Robotics - The Future of Medicine

Robotics in Health CareI used the term robotic surgery in the story at the beginning of this chapter. But the concept of robots in surgery is actually quite different than the autonomous or semiautonomous R2D2 of science fiction and the movies, and it differs from the industrial robots of, for example, an auto assembly plant. A better term might be remote computer assisted telemanipulators. This is quite a mouthful, but what it basically means is to merge industrial robotic technology with three-dimensional visualization systems and computer technology.

Two of the arms of the robotic device can hold and move instruments, such as laparoscopic instruments, and a third arm can transmit two independent images from a stereo telescopic camera mounted at its tip. Remember the discussion of the laparoscopic instrument? It's a long rod with, for example, a pincher device at one end, which will be inside the abdomen, and a set of handles to operate the pincher at the far external end of the laparoscope. The amount of freedom of movement in the laparoscopic instrument is rather limited.

Compare that to the surgeon doing open surgery whose arm, wrist, and hand is within the abdominal cavity. We speak of the wrist as having six degrees of freedom of movement-look at your wrist and watch how you can move it up, down, left, right, and in a rotational motion either direction. The laparoscopic device is much more limited. The joints and arms of the robotic surgical devices also have six degrees of freedom of movement. If these devices are inside the patient and attached to the robot rather than being held in the surgeon's hands, how does the surgeon control the system?

The answer is that the surgeon's head sits inside a console in which he or she can see a three-dimensional image of the operative field, created by integration of the right and left camera images, within the console. So the surgeon has a clear three-dimensional view of the robotic surgery and can manipulate tissue with the instruments as if the surgeon's hands were holding the laparoscopic instruments inside the patient. This is done by having the surgeon hold a series of handles at the console to manipulate the robotic arms. The surgeon is fully in control of the equipment.

mentioned that these robotic devices are being used today at some centers for cardiac surgery. Now I'd like to invite you to use your imagination again. A patient is put on the heart-lung bypass machine, so that during cardiac surgery the heart can be stopped and the surgeon can work without the heart beating. Obviously it's difficult to suture a vein bypass to a coronary artery while the heart is beating. But what if the robot was so sophisticated that it could use the electrocardiogram to tell it when the heart will beat? Then the robot's arms could be adjusted electronically to the beating heart, so that the arm of the robot and the instrument that the robot is holding are all moving the same as the heart is moving.

In essence this would give the appearance that the heart was standing still as the surgeon watches the effort on the three-dimensional console screen. Now the surgeon can do precise suturing on a beating heart rather than a heart that has been stopped. This, of course, means that the heart-lung machine, with all of its potential for complications, wouldn't be necessary.

Not too long ago, a gallbladder removal was done in France using a surgical robot. But the surgeon, Dr. Jacques Marescaux, was not at the console in the operating room, but at a console in New York! So this was transatlantic telerobotic laparoscopic cholecystectomy. Let's just call it telesurgery for short. What could this mean for the future? Imagine someone needing urgent surgery in a remote location where a trained surgeon is not available. Or imagine a soldier wounded on the battlefield, who needs a particular type of surgery, but the expert is oceans away. In both cases telesurgery could make the needed surgery available.

Mehran Anvari, a surgeon in Canada, has performed several telesurgeries, operating from his hospital suite in Hamilton, Ontario, on patients in a hospital in North Bay, a distance of about five hundred miles. A reliable telephone line and solid communications with physicians in North Bay have ensured the success of all of these surgeries and allowed the expertise of Dr. Anvari to be applied to patient care from a great distance.

Recently, in a research project sponsored by NASA, the Canadian Space Agency, and TATRC, Dr. Anvari in Canada, performed surgical skill tasks on a simulated patient located in the NOAA underwater laboratory off the coast of Key Largo, Florida, a distance of more than one thousand miles.

The research project tested the effects of latency on the ability of a telesurgeon to perform effectively and identified the types of accommodations made by surgeons to surgical challenges. And very recently, a different team used a new smaller, lighter, and more portable robotic surgery system to perform simple surgery tasks assisted by the Penelope robot. Penelope responded to voice commands to provide and remove supplies to and from the surgical field, thus allowing a surgeon to simulate surgery robotically.

 

Last Modified: June 11, 2010


Copyright (c) Stephen C. Schimpff, MD