Minimally invasive surgery opens new applications for ultrasound

Ex-Otsuka president joins Tetrad effort

Increased use of minimally invasive surgical techniques has helpedcut procedure costs, reduce risk and improve patient comfort.One limitation of endosurgery, however, is that surgeons loosetheir tactile sense in evaluating organ structures directly. Ultrasoundimage guidance can provide surgeons with an alternative to thatsense of touch, according to Tim O'Sullivan, vice president ofsales and marketing for ultrasound supplier Tetrad.

O'Sullivan, a former director of U.S. MR operations for Philipsand president of MR vendor Otsuka Electronics (U.S.A.), joinedTetrad early this year after serving the small Englewood, CO,firm on a consulting basis. He left Otsuka a year ago (SCAN 5/5/93).

While Tetrad is relatively new as an ultrasound scanner supplier,the firm has been in business for nearly a decade. Four of itsfounders came from Technicare to start the effort in 1985 followingJohnson & Johnson's decision to close its medical imagingsubsidiary, O'Sullivan told SCAN.

Tetrad initially provided contracted engineering services,including work for ultrasound firms ATL and Aloka. The firm manufacturedDoppler systems for Aloka and other companies, he said. Later,an emerging medical technology development opened up new applicationsfor ultrasound. Tetrad opted to tackle this new frontier directly.

"They decided to build their own product in 1990. Themotivation for that was minimally invasive surgery," he said.

While other ultrasound suppliers, such as Aloka and B&K,provide systems for ultrasound guidance of endosurgery, Tetradis the first to develop, build and market a system specificallyfor that purpose, O'Sullivan said. Use of ultrasound in the operatingroom requires more automation and less direct system manipulationthan do general imaging applications.

While in scrubs, surgeons and nurses cannot turn the dialsand manipulate the ultrasound system as a radiologist might. Theirability to see panels and knobs on the system itself is also limitedbecause of low operating room lighting, he said.

Surgeons control the Tetrad E/U endosurgical ultrasound systemthrough a hand-held remote device. The system configures itselfautomatically when a particular probe is chosen, O'Sullivan said.

"It is fully automated through the transducer plugs. Whenyou plug in a transducer, the system knows what sort of parametersto use," he said.

Tetrad E/U has potential application in all surgical environments,including general surgery, gynecology, thoracic surgery, urologyand neurosurgery, he said. However, general surgeons have shownmore interest in the system than have urologists and other physiciansoperating in their private offices. About eight Tetrad systemsare installed in hospital and other high-volume minimally invasivesurgery sites.

"Urologists use office-based products that are prettylow-performance," he said.

Tetrad E/U with VCR, printer and one probe sells for about$95,000. The unit is Food and Drug Administration-certified, althoughtwo probes are still under device review by the agency. One probeprovides two-way and the other four-way articulation in orderto maneuver the transducer around organs.

Tetrad E/U operates transducers at up to 10-MHz frequency,allowing them to be positioned against organs in order to bettervisualize internal structure. Standard pulsed Doppler allows surgeonsto distinguish and avoid arteries, veins and ducts.