For those who are following the advancement in robotic surgery the recent earnings report by Intuitive Surgical (ISRG), the makers of the Da Vinci laporoscopic robot, show strong growth in the use of the technoloy. They reported that profits jumped 65 percent in the first quarter of 2007. Their stock is taking off as a result, jumping over 9 percent on the news. The increase in earnings comes from their focus on increasing the number of procedures per system. Sales of new robotic systems are a large part of their earnings but their unique business model of generating recurring revenues based on the number of operations performed looks to be a long term growth driver. It is the old “razor/razorblade” model because the robotic systems use instruments that are disposed after each operation. The annualized number of procedures per system increased to 133 in the first quarter versus 119 in 4Q06.

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The Korea times has an article on “surgery tours” being run to Thailand for cosmetic surgery, particularly breast augmentation. According to a woman interviewed about her experience with one of the tours the cost was less than 3.4 million won in total for breast augmentation surgery in Thailand. The cost included 2.2 million won for the actual surgery, 700,000 won for a round trip ticket and 400,000 won for a Korean guide. That is about half the cost for the same surgery in South Korea.

According to the story there are two brokers running these tours sending about 100 women a month to southeast Asia for cosmetic surgery. The tours include the usual hotel, shopping and site seeing tours during the recovery period.

There are the usual detractors of these tours. They did manage to find one woman who complained of breast pain upon returning home and could not get any help from the tour operator. And there is always a local doctor available to disparage the quality of care at foreign medical centers. The one they found for this article had this to say “I heard that many hospitals in Southeast Asia use substances of low quality imported from China for surgery. During surgery we have often found unidentified alien substances that have never seen before,’’ said Yoo Sang-wook, a cosmetic surgeon in Seoul. Amusing. I think I’ve read similar comments from doctors in Europe about surgery in Korea. Of course if you go to the top medical centers, take Yanhee or Bumrungrad for example, there is no better quality of surgery available anywhere in the world.

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Augmented reality surgery and virtual reality surgery are terms that will become more commonplace in the medical industry as advances in computer assisted operations move forward. And the Thai healthcare industry isn’t being left behind. Recently the first robotic sugery in Thailand was performed, a prostrate cancer operation at Bangkok Hospital using the Da Vinci laporoscopic robot. Laporoscopic surgery is the use of a small camera and tools inserted into the body through a small incision. Advanced systems allow the use of many specialized tools to perform complex operations. Key to making this type of surgery viable is advanced imaging, so-called augmented reality surgery, where the view of the patient is augmented by MRI (magnetic resonance imaging) scans so that doctors can see in real time what is diseased and what is healthy, and then guide the robot during the operation.

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Next week Samitivej Srinakarin Hospital is scheduled to open a privately run medical center at Bangkok’s new Suvarnabhumi airport. The clinic is set to open on the third floor of the passenger terminal complex. It will mainly provide primary medical treatment, not only to foreign tourists but also airport staff and people working in and around the airport. There is also ambulance service on 24 hour standby to transport patients to the hospital.

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Bumrungrad International will soon become the first hospital in Thailand to offer Image Guided Radiotherapy (IGRT). IGRT is a new technology for radiotherapy treatment of cancer that was first introduced in Europe in 2003. Though imaging technology has traditionally been used to identify the exact location of a tumor prior to treatment, difficulty arises when administering radiation since cancer tumors are constantly moving due to such things a breathing. IGRT is the leading and most accurate method for accurately targeting radiation to the cancer tumor.

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The Pittsburgh Post-Gazette online edition has an article that is a good read about some experiences of a few patients who have had overseas medical care, including one individual who had back surgery at Bumrungrad Hospital. After getting an estimate of $70,000 for the procedure in the U.S., $14,000 of which would have been out of pocket, he had surgery instead at Bumrungrad, with out of pocket expenses for the medical care, extra days in the hospital, and air travel for two people totaling $7,000.

The article also has some good statistics on the level of uninsured individuals in teh U.S. and numbers of people seeking overseas health care. While the cost factor is driving most of those numbers, those who have already had treatment abroad are drawn for repeat visits to places like Thailand for the superior care, not just the prices.

