A BBI

Physicians in Hannover, Germany, and Johannesburg, South Africa, collaborated on three pediatric surgical procedures using the Socrates Robotic Telecollaboration System from Computer Motion (Goleta, California) in what the company said was the first international use of telecollaboration to introduce new technology and minimally invasive procedures to pediatric surgeons.

The company said Benno Ure, MD, of Hannover Medical School, used the Socrates system during a series of three procedures performed by Robert Banieghbal, MD, on pediatric patients located at Chris Hani Baragwanath Hospital in Johannesburg.

In the first procedure, the two surgeons performed laparoscopic surgery on a two-year-old girl to treat a severe case of gastroesophageal reflux. The Socrates system allowed Ure to share control of the Aesop Robotic Endoscope Positioner, visually annotate the surgical image during the procedure and monitor the status of additional medical devices.

Computer Motion said that over a three-day period, the two surgeons completed three procedures on children between the ages of one and three, using a minimally invasive, robotically assisted approach that allowed the patients to recover more quickly and with less scarring than with a traditional open surgery. In a case involving a one-year-old boy, Banieghbal performed his first Thal fundoplication procedure with the real-time guidance of Ure.

"The benefits of having an experienced surgeon available virtually anywhere any time, made it possible for me to perform a procedure safely for the first time, all alone," Banieghbal said. "This is a fantastic way to further surgical training."

In addition to advancing the field of minimally invasive surgery, especially in the case of the small anatomies of infants and children, Computer Motion said Socrates' capabilities also are advancing surgeon training and education by linking surgeons in the operating room with colleagues around the world.

During such procedures, the operating surgeon has full control over the surgical instruments, while the collaborating remote surgeon can also control Aesop, the robotic arm that holds the endoscopic camera positioned inside the patient, using voice commands. Both surgeons view the same magnified area of the anatomy during surgery.

The Socrates Robotic Telecollaboration System includes telecommunication equipment, networked surgical devices and robotics that provide a pathway to enable remote mentoring and surgical collaboration.

"This collaboration is the beginning of a new era of safe and effective pediatric surgery and surgeon training," said Ure, professor of pediatric medicine at Hannover Medical School. "This system will allow the expertise of major medical centers to extend around the world, to the benefit of other surgeons and directly to patients."

Computer Motion, whose surgical robotic systems serve some 3,000 surgeons in 32 countries, agreed in March to a merger with competitor Intuitive Surgical (Sunnyvale, California), a deal that the companies expect to see completed by mid-year.

Eucomed urges access to Parkinson's devices

The European medical technology industry trade group, Eucomed (Brussels, Belgium), marked the observance of the 6th World Parkinson's Day last month by urging decision-makers in the European Union to "encourage and actively promote timely patient and clinician access" to existing technologies for Parkinson's disease, as well as supporting more research into new therapies to treat the condition.

Maurice Wagner, Eucomed director general, said that in the field of Parkinson's disease in particular, "advanced medical technology can be complementary to classical pharmaceutical therapies, the efficacy of which has been shown to wane after a few years." The association said in a statement that the anticipated increase in aging populations in Europe by 2020, there will be 40% more people aged 75 or older than in 1990 will result in Parkinson's disease becoming "a major public health issue" in the coming years. The organization said that innovation in medical technology "can contribute to better, faster, higher-quality and cost-effective treatment and enhanced quality of life for Parkinson's patients."

Eucomed cited World Health Organization (Geneva, Switzerland) estimates that there are 4 million people with Parkinson's disease worldwide and that the overall prevalence in Europe is 1.6 per 100 in those over the age of 65. One in every 500 people will develop Parkinson's disease. The med-tech trade group said that about 80% of Parkinson's patients in Europe are managed using pharmacological therapies, with levodopa being the current gold standard for diagnosis and treatment. After about five to 10 years, Eucomed said, levodopa and similar drugs used to treat patients with advanced stages of Parkinson's "begin to create important side effects."

It cited deep brain stimulation via an implantable medical device similar to a cardiac pacemaker as the most effective surgical therapy available today. Such devices are used to deliver electrical stimulation to precisely targeted areas deep in the brain to treat Parkinson's symptoms. Eucomed said about 20% of Parkinson's patients may be candidates for deep brain stimulation, but the percentage of patients who have access to the therapy in Europe is generally much lower. It is 29.4% in Switzerland, but in France it is only 9.8%; in the Netherlands, 9.3%; in Spain, 8.4%; in Germany, 5.2%; and in the UK, just 4.6%.

The association said the financial cost of Parkinson's disease to medical and social services across Europe is considerable. In the UK, estimates published in 1995 gave a total figure of 382 million for 1992. Of that, 179 million was for residential care, 95 million for National Health Service costs and 49 million for hospital inpatient treatment. It added that a majority of the economic burden of Parkinson's disease comes from indirect costs such as lost productivity and informal care provided by family members, which can run several times higher than direct medical costs.

German center of excellence for Nomos

Nomos (Cranberry Township, Pennsylvania) has established a radiation therapy center of excellence at the University of Heidelberg's Mannheim Medical Center in Germany. The hospital's department of radiation oncology has integrated Nomos' line of advanced Intensity Modulated Radiation Therapy (IMRT) technologies, as well as its BAT ultrasound-guided therapy product, into its cancer treatment armamentarium. John Manzetti, president and CEO of Nomos, said the Mannheim Medical Center "represents a premier site for Nomos, utilizing virtually our entire product line as part of their radiation therapy treatment protocol." He added that with the integration of BAT SXi into the medical center's IMRT treatment routine, it is the first installation in Europe to offer image-guided target localization.

Frederik Wenz, MD, professor of radiation oncology and chairman of the medical center's department of radiation oncology, said the Nomos IMRT products "give us the opportunity to treat prostate cancer more safely to the high doses that are currently thought necessary for adequate tumor control." And he said that the company's BAT device will enable his department to more precisely locate the actual position of the prostate for each treatment fraction. "We have already established an active IMRT program for tumors of the base of skull and head and neck region," Wenz said, adding that "it is our plan to broaden the scope of our IMRT treatment capabilities to tumors of the stomach and other upper abdominal organs, which are easily visible by ultrasound." He said he also has an interest in the future application of ultrasound localization of bony structures.

Nomos introduced IMRT planning and delivery technology to the oncology sector in 1992 and said it is "becoming the accepted 'gold standard' of care in radiation treatment." It said more than 20,000 patients have received IMRT treatments at hospitals equipped with its systems.