[ ROB YOUNGE & FREDERIC MOLL I

 

 

 

A robot that

fixes hearts

 

 

 

The throng's attention was riveted on a huge video display at the American College of Surgeons' annual meeting in October.  In a live demonstration, scissors, scalpels, and forceps busily snipped artificial tissue, threaded a needle, and tied neat stitches-with no human hand in sight.  A surgeon sitting at a futuristic console nearby was working his wrists and the thumb and one finger of each hand as he peered into two small screens giving him a 3-D view, magnified and in color.

Frederic Moll was warmed by the enthusiasm of the onlookers, who were watching a surgical robot called da Vinci do its stuff.  But the 49-year-old physician and medical director of Intuitive Surgical, the small Mountain View, Calif., company that he cofounded and that manufactures the near$1 million robot, knows he can't rely on novelty for da Vinci to become an operating-room fixture.  "It's got a long way to go," he said as the physicians drifted away.  "It's too big.  It's too expensive.  It doesn't have all the tools surgeons need." But he vows to eliminate these drawbacks.

Patients can only hope.  Robotic surgery has been tried on a relative handful of people for a few types of procedures.  But if it catches on, the potential payoffs are impressive: smaller incisions, less pain, fewer infections and other complications, shorter hospital stays, faster recovery, even improved odds that the outcome of a procedure will be a success.

Da Vinci does not perform operations unaided.  It is more like an extension of the surgeon-articulated tools at the end of three arms inserted into the body through small openings.  Once inside, the tools need little room to maneuver, flexing and grasping like fingers and hands.  That deftness is the work of Intuitive cofounder Rob Younge, trained as an electrical engineer and intrigued by robotics as a Hewlett-Packard manager.  At Intuitive, he assembled a team that gave da Vinci the same manipulative skill, or degrees of freedom, as the human

 

ROB YOUNGE - Born: June 13,1951; Grand Junction, Colo. Education: B.S., M.S., electrical engineering, Stanford University. Favorite spectator sport: Watching kids play.

FREDERIC MOLL - Born: Nov. 3,1951, Seattle.  Education: M.S., business, Stanford; M.D., University of Washington.  Big goal: To revolutionize surgery.  Small goal: To understand women.

 

 

 

50 U.S.NFWS&WORLDREPORT,DFCEMBER25,2000/JANUARY1,2001

 

 

 

 

 

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ONNOVATORS 2001

 

hand and wrist.  A surgeon no longer has to contort like a gymnast to suture an elusive artery, since the tools can reach around and behind vessels and organs.

Moll was inspired after witnessing a demonstration in 1995 of a crude surgical robot developed for the militaryby SRI International.  He knew he would need an imaginative engineer.  On an adviser's recommendation, he sought out Younge, who immediately realized that the technology existed to make a surgical robot feasible.  'It was like getting the stars in the skies to line up all at the same time," says Intuitive's chief technology officer, who as a boy in Grand Junction, Colo., would chase the telephone repairman down the street to beg for wire to wind electromagnets.

Da Vinci performed its first operation on a human being in March 1997.  Doctors at the University of Dresden's Cardiovascular Institute have now performed many heart operations, including well over loo beating-heart coronary bypass surgeries a difficult procedure.  Last July, the Food and Drug Administration cleared da Vinci for use in laparoscopic procedures, such as removing the gallbladder or surgically correcting severe heartburn through small incisions.  The robot has been employed experimentally in Germany to remove cancerous prostate glands while sparing the nerves that control erection and the muscles that control urination.

Valve jobs.  In the United States, mitralvalve repair has become da Vinci's forte.  This valve regulates blood flow between the heart's left atrium and left ventricle.  Blood can pool if it weakens or leaks, causing heart failure and thousands of deaths each year.  Last May, a team led by W. Randolph Chitwood at East Carolina University's Brody School of Medicine in Greenville, N.C., performed the first da Vinci-aided beating-heart mitral valve repair in the country.  By late June, 69-yearold Ingeborg Benfield was hiking in the

 

 

 

MAHK LEE FOR USN&WR

 

 

 

 

 

INT@ITI@E SURGICAL

 

 

 

Doctors are already relying on the da Winci rooot to aid surgery on patients in Belgium.

 

 

 

Swiss Alps.  It would have been difficult or impossible with conventional treatment, with her chest split to provide easy access to the heart, since her cut bones and muscles would not have healed sufficiently.  Chitwood has now done more than a dozen successful valve repairs and has set up a multicenter trial for 2001.

Chitwood, who has no financial stake in Intuitive, marvels at da Vinci: "When you're doing a procedure, it's like you're in a space of your own, as if you're in the machine.  When I was first learning how to use it, I dropped a suture and reflexively reached under the console to pick it up."

Many physicians will resist switching to robot-assisted surgery.  Whether surgeons become converts, says Moll, "depends on whether they want to do a more precise and accurate job." One way da Vinci can help is by filtering out hand tremor.  "Min-

 

 

 

imal-incision" surgery, in which the surgeon manipulates rigid rods through small openings, can be particularly nightmarish.  "It's like playing a video game with long sticks," says Younge.  Just 0.1 millimeter of shake-less than 1/250th of an inch-balloons to 1 mm at the far end, or half the diameter of a small artery.  "That's why cardiac surgeons don't lift weights or have coffee before surgery," says Chitwood.

Da Vinci and its competitors, like robots made by Computer Motion in Santa Barbara, Calif., are slowly gaining a foothold.  "We're at the point that the horseless carriage was when it was first introduced," says Robert Maciunas, a neurosurgeon who moderated a robotics session at the surgeons'meeting in October.  "It wasn't a real automobile-but if I'd been a smart buggy-whip manufacturer, I might have thought about retooling." *

 

 

 

Teaching robots to feel like humans

 

 

 

obots do the darndest things these days; they walk, they talk, and in the Rcase of this year's mechanical pets, they even sit up and beg.  But sensitivity training for machines?  Well, almost.  Allison Okamura, a 28-year-old mechanical engineer at Johns Hopkins University in Baltimore, is helping machines to feel.

Most robots, designed for repetitive tasks such as spot welding, don't have to tell whether an object is soft or hard.  But as scientists and doctors turn to machines to help them explore distant worlds or conduct

 

 

 

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surgery, a sense of touch has become a priority.  It's surprisingly diff icult to do.  Neurophysiologists still don't know exactly how the human brain processes tactile information.

That hasn't stopped Okamura.  She works with behavioral scientists to study how humans conduct "haptic exploration"-tech talk for feeling your way around.  And she's teaching her robot fingers, armed with sensors for vibrations, pressure, and movement, to explore objects the same way. -ThomasHayden