Another popular destination for medical care for Americans is Costa Rica. The prices don’t compete with Asia, however. Gastric banding surgery, for example, costs $16,000 in Costa Rica while at Yanhee Hospital in Bangkok, one of the world’s largest cosmetic surgery hospitals, it costs $8,400. The only competitive edge Costa Rica offers is a shorter flight from the U.S.

In the article Bumrungrad spokeman Ruben Toral is quoted as saying that a major reason that costs are so much lower in Thailand is lower malpractice insurance premiums. While a U.S. doctor may pay malpractice insurance premiums as high as $100,000 per year doctors in Thailand pay around $5,000. That huge difference goes right to the root of the cost equation. Doctors can be sued in Thailand but windfall awards of millions of dollars for pain and suffering are not awarded. The result is that all patients benefit from world class care at reasonable prices.

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Previously in Medical Care Outsourcing Soon to be Primetime it was mentioned that the insurer United Group Programs was beginning to offer coverage for offshore medical procedures and had even added Bumrungrad International Hospital in Bangkok to their preferred providers list. It seems to going prime time rapidly, with over 40 companies having already signed on to UGP’s plans. The company introduced these plans only six months ago so the ramp up is rapid. Expect to see this expand rapidly as other insurers step up to this new opportunity.

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Three leading private hospitals in Bangkok are working with Thai immigration to make it even easier to extend your stay for medical treatment purposes. Thai immigration code has a special clause allowing for long stay visas for health rehabilitation. And to make it even easier, Bumrungrad, Bangkok International and Samitivej hospitals have each established visa extension service centers in their facilities. What makes this particularly effective is it is in conjunction with Thai immigration. An immigration officer pays a visit each week to process applications for extensions and if all is in order the extension is granted on the spot. Since this type of extension requires the medical facility to sponsor the applicant, the patient has very little to do other than complete their personal information and sign the form. The hospital’s visa concierge does the rest. No need to navigate through Bangkok’s busy streets and wait in line at the immigration office. It is all handled within the cool air conditioned confines of the hospital.

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Samitivej Srinakarin Hospital in collaboration with Chulalongkorn Hospital and Thai StemLife will carry out clinical trials on the use of stem cell therapy on diabetic patients to treat limb ulcers that often lead to amputation. The therapy involves collection and replication of a patient’s adult stem cells that are then injected back into the patient’s blood stream or around the ulcers.

Adult stem cells are collected from a patient’s own peripheral blood by dosing the patient with a drug for three to five days to stimulate bone marrow to release stem cells into the blood stream. The stem cells are then extracted and stored for later use.

The researchers will also study if the application of stem cells would increase the amount of insulin produced in patients’ bodies, thereby offering another potential treatment of diabetes.

Thai StemLife is the Bangkok branch of a cord blood banking service based in Malaysia. In addition to cord blood banking they also provide peripheral blood stem cell collection services.

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Samitivej Hospital is one of the big name private hospitals in Bangkok with a history and reputation comparable to Bumrungrad. Samitivej was present at a recent health and beauty convention promotiing their “Estetics Institute”. It is a new wing at the hospital that focuses on a variety of cosmetic medical procedures.

Their list of available treatments is lengthy. A sample includes:
Light and laser treatments

• Collagen Remodeling Laser - stimulate collagen for improved skin
• Pigment Laser - scar and tattoo removal
• Vasular laser - varicose vein removal
• Cool Laser - acne treatmetn

Facial Rejuvenation

• Facial Peel
• Microdermabrasion
• Collagen Mask
• Phonophoresis - ultrasound skin feeding
• AHA - fruit extract treatment

Slimming

• Endermologie - eliminate cellulite
• Lipodissovled Therapy - reduces fat deposits
• Radio Frequency - remolds and firms skin

Other services include skin allergies diagnosis and even hygenic ear piercing. Sample prices were not offered but one should expect they are comparable to the other large private medical centers.

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