It’s not the trailer for the latest sci-fi blockbuster. Over the past several years, more and more hospitals have been using robotic technology to perform a wide variety of procedures, from prostatectomies to its newest use cardiac bypass surgery. These technologies, pioneered by the military and NASA, allow physicians to expand the number of procedures they can perform effectively on a minimally invasive, laparoscopic basis.

Explains Dr. Thomas Krummel, Professor and Chair of Surgery at Stanford Medical School, “(Robotic surgery) is another tool that has specific applications.” Dr. Sanjeev Dutta, Director of Stanford’s Surgical Skills Curriculum, concurs, calling the robot “an enabling technology.”

Experts estimate that approximately 70,000 robot-assisted surgeries were performed in the U.S. last year. Those procedures included 35 percent of all prostatectomies performed (the first procedure for which robotic technology was FDA approved) as well as kidney transplants, hysterectomies, heart repairs and bypasses, reversal of tubal ligations, gall bladder removal and gastrointestinal procedures.

Less invasive approach lowers risk of complications, speeds recovery
Robotic surgery systems allow surgeons to perform operations through significantly smaller incisions. In turn, that results in:

less blood loss
lower risk of infection
shorter, often less painful recovery

Equally important, the use of the technology allows physicians to gain access to small, hard to reach spaces in the body and provides clear, 3-D real-time images of the surgical area. It also removes any hand tremor from the surgical equation, permitting greater precision. In operations like prostate removal, that can improve outcomes, sparing more nerve function to decrease the incidence of impotence and incontinence. One-year cancer-free survival rates are similar for open and robotic prostate surgery.

A 2003 study comparing open prostatectomy to those performed with robotic technology found that the open surgery patients lost five times as much blood, had a four-fold greater risk of complications and spent more than three times more time in the hospital. In addition, those who underwent robotic surgery were able to engage in intercourse 11 months post-op while half of open surgery patients were still experiencing impotence two years post-op. Similar findings were reproduced a year later at another hospital.

Overcoming the restrictions of “operating with chopsticks”
There are a few drawbacks to robotic surgery. The systems cost more than $1.5 million to purchase and require both costly replacement parts and a large area of operating room space. Smaller, less costly robotic systems are in the early stages of development at several labs including Purdue University.

The drawback that frustrates physicians most, however, is the loss of the sense of touch while operating. Solving that problem is the focus of the work of Allison M. Okamura, Associate Professor of Mechanical Engineering and Director of Johns Hopkins’ Haptics Exploration Laboratory. The concern is that the lack of the sensory feedback to which they are accustomed causes surgeons to work more slowly, increasing the risk of bleeding and other complications.

“The sense of touch is important to surgeons,” Okamura explains. "They like to feel what’s happening when they're working inside the body. They feel a ‘pop’ when a needle pokes through tissue. They can feel for calcification. Their sense of touch helps tell them where they are within the body. In robotic procedures and other types of minimally invasive surgery, surgeons insert long tools between their hands and the patient. This approach has definite medical benefits, but for the surgeon, there's a loss of dexterity and haptic information. It's like operating with chopsticks that have grippers on the end.”

Okamura and her team are working on several possible solutions. One promising approach is to attach force sensors to the robotic arms that tell the doctor how much force he or she is applying.

No robot takeover
Don’t expect to see fully automated, human-free operating rooms anytime soon. “Robotic surgery systems are wonderful tools that open new opportunities for minimally invasive approaches to a wide range of procedures,” says Miles J. Varn, PinnacleCare’s Chief Medical Officer. “While they are a way to enhance the performance of physicians, it is still essential that you choose a skilled and experienced physician, a process that a PinnacleCare Advocate can put in motion for you.”

Resources
“Lower Cost, Portable Surgical Robots Could Be Smooth Operators.” This article on Science Daily provides interesting details on robotic surgery innovations in the pipeline.
http://www.sciencedaily.com/releases/2006/03/060306113436.htm

“Developing Force-Feedback Technology for Robot Assisted Surgeries.” Wired magazine offers a summary on current progress in the development of haptic feedback for robotic surgery with links to more information.
http://blog.wired.com/wiredscience/2007/04/developing_forc.html