Remote Control Surgery
Gretel H. Schueller
One day if you need surgery, take heart. New technology is making operations safer, less bloody, and painless.
A patient lies on a narrow operating table. Three spidery robotic arms, each 0.9 meter (3 feet) long, loom above him. Slender tubes from the robot’s metal wrists pierce his chest. Several feet away at a monitoring console, a surgeon peers at images inside the patient’s body–a beating heart and tangle of blood vessels, magnified 10 times on a computer screen. Grasping two pencil-sized control sticks, he maneuvers the steel robotic arms to perform heart surgery.
Sound like a sci-fi episode of ER? It’s actually an operating room at the London Health Sciences Centre in London, Ontario. And with the help of the three-armed robot, Dr. Douglas Boyd, director of the Minimally Invasive Cardiac Surgery Program, performs remote control heart surgery. “This is a very exciting time for medicine,” Boyd says.
Remote control isn’t just for your TV anymore. Today, a handful of doctors around the world perform surgery without ever touching their patients. One day, remote control technology may let surgeons operate on people thousands of miles away in another country, or even on astronauts in outer space.
FIGHTING HEART DISEASE
How does remote control surgery differ from conventional surgery? Take a coronary bypass (corrective heart) operation, for example. More than 450,000 Americans undergo bypass surgery each year–heart disease is the nation’s leading killer. And one new study shows that boys as young as 15 can start to experience clogged coronary arteries, blood vessels that supply vital oxygen-rich blood to the heart (see diagram, right).
In a coronary bypass operation, surgeons graft a segment of a blood vessel taken from another part of the body, like the leg, onto a clogged coronary vessel. Their aim: to reroute or “bypass” blood flow around the blockage—like a detour around a traffic jam.
In conventional bypass surgery, a doctor cuts a 30.5-centimeter (12-inch) incision from neck to abdomen, then saws into the breastbone and cracks open the ribcage to expose the heart. “We make such big incisions because we need to get our big hands inside,” says Dr. Randall Wolf, director of minimally invasive cardiac surgery at Ohio State University.
In contrast to human hands, a robot’s steel hands feature fully rotating wrists; attached to each wrist is a single dainty “finger,” thin as a string bean. At the “fingertips,” surgical tools like scalpels (thin surgical knifes), scissors, needles, and staplers–some no longer than a pinkie nail–fit into incisions the diameter of a pen.
During conventional bypass surgery, a doctor actually stops the heart and inserts a tube that diverts blood flow to a heart-lung machine. The size of a truck engine, the machine keeps blood warm, adds oxygen, then pumps blood back into an artery after surgery.
In remote control surgery, doctors don’t stop the heart, and no such machine is needed because surgeons don’t open the chest cavity–with much less blood loss as the result. All this means less pain for the patient and much faster recovery time.
THE HOLE STORY
Since the 1980s, doctors have used tiny incisions in abdominal surgeries known as laparoscopy. But such operations don’t entail the microsurgery of heart operations, which involve cutting and sewing minute blood vessels. Doctors couldn’t perform delicate microsurgery without malting large incisions and putting their hands directly in patients’ bodies. The development of precision-honed robots has allowed them to “bypass” such obstacles.
One tool that has aided remote control surgery is a tiny camera called an endoscope. Developed in the ’80s, the camera is attached to a flexible tube made of glass fibers as fine as cats’ whiskers. Some fibers pipe light into body tissue, while other fibers transmit images back to a monitor,, the endoscope serves as the surgeon’s eyes inside the body.
In remote control surgery, a doctor sits comfortably at a computer rather than bending over a patient for hours. The only tools he or she wields are two pencil-sized control handles designed to look and feel like surgical instruments. The computer translates the surgeon’s control-panel movements into a robot’s precise micro-motions inside the body. Electrical cables flash computer commands to each robotic arm at a rate of up to 400 times per second.
The surgeon usually makes four small incisions between the patient’s ribs. The endoscope snakes through one hole and the doctor controls the camera’s path, using a foot pedal or microphone that relays vocal commands to the endoscope. Another incision holds a fork-like prong to steady the heart surface. The last two incisions let the tiny surgical instruments enter the body and perform the “blood and guts” of microsurgery.
