The economics of healthcare have long incentivized innovation around commonplace conditions with high patient volumes. Consider the century-plus of discovery in cardiovascular disease, the most common cause of death in the world. The Archives of Internal Medicine published the first concept of the pacemaker in 1932 and the first attempt at electrical defibrillation dates to 1775.
Our approach to medical discovery, however, must evolve as technology grows more sophisticated. The innovator’s mindset is shifting from solving the problems right in front of us to solving problems once considered impossible to fix. The lines between curable and incurable diseases are blurring in surgery because medical devices are scaling up precision and scaling down the size of anatomy that surgeons can operate on.
The next great breakthroughs in medicine will come from fixing the “unfixable” problems – and advances in surgical technology will reimagine where physicians draw the line between possible and impossible.
Too small to fix
Repairing microscopic anatomy – vessels, arteries, nerves – has earned “impossible” classification in many cases because the human hand simply cannot operate on something the width of a couple of strands of hair. By unlocking the ability to work on a microscopic level, we can address a wide array of disease states that negatively impact population health today.
Lymphedema, for example, is a life-altering disease that afflicts nearly one in three women who receive treatment for breast cancer and 250 million patients worldwide. There are no drugs or therapeutic cures for lymphedema, because until now, we have not had the ability to surgically repair the lymphatic system, which flushes waste – known as lymph – from the body. But robotic platforms, coupled with powerful magnified vision, allow surgeons to see the problem and manipulate instruments with a delicate precision that they’ve never had before.
We can also reconsider existing treatment options and improve upon them. For instance, reconstruction surgery after breast cancer treatment can become safer and more effective. Rather than relying on synthetics, which are prone to infections, we can normalize autologous breast reconstruction. It is a more challenging procedure but produces better outcomes, as it utilizes the patient’s own tissue instead of synthetics. The less superficial flap reduces donor site morbidity and the risk of infection, while robotic-enabled precision can make the procedure as minimally invasive as possible.
Another opportunity to improve treatments exists in post-traumatic surgery. Today, physicians default to amputating a large percentage of limbs or digits after a serious trauma because they lack the tools to save the appendage in a highly complex surgery. The effects of amputation create significant mental and physical burdens for patients, which we can avoid by revascularizing, or restoring blood flow to the limb. 28 million people in the U.S. are at risk of amputation surgery each year and an estimated 58 million people worldwide live with an amputated limb worldwide.
We choose to go to the moon
When President John F. Kennedy famously declared “We choose to go to the moon” in his 1962 speech at Rice University, he set the tone for a new era of scientific discovery. It ultimately resulted in the successful Apollo 11 mission and subsequent decades of exploration of outer space, despite widespread public opposition to investing in the space program.
Kennedy’s ambition marks one of history’s best examples of thinking beyond what we currently perceive as “possible”, and it is a valuable lesson that medical innovators should take to heart today. In medicine, however, the next frontier of exploration is not as big and grand as flying to the moon – rather, it is characterized by the microscopic parts of human anatomy that traditional medicine has never reached.
A perfect example of Kennedy’s spirit occurred earlier this year when physicians at Boston Children’s Hospital and Brigham and Women’s Hospital repaired a brain malformation in a baby still in her mother’s womb – the first such surgery in the U.S.
The landmark procedure serves as a remarkable case study in treating emergent conditions in unborn children or very young infants, while it also begs the question, “how small can medicine go?” The once prohibitive complications of operating on highly delicate anatomy no longer represent a barrier to care, and pediatric medicine stands to benefit from advances in surgical precision.
As an investor in medical technology, I have seen how device makers have altered their approach in recent years to tackle more complex and specialized conditions. That paradigm shift is channeling more funds into complex disease states, rather than the most common ones.
Intuitive Surgical – the first company to dominate the surgical robotics space – burst onto the scene in the early 2000’s with a device for minimally invasive general surgery. Since then, a new generation of devices has emerged that focus on very specific procedures. The devices themselves are evolving from generalist to specialist, and that is making them more capable in areas of medicine that historically lacked treatment options.
As the specialized devices continue to gain momentum in clinical use with highly skilled surgeons, they will cross more uncrossable barriers and open the door for surgeries we haven’t even imagined yet. Medical innovation’s “landing on the moon” moment is coming, and it will rewrite our definitions of curable and incurable disease.
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