A Guiding Hand
Robots are showing up in ever more surgical suites. But they're better suited for some operations than others
When John Lynch was diagnosed with prostate cancer earlier this year, he was determined to fight it. The 47-year-old former New York City police officer had dodged bullets all his professional life, and now that he'd retired he wasn't about to be struck down by cancer. Biopsies indicated that the disease was in its earliest stage, so his chances of beating it were good. But survival wasn't his only concern. Impotence and incontinence are common following surgery to remove the prostate, a gland about the size of a walnut located just below the bladder. Lynch wanted to avoid those two unpleasant side effects at all costs.
Lynch spent days researching treatment options on his computer and talking with doctors. He considered everything from cryosurgery--freezing prostate tumors to kill the cancer cells--to implanted radioactive seeds to traditional surgery. But the treatment that offered the most promise for getting rid of the cancer while preserving his other bodily functions seemed like something straight out of a science-fiction movie: robotic surgery.
Though they conjure up images of the leggy androids of I, Robot or the gilded physique of C-3PO of Star Wars, surgical robots look nothing like humans. The 1,400-pound metal-armed machines resemble dental office equipment more than anything else. And unlike the independent-minded machines in the movies, these robots don't think for themselves and can't perform any tasks on their own. A surgeon controls their every move. But they do enhance a surgeon's performance. And they're being used for an increasingly wide array of surgical procedures, from performing hysterectomies and removing uterine fibroids to repairing heart valves and doing gastric bypass surgery. Although the Food and Drug Administration approved the technique just five years ago, by 2009 half of the estimated 60,000 prostate gland removals done annually in the United States will be done using a robot, according to Sg2,a Chicago-based company that evaluates new technologies for hospitals.
Hands off. Robotic surgery was originally conceived as a way to treat soldiers wounded in battle. The idea was that the patients could be loaded into a mobile surgical unit equipped with a robot, and a surgeon far from the front lines could patch them up. Research into "telesurgery" continues, and doctors have successfully performed long-distance surgeries a few dozen times. But today the focus is on adapting robotic technology for use in everyday surgical situations.
In robotic surgery, the robot is positioned next to the patient, while the surgeon sits several feet away at a special console, controlling the robot's arms, which hold surgical instruments and cameras. Instead of a long incision in, say, the abdomen, a number of small incisions, or "ports," are made through which the instruments are inserted. Sitting at the console, the surgeon looks at the computer screen through binocular-like lenses, which provide a magnified, three-dimensional view from inside the patient. Using hand and foot controls, the surgeon manipulates the instruments as if they were in his or her hands, cutting away tissue, cauterizing blood vessels, and suturing using needles held by pincerlike "needle drivers." The robot's wrist can turn nearly 360 degrees, allowing great flexibility. The robot also eliminates any tremor in a surgeon's hands, and for delicate work, "motion scaling" software reduces a surgeon's actual hand movements to much smaller, finer instrument movements.