In the state-of-the-art hospital operating room, 67-year-old Eugene Bem lies anesthetized, pierced through the chest by three narrow, stainless-steel rods held by aluminum and plastic mechanical arms draped in translucent vinyl. Under way in the operating room is a critical portion of a heart bypass operation, but missing is the customary crowd of surgeons around the patient. Instead, in a corner across the room, a cardiac surgeon sits alone at a computer, his back to the operating table. Hunched over an enveloping, streamlined console, his feet tapping at pedal switches and fingers rapidly manipulating sensitive handheld controllers, the doctor in surgical scrubs could pass for some silent-movie mad scientist at his mighty Wurlitzer organ.
In fact, it’s a day this past summer at New York’s Beth Israel Medical Center, and cardiac surgeon Hani Shennib is offering a preview into the future of robotically assisted heart operations. Peering remotely into his patient’s chest cavity via a tiny video camera mounted at the end of one of the three steel rods, the surgeon performs the delicate task of harvesting a chest artery to be used in a heart bypass graft. Still at the console, Shennib grasps, cuts and cauterizes using surgical instruments on the tips of the other two rods; the instruments, deep in the patient’s chest, respond precisely to the physician’s hand movements, which are relayed via a computer to the electromechanical arms.
Welcome to the future of the operating room. The computer-mediated part of this heart operation is still under clinical testing pending approval by the U.S. Food and Drug Administration. But just a few days prior to the Beth Israel procedure, the FDA approved the commercial sale of the computer-controlled robotics for abdominal laparoscopic surgery as well as minimally invasive gallbladder, prostate, colorectal and esophageal procedures-potentially 3.5 million operations a year in the United States.
With more than 50 advanced robotic systems already in hospitals around the world (the machines have previously been approved for sale in Europe and are in clinical trials in Japan), the robot-assisted operating room of tomorrow is just around the corner for many patients. Indeed, the cascade of robotic surgery “firsts” proclaimed by hospitals in the United States and abroad became a torrent after the FDA’s initial commercial approval.
The day after the FDA announcement, for example, Henrico Doctors’ Hospital in Richmond, Va., publicized the first non-clinical-trial use of robotic surgery for a gallbladder removal; the operation was performed by surgeon William E. Kelley with a da Vinci system on 35-year-old Kimberly Briggs. To demonstrate just how nontraumatic the procedure could be, less than four hours after her operation was over Briggs was wheeled into a press conference, where she told reporters, “I feel great.”
The potential advantages of the robotic systems are dramatic. The robotic arm positions and holds the video camera with greater accuracy and steadiness than any human being could. Seated comfortably instead of standing over the patient, the surgeon is less subject to stress and fatigue-a critical factor during procedures that can last many hours. Should there be a tremor in the surgeon’s hand, as there could be during a long operation, the computer filters it out. There’s an expression for this robotic version of a steady hand: “virtual stillness.”
The technology also holds the promise of making minimally invasive operations, in which surgery is performed through small incisions, available to a far larger group of patients. Minimally invasive techniques mean less trauma for the patient and have become common for such operations as gallbladder removal. In today’s more conventional version of minimally invasive surgery, long-stemmed, narrow instruments are directly controlled by the surgeon; it’s somewhat like using chopsticks to perform surgery. Because of the special training required and limits to its applicability, this form of surgery is practiced by fewer than one-third of U.S. surgeons. Thanks to computer-assisted procedures that are more exact and reproducible, a new generation of minimally invasive techniques could make less trauma for the patient the norm rather than the exception.
In the case of cardiac operations, these advances mean the surgeon is able to spare the patient the trauma and pain involved in cracking open the breastbone and using a heart-lung pump while the heart is stopped. In fact, Beth Israel heart patient Bem was released the next day instead of after the weeklong hospital stay (at $1,400 per day) that is routine following open-heart surgery.