The Robotic Doctor is In

By 10 am the robot has already carved out an entire human organ.The patient's gallbladder, riddled with infection, is gone, and in a darkened operating room at Boston's Beth Israel Deaconess Medical Center, the machine is going back for seconds.

Its next target is a tumor, buried in that same woman's kidney. So the bot remains perched, its arms fanned out over her like some great, hulking insect. Those arms twitch and wriggle, and inside the sleeping woman's abdomen its tiny, dexterous manipulators slice and burn through fatty connective tissue, maneuvering around veins, arteries, and nerves, clearing a path to the cancer with a level of precision no human could ever hope to muster. The robot, called the da Vinci Si Surgical System, isn't performing a partial nephrectomy under its own volition. It is being controlled by two human surgeons seated at a pair of consoles in a corner of the OR. They take turns commanding the machine, using an array of foot switches and hand controls, to snip or sear through tissue. Their movements are replicated by the robot a dozen or so feet away and interpreted too?the da Vinci smooths out the control signals, eliminating physiological tremors from the doctors. The robot enhances even as it obeys.

This isn't some experimental test or limited pilot program?it's simply how surgery is done today. The da Vinci system, which first reached hospitals 14 years ago, has become the most common surgical robot on the planet, with almost 2500 units worldwide performing over 200,000 procedures per year. And while the bot was initially used in urologic surgery, it's since racked up so many procedures that the system's manipulators now touch nearly every internal organ. Instead of encircling the patient in a tight, huddled pack, the nurses, technicians, and surgeons in a da Vinci operating room each have a discrete station in a different part of the OR, and all the specialists are staring at screens showing the same intimate, zoomed-in contours of the patient's insides. Over the past decade robots have reshuffled a work environment that had taken more than a millennium to perfect and have transformed an entire profession.

"The surgeon's role is totally different now," says Andrew Wagner, director of minimally invasive urologic surgery at Beth Israel and the attending surgeon for the procedure I watched. "A couple times a month, a patient will say, 'Let me see your hands.' They want to see how steady they are. And I do it. I play along. What I don't tell them is that it really doesn't matter. Motion scaling removes that part of the job."

According to Wagner and the growing number of surgeons and hospital administrators who've seen the da Vinci in action, the benefits of robot surgery come from the ability to synthesize human intelligence with machine-assisted precision. Like the majority of other surgical robots, the system specializes in minimally invasive procedures. Its slim, cable-driven manipulators fit into relatively small incisions, fully or partially removing organs more nimbly than the poles used in traditional laparoscopic surgery, and with less trauma than open surgery. There's less violence done to the patient, which not only turns potentially massive scars into minor ones, but can also reduce the rate of complications and cut recovery times. Whereas open prostatectomies typically require a three-day hospital stay, a patient could go home within 24 hours of a robotic procedure, if not that same day.

"We've moved from doing prostate and kidney surgery all open to 90 percent robotic," Wagner says. While many of his patients are excited by the prospect of being operated on by a robot, others are terrified. "The word robot is very misleading. They think I push a button and then walk out of the room," Wagner says.

The Robot Surgeons Coming to an OR Near You

Eight years ago, the problem with the Renaissance surgical bot wasn't underperformance?in fact, it was doing too much. Still in development at the time, the machine was designed to guide a drill to specific positions along a patient's spine and, when given the go-ahead by the attending surgeon, bore away. But during preliminary testing, Israel-based Mazor Robotics found that orthopedic surgeons wanted the robots to have less autonomy. They were fine with letting the robots aim, but they wanted to pull the trigger and retain that tactile feedback of the bit spinning through bone. So, Mazor CEO Ori Hadomi says, the company demoted its creation and removed the automatic drill.

The Renaissance bot is a relative newcomer to the OR, with just 18 systems in the U.S. so far, but it's not alone. The wide range of partially autonomous surgical robots currently deployed includes the Lasik laser eye surgery system, Mako Surgical's joint resurfacing RIO system, and the CyberKnife system, which doesn't physically cut into patients but hits them with precisely targeted doses of radiation. These are true robots?machines that are given specific orders but whose programming determines how to execute those tasks.

The CyberKnife, for example, isn't simply a medical-grade particle accelerator with good aim. Its algorithms allow it to hit a moving target, adjusting its beam to accommodate a patient's breathing or other involuntary movements, so its beam can be narrower and its sessions fewer. Someone who might have needed a six-week course of radiation from a traditional linear accelerator can spend as little as a week with the CyberKnife. And since the machine is hitting bull's-eyes every session with an emitter that conforms to the irregular shape of a given organ, there are fewer side effects and less crippling discomfort.

The CyberKnife might be saving patients who, with traditional treatments, would have been written off. Initial results from an ongoing study at the University of Pittsburgh indicate that CyberKnife treatments can turn pancreatic cancer patients, who often would have been considered inoperable, into viable surgical candidates. Dwight Heron, a professor at the university and an oncologist, says, "This is something we've never seen before." By shrinking the tumors with precisely targeted radiation before subjects go under the actual knife, surgeons can potentially remove one of the most lethal cancers. "We're talking about patients where surgeons say, 'We can't take it out. Maybe you'll live a year.' Now they'll live potentially five years and may even be cured," Heron says.

Source: http://www.popularmechanics.com/science/health/med-tech/the-robotic-doctor-is-in-15204883?src=rss

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