CLEVELAND, Ohio — On the eve of her hysterectomy, Paula Miller was as excited about making medical history as she was being freed from the excruciating pain and nausea of her menstrual period.
The 37-year-old mammogram technician would the next day have her uterus removed by a surgeon at MetroHealth Medical Center who she had just met but trusted immediately: Dr. Kevin Stepp.
“It’s amazing the technology they come up with, that I’m going to be part of medical history with him,” said Miller, who also works at MetroHealth. “It’s very exciting.”
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Stepp wanted to remove the organ through a single incision in Miller’s belly button — something he had done dozens of times before — but this time with the help of a robotic system called ViKY. The system would enable him to perform the surgery by himself — without the usual one or two assistants.
The surgery also was exciting for Clement Vidal, chief executive of EndoControl of Grenoble, France, the maker of ViKY (which is a French acronym that describes the way the device functions). Vidal wanted to watch how used his company’s technology so he could tell other surgeons how to use it.
It would be the first time ViKY wouldbe used anywhere in the world to both guide the laparoscopic video camera and light that “see” inside Miller’s abdomen, as well as position her uterus during surgery.
Surgical robots enable surgeons to go places inside the body where their hands and hand-held instruments don’t fit. With robotic devices, surgeons can navigate a blood vessel, repair a heart valve from the inside and remove a uterus (through the vagina) by working through one small incision in the belly button.
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Robotic technologies also are cool. Dr. Miranda Bailey, a surgeon on ABC’s Gray’s Anatomy television show, acted like a kid in a candy shop when fictional Seattle Grace Hospital got its first multi-station DaVinci Surgical System. DaVinci has made the rounds at medical conventions, attracting lines of doctors who want to try the system that operates something like a video game.
DaVinci is a sophisticated surgical technology made by Intuitive Surgical Inc. that enables surgeons to operate remotely — they sit in front of a computer screen and use a console of levers and buttons to move instruments that operate on patients who are located several feet away.
ViKY looks nothing like DaVinci. Rather, the French company’s device looks more like a medical instrument-holder on a circular base.
That’s okay with Stepp, assistant professor at Case Western Reserve School of Medicine, who found the device by keeping track of the search term “single-incision laparoscopy” in his Google Reader. Stepp likes ViKY partly because he can do surgery at the side of his patient, using the robot like a couple extra pairs of hands.
ViKY also is a bit of a David-and-Goliath story. The device was born in 2000 in a laboratory at Grenoble University, Vidal said. “And in 2005, we decided to transfer it to the industry,” he said.
“So, there are all sorts of little startups that are trying to come up with better robots,” said Stepp, who also is fellowship director of minimally invasive surgery and urogynecology. “Just like when you bought an IBM computer in the 1960s, it was big as a house and cost twice as much, but now, I have one on my hip.”
One of two things usually happen to these surgical robot start-ups. “They either get bought up by Intuitive (the maker of DaVinci),” or they start making their own headway, he said.
The global market for surgical robots each year is about $1 billion, Vidal said. Intuitive Surgical, maker of DaVinci, dominates that market, accounting for more than 90 percent of sales, he said.
The first of four ViKY components — an endoscope holder — was CE Mark approved for sale in Europe in 2007, Vidal said. In December, the U.S. Food and Drug Administration approved ViKY for sale in this country.
Unlike daVinci, ViKY is simpler, smaller and specialized to do certain surgical tasks, Vidal said. ViKY also costs a fraction of daVinci, which can do many more surgical jobs. “The DaVinci is $1.7 million for the old version, and $200,000 a year to maintain it,” Stepp said. “All said and done, the four components of the robotic [ViKY] system should cost around $150,000 or $170,000.”
Stepp used ViKY’s endoscope holder three months ago. Today, he also will use the system’s second component — a uterus manipulator. The surgeon has no financial relationships with EndoControl.
He begins surgery by fixing two ViKY units to rails on the operating room table. One unit is positioned above Miller’s belly button, the other just outside her vagina.
Using foot pedals, Stepp can move the units holding the laparoscopic camera and light and the uterine manipulator in or out, up or down, and right or left.  Surgical technicians who usually operate the camera or move the uterus during surgery stand nearby, arms crossed, watching.
A half-dozen MetroHealth surgeons walk in and out of the operating room to watch their colleague perform his first laparoscopic hysterectomy by himself. Stepp asks questions of Vidaland gives him feedback on how the devices work throughout the surgery.
Stepp and his partner, Dr. Rob Pollard, have performed about 45 single-incision hysterectomies over the last year. For women who can’t have their uteruses removed vaginally, “this is absolutely the least invasive way to do it with just a single incision through the belly button, he said.
Inexpensive surgical technologies like ViKYalso could lower health care costs. “For example, each component of this device certainly costs less than what you would pay a surgical tech over the course of a year,” Stepp said.
