Robotic Surgery — Today and Tomorrow. Digital Health Interviews: Cristián Konstantinidis

We all know that robotic technology has been widely utilized in various industries, but over the last couple of decades, this technology has gained great acceptability in the healthcare sector. The application of robotic surgery has been evolving constantly. From performing a variety of menial tasks, like handing over operative instruments on voice commands, to operating the most complex surgical procedures, robotic surgery is a promising surgical alternative. In our new episode of Digital Health Interviews, we decided to talk about the robotic reality and future of the industry with Cristián Konstantinidis — a urologist, a medical advisor, and a general director at Medical Robotics.

Introduction:

Cristián Konstantinidis: a urology specialist physician with solid academic background and proven experience in management and leadership. He has worked as a medical advisor in the pharmaceutical industry and medical device start-ups and participated in clinical and digital health research projects. With excellent communication skills, a positive attitude, and being strongly oriented to innovation, currently he is a general director of Medical Robotics — a company committed to disseminating, developing, and facilitating access to robotic surgery so that more patients benefit from this technology.

At first, we wondered when exactly it became not enough for our expert to be just a wonderful doctor, but also to have a deep understanding of technology and innovation. Did he feel the need for technology improvement in his daily work?

Cristián Konstantinidis: “It’s all about my personality. I am always looking for something new, I like innovation very much, and it pushes me to learn even more. I was looking for something that I could make a personal mark on. I started cooperating with startups and consulting them. At some point I started learning a lot about technology, so that led me to where I am now: working with robotics and being a medical consultant for many startups.”

His advice helps entrepreneurs better understand the clinical environment: “Very often, entrepreneurs have simply brilliant ideas, develop solutions to fix some problem, and that’s great. But they need to understand how the whole system works as well as the relationship between the clinician and the patient. If you can’t get your solution between these very close connections, it won’t work. I help startups dive into this scenario. Any physician, as long as he is open to technology and how that technology can help his patients, will become an excellent medical advisor.

Most doctors are open to technical innovations, but it is very difficult to turn them into true believers. When we hear about a new solution, we see so many problems in its adoption in the clinical field. But step by step it starts to become better. I think medical doctors will be very happy to promote the use of every new technology, but it needs to be patient-friendly and trustworthy.

I think entrepreneurs understand this situation very well. It’s not just about creating a solution, it’s about putting it into practice. You have to check how exactly it works and whether it fulfills the functionality you put into it. It’s even good that doctors are quite skeptical about it. They cannot test anything on their patients. If you are going to make a new solution, you have to be very sure: you have to go through all the regulations and have a real impact on your patients. If you go the way without results, why go on the road at all?”

Then we talked a bit about the healthcare system in Spain from the healthcare provider perspective. Cristián spoke about the system and how it works.

Cristián Konstantinidis: “The Spanish healthcare system is very powerful. All people living and working here are in the public system and on public health insurance. We also have a private system that coexists adequately, but the public system is always open to you. You can switch to a private system because it is faster and can give you some advantages. It is possible to combine them quite well due to the universality of the public healthcare system for everyone. If we talk about the working conditions for doctors, then, of course, we still have a lot to work on. Compared to other European countries, our doctors receive lower salaries, so there is space for improvement. But it’s a good system to work in. You have many opportunities, and innovations are welcomed by clinics and large hospitals, so it helps doctors enjoy working in the public sector. As for me, I worked mainly in the private sector, and I am also satisfied.”

One of the biggest problems in healthcare worldwide is interoperability — basically having patient’s data accessible throughout the city, country, and maybe a planet someday. Some countries have already successfully solved the problem. For instance, in Israel, no matter where you are going to the hospital, the doctor has full access to your history which helps with diagnosis. How is the situation in Spain with this?

