Robotic help in operating rooms

: .Remotely controlled devices are changing the way doctors do surgery.

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'pal centers around the country, including the University of Illinois at Chicago.

I The curious doctors stuck their geads in a console that gives a three-dimensional view of the operating table a few feet away. They ised paddle-like controllers to giove tiny robotic surgical instruRients. Lacking an actual patient, Oiey practiced taking needles out of pincushion.

Surgeons at UIC have been using pie robotic system to remove kidneys from live organ donors and to fake out diseased gallbladders, Among other applications. Dr. San@go Horgan, director of minimalty invasive surgery at UIC, said such devices could send the whole profession down a new path.

"It's just an amazing instrument, no doubt," Horgan said. "It's really amnging the way we do surgery.' " A major advantage of robotic tools is that they do not tremble like human arms. Doctors also can program precise configurations to use at different points in the surgery. Unlike current endoscopic techniques that give a two-dimensional image on a conventional monitor, Horgan said the da Vinci's three-dimensional views allow for more finely detailed work on blood vessels and other tissue.

"You can be much more accurate, with less blood loss," Horgan said.

Despite the advances, experts cite some drawbacks in such systems. The cost-about $1 million for a da Vinci robot or the competing ZEUS device made by Computer Motion Inc.-may put the tools out

of reach for many hospitals.

Another problem is that with remotely controlled instruments,

surgeons lose the tactile feedback they have when they use scalpels or other tools with their own hands.

Dr. Alfred Cuschieri, a surgeon at the University of Dundee in Scotland and a pioneer in endoscopic technology, said he is @g to develop devices that provide such feedback. His team also is working on display technology that projects a magnified image of the operating area, suspended in the air in lyont of the surgeon.

"When a surgeon looks at the monitor, that means looking away from the hands," Cuschieri said. With a suspended image, he said, "the surgeon can look down at the patient's anatomy in coordination with his own hands."

As surgeons become more comfortable with the robotic tools, they are finding more sophisticated applications.

In May, doctors at East Carolina University in Greenville, N.C., began a clinical trial using the da Vinci device to repair mitral valves in patients' hearts. Such procedures account for a large chunk of the 70,000 heart valve operations performed each year.

The Carolina team found that robotic surgery cut patient recovery times by half, in large part because surgeons do not need to cut open the entire chest to work on the heart. Such advantages may justify the cost of robotic techniques by reducing expensive hospital stays.

Yet the robots work by a principle familiar to con . iputer users- garbage in, garbage out.

"Imis is not going to take a Cgrade surgeon up to a whiz-bang surgeon," said Dr. W Randolph Chitwood, leader of the Carolina team. "We're not talking about R2D2, C-3PO types of robots. It's an enabling technology."

Remote surgeries such as Ka-voussf's Chici-go-Baltimore feat likely will not lead to the replace-

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'61BUNE STAFF WRRMR

'.A quick glance at the booth in McCormick Place where Dr. Louis Kavoussi tapped away at a computer Tuesday offered little sign that he was assisting in a delicate operation-let alone surgery on a patient more than 700 mfles away.

Yet with the click of a mouse and a flash of signals over high-speed phone lines, Kavoussi cut nerves and Bed a surgi camera

co gues at Johns Hopkins

University.

The operation reflected the rapidly expanding role of computers and robots in operating rooms, a major theme at this week's Chicago meeting of the American CoRege of Surgeons. Such emerging techniques permit greater surgical precision and may one day allow land-based doctors to assist with operations on far-flung naval vessels or on the International Space Station, experts said.

Even so, the echoing haU at times made Kavoussi sound more like a teenager at a raucous party than an expert helping feuow surgeons through a tricky procedure.

"I'm sorry, T.J., speak up a-id toward the mike-there's a lot of noise in here," Kavoussi said early in the operation. The procedure, staged especially for the convention, marked the second time doctors have used the technique to operate at such a great distance. The & natient, who had been suffer-

e--,

ing from chronic pain, needed su Irgery to sever nerves leading to one of his testicles. While looking at video images transmitted from in-, side the Baltimore patient's body, Kavoussi operated a cauterizing unit that slowly burned away the nerve bundle.

On the whole, it's probably a good thing the patient was unconscious,

Robots and computers are almost everywhere at the surgical grou@'s Annual Clinical Congress, being held at McCqrmick Place through Friday. In addition to the long-distance technique that Kavoussi demonstrated-4esigned by Karl Storz Endoscopy@ozens of doctors flocked to the lavish booth for the da Vinci Surgical System, which in July became the first surgical robot approved by the U.S. Food and Drug Administration. Surgeons from around the country stood in line to try out the robotic device, now being used at 15 med-

SF I RonoTics, BACK PAGF

ment of local doctors, most experts said. The most inunediate application may be for the training of less experienced doctors by surgeons who have mastered a technique.

Some of the technology used in surgical robots was originally developed for the U.S. Army in hopes of using it in battlefleld situations, where an experienced surgeon operates on a wounded soldier from behind the lines. Daniel Goldin, administrator of the National Aeronautics and Space Administration, has said the technology also could be used to assist or simulate operations for astronauts on the space station or on a future mission to Mars.

For all the advanced technology on display at McCormick Place, on@, of the most popular booths amon doctors who spend uncount hours on their feet was one that fe@@,' tured a low-tech product: Birken-i stock shoes. Coms and bunions doubtless will be a prime conce@ in the medical profession for ye@ to come-at least until machines @. place human surgeons altogether.,.,4