as the big vein leading to biliary tract or liver and other tissues and robotic arm contributes significantly to precise and safe surgeries by avoiding them. 

Furthermore, in the existing laparoscopic surgery, the doctor has to hold instruments personally while standing so the level of fatigue is high. Meanwhile, in robotic surgeries, the doctor can perform surgeries in a comfortable posture while seated so the level of fatigue is much less. If the doctor’s fatigue level is low, it also helps improve the result of surgery. 

 Q: So, in other words, there was a need in terms of time and consequently, more precise surgeries can be performed and it helped enhance the result of surgery by reducing the level of fatigue. Have you tried using its competing product, da Vinci? 

  - Lee: Yes.

 Q: Then, please tell us about the similarities and differences between da Vinci and Revo-i. 

  - Lee: The overall characteristics of the surgical robot are similar. The biggest difference is the price. In case of considering the equipment price, instrument and service in general, it is half the price, if I’m not mistaken, although there would be differences depending on the model. 

Even when we purchase a car, we tend to compare the performance compared to price. From the performance perspective, it is not that far behind compared to da Vinci. The fundamental performance of a surgical robot is not much different from each other in both products. As for performance compared to price, I think Revo-i is sufficient enough. 

 Q: For example, when performing a cholecystectomy, what is the level of satisfaction when comparing the surgery result of laparoscopy, Revo-i and da Vinci?

  - Lee: It is the patients who feel the result of surgery eventually. In this aspect, there is no distinct difference in the 3 surgery methods. From the patient’s point of view, they would be pretty much the same. Even when comparing laparoscopy and robotic surgery, there is not much difference in the pain that is felt by the patient after surgery or in the recovery speed and others. However, there is an advantage that is felt by the doctor during the surgery and in terms of stability during the surgery process, stability is more profound in robotic surgery.

 Q: So, there is not much difference in the result of all 3 types of surgeries; laparoscopy, Revo-i and da Vinci. Although there are disputes on which, out of robotic surgery and laparoscopy, is more excellent to this day. What are your thoughts on this? 

  - Lee: There are areas where robotic surgery is more outstanding. It’s difficult to say which is more excellent concerning all surgeries. It differs depending on the type of surgery, the time required and the level of difficulty. 

 Q: I think it would be safe to say that there are surgeries that can take advantage of robotic surgery and that the more precise the surgery is, the more favorable robotic surgery would be. You mentioned that you had used da Vinci as well (for 2 years in Bundang Cha Hospital). Was Revo-i easy to handle, too? 

  - Lee: I’ve used da Vinci many times. Revo-i is also similar to da Vinci. I think that anyone who has used da Vinci would be able to handle Revo-i easily. 

 Q: Are there surgeries in Gibbeum Hospital that can expand the application of robotic surgery, other than cholecystectomy and appendectomy? 

  - Lee: Currently, these two types are the basic. We’re attempting to apply it to the removal of artificial membrane in the field of hernia but we haven’t tried it yet. Whether to apply expand it into the fields of OB/GYN and urology is for the hospital to decide. 

 Q: It seems that 2.5 robotic surgeries have been performed on monthly average until now. 

  - Lee: In the initial stage, there was a settling down period and recently, there are about 5~10 cases on monthly average. There were 8 cases even in this month. As for the surgery time, it used to take about 50 minutes to 1 hour in the beginning but recently, it has been reduced to 30~40 minutes. I think it could be reduced further in the future. Compared to laparoscopy, it takes about 5~10 minutes to prepare the setting for robotic surgery and other than that, the surgery time is almost similar. 

 Q: Does the same apply to da Vinci as well? You’ve used both so what you do feel?

  - Lee: Yes. Time is required slightly in the ‘docking’ process which involves connecting the surgical robots to the patient’s body at an appropriate angle. The surgery time of da Vinci is also similar. When moving the robotic arm, it has to move comfortably and maybe it’s because I’m used to da Vinci but Revo-i feels slightly like a heavy car when compared to cars. When moved for the first time, it feels weighty. But once used to it, it didn’t feel uncomfortable. 

When Revo-i was installed in our hospital, there was a lot of pressure and tension. Nowadays, it is being used well comfortably. Compared to when da Vinci was used previously, there is no significant inconvenience. I think the difference merely lies in whether you’re used to da Vinci or Revo-i. You may not find a huge difference when the level of surgery isn’t high. 

  Q: There are many small and medium hospitals or secondary general hospitals that are not equipped with surgical robots. If you were to recommend Revo-i? 

  - Lee: Robotic surgery is not generalized in secondary general hospitals. If a hospital intends to proactively install surgical robots in such circumstances, I think it’s worth considering Revo-i. 

I haven’t experienced urology, OB/GYN but if a secondary hospital equipped with urology, OB/GYN, surgery departments intend to be equipped with surgical robots, I think Revo-i would be sufficient. In addition, the advantage in terms of price is extremely significant. 

 A: According to your experience, do you think that it is not much different from its competing product, da Vinci? Even if Revo-i isn’t able to cover all the surgeries that da Vinci can perform, can it cover most of them? 

  - Lee: I think it can cover most of them. Surgeries that can be performed in our hospital’s scale are about cholecystectomy and appendectomy. In order to perform more surgeries, instrument that is much bigger than what I’m using is required. It’s difficult to guarantee areas that I haven’t experienced. 

 Q: I’m sure there are needs for Revo-i in semi-general hospitals or secondary general hospitals. What are the areas that require reinforcement in Revo-i that you have experienced during surgery? 

  - Lee: As mentioned previously, the disadvantage is that it feels slightly heavy. In addition, if the robotic arm is too thick, the range of movements of the robotic arms will become smaller. I think it would be good to complement these two things. I’m not talking about the area which goes into the patient’s body that is thick. It is the area which moves outside of the patient’s body, causing arm collisions with the other arm. 

  Q: What you experienced any post-maintenance recently? 

  - Lee: The service team was always standing in every surgery. Whenever I said that I wished a certain type of instrument existed when performing a surgery, I discussed it with the Technology Development Team and they made it. It seems that Meerecompany was caring a lot because it was the first time using Revo-i at our hospital. There were no issues in majority of surgeries. Even if there were small issues, such as adjusting the height of the master console, the service team was taking actions immediately. The post-maintenance is definitely better than da Vinci. 

 Q: I’m certain that there are large hospitals as well as small and medium hospitals that are contemplating on installing surgical robots. I’d like to ask once again. Can Revo-i compete with da Vinci? 

  - Lee: I consider it as a competing product. It’s difficult to answer flatly whether it is competitive or not. Although Revo-i definitely has enough potential to compete with da Vinci, I think it is difficult to say that it isn’t comparable with da Vinci yet. Revo-i is equipped with all the fundamental performances that a surgical robot has to be equipped with. I think it is good enough to be competitive if the technical aspects are slightly complemented. If secondary hospitals and the like are considering making purchase, I think Revo-i should be worth considering. 

 Q: Until now, Gibbeum Hospital is the only hospital that is actually using Revo-i. Has any presentations been made in societies related to such contents? If not, are there any plans to do so in the future? 

  - Lee: It’s difficult to make presentations based on cholecystectomy only. There is a difference when presentation is made based on surgeries with value such as liver, pancreas and colon and when presentation is made based on cholecystectomy.  

Article: http://www.whosaeng.com/120952