REVO

○ After experiencing the latest surgical robot

Surgical robots are no longer unfamiliar in Korea. It is an equipment that enables a doctor seated at an external console to maneuver it remotely by inserting a surgical camera, robot arms and the like into the body after making 2~4 holes in the patient’s body. 

‘Revo-i’, a surgical robot developed in 2009 with the participation of the government, Samsung Electronics, Seoul National University, Yonsei University Health System, Daegu Gyeongbuk Institute of Science & Technology (DGIST), KAIST and Korea Electronics Technology Institute and other local engineers is being used in laparoscopic surgeries such as cholecystectomy and prostatectomy. ‘Da Vinci’ which is a surgical robot that is used the most currently is being utilized in key cancer treatments such as thyroid cancer, cervical cancer and prostate cancer in various departments such as Urology, Obstetrics & Gynecology, General Surgery and Otorhinolaryngology. 

I personally experienced the latest surgical robot that has been adopted in Korea by visiting the ‘Revo-i’ Training Center in Jongno-gu, Seoul on March 29 and the ‘Da Vinci’ Training Center located in Sangam-dong, Mapo-gu, Seoul on the 11th last month. 

○ Revo-i which seems not much different from the market leader’s Da Vinci

The Revo-i Training Center is equipped with a control console where the robot is personally maneuvered, a robot arm, monitor and the like. I sat in the console and when placed the fingers of both hands in the controller, the robot arm started to function immediately. When I placed the controller on the thumb and index finger and narrowed or widened my fingers, the forceps of the robot arm moved alike. I thought that the movement of Revo-i would be obtuse because it was a late comer in the field of surgical robot but it wasn’t at all. 

Lee Jin Han, a reporter specializing in medical field at Dong-A Daily News is seated at the console of Da Vinci SP (top image) and Revo-i, made with domestic technology and is seen operating the robot arm. Both surgical robots have recently been launched. Image captured from video clip.

The screen was relatively easy to see. Although it wasn’t easy adjusting to the 3D screen, I was soon able to feel the three-dimensional effect when I placed my forehead closely to the machine and when my eyes were closer to the screen. Although the screen generally felt small, the screen could be magnified by 10 times and with the eyes placed closely, it seemed that it would not affect the surgery. 

△ I tried holding and moving the small hook or △ Pulling the pin and transferring it elsewhere or △ Suturing artificial skin using a thread. The first and second motion was relatively easy. But as it was my first time suturing the skin with a needle and thread, I failed in my first attempt but succeed in the second. It was similar to playing a game so I thought that a normal person would easily get used to it after consistent practice. 

Lee Jin Woo, the head of General Surgery at Gibbeum Hospital who had successfully completed a cholecystectomy using Revo-i recently said that “There wasn’t much difference when compared to the existing surgical robot”. Prof. Koon Ho Rha, urologist at Yonsei Severance Hospital who was in charge of the clinical tests of Revo-i stated that “After analyzing the patient’s recovery progress, satisfaction level, effectiveness, safety and others in a patient who has received surgery with Revo-i, it was similar to those of Da Vinci” and that “With Revo-i, all types of abdominal surgeries are possible”. 

○ Da Vinci a step ahead in terms of 3D effect

85 units of Da Vinci which was first adopted in Korea in 2005 are installed in 58 hospitals as of March. In Korea, more than 100,000 surgeries using Da Vinci have been performed. Da Vinci started with its first model S and has been upgraded to SI→XI→X (entry-level) and now, there is a ‘SP’ version which requires only one hole to be made in the patient’s body. I experienced Da Vinci’s latest devices, XI and SP. 

The dimensional effect of Da Vinci XI’s screen was definitely more outstanding than Revi-i. Thanks to the high resolution dimensional screen which enabled magnification up to 10 times, I was able to easily engage in motions such as holding and moving the hook or cutting the vein. However, the feeling of moving the robot arm was not much different from Revo-i. Revo-i is known to be equivalent to the SI model. However, compared to the existing surgical robot, XI had thinner robotic arm, making up for the disadvantage of robot arms colliding with each other. 

I tried performing the surgery of removing uterus in virtual reality through virtual simulator. It involved removing uterus from a virtual female and any mistake made while cutting could cause severe bleeding. Although it was my first attempt, I was able to remove part of the uterus without significant blood loss without much difficulty. 

Da Vinci’s SP refers to Single Port, in other words, single hole (various procedures can be performed by making one hole only). For SP, compared to the existing Da Vinci, it has to penetrate through a single hole to move so the scope of activity is somewhat restricted. With Da Vinci XI, it succeeded in suturing the scar area in the first attempt but with SP, I was not able to succeed. Advanced training seemed to be required. SP is a robot that has been designed to perform surgeries on deep and narrow areas such as surgery through the mouth or anus. 

○ What to select?

The biggest advantage of Revo-i is that the cost of surgical robot or surgery is relatively affordable as it is a domestic product. In case of Da Vinci, the price of one unit surpasses KRW 2 ~ 2.5 billion. Here, the annual maintenance cost charged by Da Vinci’s manufacturer, ‘Intuitive’ is approximately KRW 230 billion per unit. Furthermore, the high-end robot arm which has to be replaced after approximately 10 uses so the cost of parts is also high. 

Mereecompany that has developed Revo-i claims that the entire cost can reduce by approximately 42% compared to Da Vinci. This would naturally mean that the cost of surgery borne by the patient could also be reduced. In fact, in case of a cholecystectomy utilizing a surgical robot, if the cost of surgery using Da Vinci would cost KRW 7 ~ 10 million but with Revo-i, it would cost about KRW 5 million.

Prof. Rha stated that “In case of Revo-i, although it lacks procedural experience in various areas at the moment, it would expand significantly once experiences in various area accumulate and once the insurance benefit coverage takes place next year.” 

Medical reporter Lee Jin Han / likeday@donga.com

Article

http://news.donga.com/3/all/20190502/95343152/1