Cristián Konstantinidis: “It is a serious issue in Spain. It gets better with this: you can have access to all the information here in Barcelona from the public system. It has been running for the past seven years; you can see reports, diagnoses, and images that were taken in completely different hospitals. Also, we have a special MyHealth app for patients, so they have records of all incidents, and visits to doctors at their disposal. If a person goes to an emergency or needs an urgent operation, all important information about him is collected in one place. But this only works in the public sector. If you go to the private sector, the doctors working in it do not have access to this information. So the patient can independently show it on the screen of his mobile phone. Therefore, there is still a lot of work to be done in this direction. I hope that blockchain will give us a lot of opportunities. Now we do what we can.”

Finally, we talked about one of the most interesting topics in modern healthcare — robotics. The company where our expert works is doing everything possible to promote patient access to robotic surgery in the private sector because it is very expensive.

Cristián Konstantinidis: “Robotic surgery has proven itself very well in the field of urology. We help patients find the right surgeon to perform the right robotic surgery. We work with a very large number of patients, surgeons, and insurance companies.”

In 1998, the standard version of the DaVinci™ robot was used in coronary bypass surgery, two years before receiving FDA approval. The robot is 22 years on the market. How widely do surgeons use it around the globe?

Cristián Konstantinidis: “In the USA they are very widespread. Here, in Europe, there are no big problems with them either. In Barcelona, we have 20 or 25 robots, and all over Spain, there are more than a hundred. Of course, they are very expensive. But if a medician has tried robotic surgery even once, he will never want to go back to the usual one. There are more and more of them, so they will reach even developing countries. I think that in the future, in 20 years, all operations will be carried out in this way. The question, however, is whether all surgeons will then be able to operate without robots. How many patients should there be for non-robotic surgery so that surgeons do not lose their qualifications? There are many similar questions regarding the development of robotic surgery in the future, this is a very interesting topic for discussion. I think in the future, in order not to forget the old classical techniques, we will have VR scenarios to help in learning.”

To feel confident in robotic surgery, you never stop learning. Everything depends on your background: “If you know radio laparoscopic surgery, it will be easier for you to get into robotic surgery. Depending on the complexity of the procedures, you should have 20 or 30 robotic operations in your experience. If you are starting in robotic surgery, it is recommended that you have someone experienced with you for the first 20 procedures.”

Robotic surgery through DaVinci™ appeared twenty years ago, and it is the undisputed leader. But Spain has a lot of robotic platforms on its market: “The most famous here in Europe is the Hugo Medtronic platform, we also have the Versius product from Cambridge on the market. I haven’t tried their platforms yet. I love the trends and how they help surgeons perform better surgeries.”

Then we decided to look at what healthcare-related apps are installed on Cristián’s phone. His choice is the following: Touch Surgery (an educational platform), Pubmed (scientific articles), MyHealth (a public healthcare app, also used for vaccination certificates), Doctoralia (a telehealth platform), Devicare (a startup app with solutions for kidney stones treatment), Myintuitive (a robotic surgery application).

According to our guest, to ensure the quality level of the healthcare industry in 10 years, we need to master the blockchain system as soon as possible.

Cristián Konstantinidis: “Using this technology, we will be able to use the full potential of electronic medical records. Combining this with big data and artificial intelligence will give us a qualitatively new level of healthcare, both in preventive medicine, treatment, insurance, and recommendations. We have been dreaming about it for the last 15 years. I think the metaverse will also have something to say in the medical industry soon. The future will be far more digital than it is right now. I think robotic platforms will be fully involved in the surgery. Hardware will help us perform better surgeries, and software will help us better see the anatomy of patients or even advise us how exactly to perform surgery in each case. Surgery will be artificial intelligence-assisted.”

And traditionally, at the final of the episode, catch recommendations for startup founders in digital health.

Cristián Konstantinidis: “You need to make a relevant impact on the patient's healthcare. To do this, you must not only make quality decisions but also collaborate with clinicians. You have to understand the environment to work properly between clinician and patient.”

Our previous episode was with Daniela Clape: Xpeer — a Bright Future of Medical Education