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The robot is ready, the surgeon has completed his virtual tour of the patient’s anatomy, and the audiovisual tech has confirmed that the observers in distant conference rooms can see the operating table clearly. As the surgeon sits at the console and grabs the control handles, his mind flashes to the days of playing video games with a joystick. No, you haven’t just read the opening to a new science fiction novel; you’ve read a description of what is possible today with a variety of technological advances that are available now or in development for near-future use.
"There is great potential for robotics in same-day surgery," says Kenneth Salisbury, PhD, professor in the departments of computer science and surgery at Stanford (CA) University and scientific advisor to Mountain View, CA-based Intuitive Surgical, a company that manufactures robotics for surgery.
Surgeons want to do more complex minimally invasive surgery, but the laparoscopic tools that are now available don’t offer the dexterity needed for work with very small vessels, Salisbury says. Dexterity is enhanced with a robotic tool that has a moveable wrist that can cut and suture inside the body, he says. The use of robotic tools, also called telesurgery, is advantageous when working with small vessels in areas such as eyes because the risk of normal hand tremors is reduced since the robot is steadier than a human hand, Salisbury adds. Another advantage of robotics is the ability to reduce the scale of motion. "While the surgeon may move the control stick 5 mm, we can program the computer to reduce the scale of motion from 5 mm to 1 mm," he explains. This increases the surgeon’s ability to operate accurately on a very small scale, he adds.
Several companies have developed robotic devices for surgical applications, says Salisbury. While there is a capital investment for the robot and the computer that operates it, the most critical cost for many facilities is the replacement cost for the surgical tools, he says. "Although the tools can be sterilized and re-used for a certain number of procedures, they do have to be refurbished by the factory periodically," he explains.
The initial investment for the robotic surgical system produced by Intuitive Surgical is $1 million, says Sheila Shaw, manager of corporate communications for the company. "This price includes the computer, the surgeon’s console, the robotic equipment, the software, and instruments for initial procedures," Shaw says. After the initial investment, different tools can be purchased at prices that are comparable to standard laparoscopic tools, she adds.
Salisbury also sees the advantage of combining telesimulation as a way for a surgeon to practice the procedure before surgery. By using virtual imaging, computer simulation, and robotics, the surgeon can practice on patient-specific anatomy prior to the procedure, he says.
Virtual imaging is another technology that has given rise to a number of debates within different specialties. Virtual imaging is a process of using sophisticated CT scanning equipment to produce images that are stored and subsequently recreated by a computer to produce a visual image of the organ, explains Lester Rosen, MD, FACS, professor of clinical surgery and colorectal surgeon at LeHigh Valley Hospital in Allentown, PA. For example, the radiologist or surgeon subsequently can take a virtual tour of the colon and look for abnormalities, he explains.
The debate among gastroenterologists is whether virtual imaging can replace colono-scopy as a screening tool for colon cancer, says Michael J. Stamos, MD, FACS, a surgeon at Harbor-University of California at Los Angeles Medical Center in Torrance and chairman of the professional outreach committee of the American Society of Colorectal Surgeons in Arlington Heights, IL.
There are advantages and disadvantages of virtual endoscopy as a screening tool for colon cancer, Rosen says. (For more on the disadvantages and advantages, see "Virtual imaging spurs debate," in this issue.) "Because the virtual colonoscopy is less threatening to many patients, we may see an increase in the number of patients using this procedure to screen for colon cancer," says Stamos. "This may increase the percentage of conventional colonoscopies that are therapeutic rather than diagnostic."
Emerging technology also provides a challenge for same-day surgery managers who are planning renovations or new buildings, says Judith H. Bernhardy, RN, CNOR, director of surgical services for Norton Hospital in Louisville, KY. The new surgery building that Bernhardy and her staff moved into the week of Thanksgiving 2000 consists of 14 operating rooms that surround a central core and contain the latest surgical, sterilization, video, and even air-conditioning equipment, she says. (For more about the OR, see "You can build tomorrow’s ORs today," in this issue.)
Although her facility is equipped with the latest, Bernhardy points out that the challenge is trying to build for the future. "When you are planning, you have to think outside the box and imagine what might be available in the future," she says. You also have to be prepared to make changes during your construction phase to accommodate technology that might come onto the market, Bernhardy points out. "For example, we thought we had the best washer and decontamination system planned, then we learned of another that received better reviews from peers," she says. "Changes were made to accommodate the new system, and we are glad we made the change."
For more information about emerging technology, contact:
• Kenneth Salisbury, PhD, Professor, Departments of Computer Science and Surgery, Stanford University, Gate 150, 353 Serra Mall, Stanford, CA 94305-9010. E-mail: firstname.lastname@example.org.
• Michael J. Stamos, MD, FACS, Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 25, Torrance, CA 90509. E-mail: email@example.com.
• Lester Rosen, MD, FACS, 1275 S. Cedar Crest Blvd., Allentown, PA 18103. Telephone: (215) 433-7571. Fax: (215) 433-7210. E-mail: firstname.lastname@example.org.
• Judith H. Bernhardy, RN, CNOR, Director of Surgical Services, Norton Hospital, 200 E. Chestnut St., Louisville, KY 40202. E-mail: email@example.com.
For information on surgical robotics, contact:
• Intuitive Surgical, 1340 W. Middlefield Road, Mountain View, CA 94043. Telephone: (650) 237-7000. Fax: (650) 526-2060. Web: www.intusurg.com. Intuitive manufactures a robotic surgical system that was approved for use in minimally invasive cases by the Food and Drug Administration in 1999.
• z-kat, 2903 Simms St., Hollywood, FL 33020. Telephone: (888) 566-8122 or (954) 927-2044. Fax: (954) 927-0446. Web site: www.z-kat.com. A robotic arm that can be used for surgery is in development.
• Integrated Surgical Systems, 1850 Research Park Drive, Davis, CA 95616. Telephone: (530) 792-2600. Fax: (530) 792-2690. Web site: www.robodoc.com. The company manufactures robotic systems for orthopedic and neurosurgery.