I continue to be amazed at surgical robotics, the use of totally endoscopic approaches to coronary artery bypass grafting and other "big device" surgical technologies. By "amazed", I mean that we can spend so much money on these systems and expect the bloated healthcare market to pay for them.
Are they amazing in technical development? In their sophistication in performing surgical procedures with high precision? Yes and yes.
Are they necessary to perform treatment of acute coronary artery disease? I’ll go out on a limb and say NO.
Two remarkable trends in technology development in the area of treatments for acute coronary artery disease are going in completely different directions. On the one hand, systems and methods like totally endoscopic coronary artery bypass or "TECAB" (if you you need a five letter acronym, there might be too much engineering) are employing complex systems to perform traditional bypass in a purely endoscopic format. These are truly big devices that encompass the scope system, remote surgical endoscopic instrumentation, a system to immobilize the beating heart during bypass, etc. On the other hand, coronary stent manufacturers are working toward achieving the result of revascularizing an existing coronary artery by having the least impact possible, up to and including having the stent simply disappear (bioresorb) over time (see Abbott, Amaranth Medical, Arterial Remodelling Technologies, Bioresorbable Therapeutics, Boston Scientific and half a dozen others).
Quite a polemic.
TECAB and other methods to perform minimally invasive surgery for acute coronary artery disease are perhaps seeking to emulate what was done by laparoscopy in cholecystectomy (gall bladder removal), a high volume procedure that laparoscopy changed from a traumatic procedure with long recovery times to a relatively atraumatic procedure now performed at times on an outpatient basis. The problem I have with this premise? (I know I am assuming this is TECAB proponents’ thinking.) The problem is that cholecystectomy was a straightforward open surgical procedure that had no minimally invasive alternative. Coronary artery bypass is NOT a straightforward procedure and does INDEED have a minimally invasive alternative — angioplasty with coronary artery stenting.
So, surgical robotics and totally endoscopic coronary artery bypass for treatment of coronary artery disease are just too heavy handed given the availability of coronary stents as a successful alternative.
The "big device" systems do have value, for those procedures with no therapeutic alternative, like neuro procedures in which the complexity can be so great that precision is a matter of life or death.
By the way, we published a stents report based on global research.
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