Initially, a harmonic scalpel, a knife that vibrates so fast it liquefies tissue, slices a clogged artery. “When you cut arteries they bleed, and that’s a big problem in a closed chest,” Boyd explains. In order to avoid massive internal bleeding, the vibrating scalpel also causes blood vessels around a cut to seal off. Then the robotic arms graft a healthy artery onto a blocked one, and stitch the graft with a needle shorter than a hyphen.
At the end of conventional heart bypass surgery, a surgeon restarts the heart with an electric shock and wires cracked rib bones together. The patient leaves the hospital in extreme discomfort, with a track of staples from neck to navel, and the possibility of infection and stroke. Average recovery time: six weeks.
After remote control surgery, patients need only a few BandAids on their small incisions. One of the first patients to undergo remote control surgery, Canadian dairy farmer John Penner, was back working on his farm less than a week after his operation last September. “I knew I’d been a part of history in the making, and I felt grateful,” he says.
“The field is very new, but the potential is huge,” says Wolf. Surgical robots cost $1 million, but doctors have already begun experimental remote control surgery on the hearts of 5-month-old infants as well as on the human brain. One day, doctors won’t even have to be in the same room, the same country, or even on the same planet as the patient! Says Boyd: “I can operate on a patient eight feet away. I could be 80 feet away–and then eight miles or 80 miles away. And then maybe we could perform surgery on astronauts in outer space.”
Blood Supply to the Heart
Coronary arteries: Blood is fueled to the heart by two thick arteries branching off from the aorta, the body’s largest artery.
Coronary veins: These veins shuttle blood and harmful waste products away from the heart.
Capillaries: The heart’s smallest veins and arteries are connected by a network of tiny blood vessels. Their thin walls allow nutrients to pass from blood into surrounding tissue.
Your heart, a fist-sized muscle, pumps blood 60 to 80 times per minute. Blood flows through a network of veins and arteries, supplying life-sustaining oxygen to your body’s 50 billion cells.
SPACE AGE HEART SURGERY
Normally, to reach a failing heart, surgeons must saw through the breastbone and crack open ribs. The result: a 30.5 cm (1 ft) long hole, large enough to allow doctors to dig their hands into a patient’s chest. Now, using robot-assisted surgery, doctors can perform the same operation using remote-controlled robotic hands. The space-age technique requires a few pencil-sized incisions and reduces recovery time from 6 weeks to 10 days.
A SURGEON’S INSTRUMENTS
Designed to look and feel like traditional instruments, control sticks let a surgeon quickly adapt to remote control surgery. Each movement is processed by a computer, creating an identical but scaled-down motion at the point of surgery inside the patient. Advanced robotic systems eliminate the tremor of human hands.
Gaining access to the heart typically requires surgeons to saw through the sternum (breastbone) and crack open the ribs.
Surgeons can now achieve access to the heart by sliding thin, remote controlled robotic arms between the ribs through tiny incisions.
An endocsopic camera and instruments like robotic “hands”, scissors, and scalpels are fitted to the end of long, thin tubes inserted into the patient.
The surgeon is able to sit comfortably in front of a main monitoring console, eliminating the physical fatigue and strain associated with hours of standing and bending over the patient.
A complex structure unifies the operating table and robotic arms into a single “smart” system that transmits information to the surgeon’s console. For example, the instrument’s “hands” inside the body can be equipped with sensors that record subtle changes in a blood vessel’s tension and resistance. This data is instantly transmitted to the control instruments held by the surgeon.
Research: Research and make a list of other tasks that robots currently perform.
Did You Know? * New surgical technologies include “virtual retinal display,” which beams pictures and information directly onto the surgeon’s retina.
* So far, remote control surgery has also been used in brain and stomach surgery, and in infant heart surgery.
* “Star Trek” medicine could one day be real. Tiny robotic devices that you swallow perform scratch-free surgery.
National Science Education Standards
Grades 5-8: personal health * science and technology in society * risks and benefits * abilities of technological design
Grades 9-12: personal and community health * science as a human endeavor * natural and human-induced hazards * behavior of organisms
“Next Up: Surgery by Remote Control,” The New York Times, April 4, 2000, p. F1
“The Beat Goes On,” Popular Science, March 2000, p. 62
“Operating on a Beating Heart,” Scientific American, October 2000, p. 58
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