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That's DOCTOR Robot, if You Please


WebMD Health News

May 29, 2001 -- At the rate things are going, heart bypass surgery may soon bypass the need for surgeons. Well, no, not really. But new technologies, including computer-assisted robotic surgery and devices that allow surgeons to connect two blood vessels faster than a plumber can solder pipes together promise to make heart surgery safer and help patients recover faster.

"I'm convinced that all surgery will eventually be done with computer assistance, and how long that takes is more related to the evolution of the technology than to the enthusiasm of surgeons," says Ralph J. Damiano Jr., MD, chief of cardiac surgery in the division of cardiothoracic surgery at Washington University School of Medicine in St. Louis.

In the June issue of the journal Annals of Surgery, Damiano and colleagues at Washington University and at Pennsylvania State University in Hershey report that all 19 patients who underwent endoscopic or "keyhole" coronary bypass surgery with assistance from a robot were alive and well one year after surgery.

In coronary bypass surgery, a surgeon uses blood vessels from other parts of the body to create new blood flow to bypass a blockage in one of the coronary arteries, the vessels that carry blood to the heart.

Endoscopic surgery, in which surgeons operate using specially designed instruments inserted through just a few small incisions as they watch the proceedings on a video monitor, has revolutionized both orthopaedic surgery and general surgery.

But because endoscopic techniques require surgeons to use long cutting and grasping instruments rather than the more familiar scalpels, retractors, and scissors, the surgery has generally been too difficult to apply to heart bypass surgery, which requires surgeons to sew small blood vessels with extreme delicacy and precision.

To get around this problem, Damiano and colleagues devised a system in which computer-controlled robotic tools would compensate for minor, involuntary motions that would otherwise make endoscopic heart bypass surgery impractical.

In the system, the surgeon sits at a computer console in the same operating room as the patient. The console houses a video monitor, computer control system, and two instrument handles identical in size and shape to surgical instruments. As the surgeon moves the handles, the computer "resizes" the motions and filters out hand tremors, and then relays the motion to two robotic arms on the operating table. The surgeon is also able to control the view by giving voice commands to a third arm that controls the camera.

The results show that the most difficult part of the procedure -- the attachment of the new blood vessel to the old one bypassing the diseased part -- can be performed with endoscopic tools with help from a robot, Damiano says. He tells WebMD that although the robot arms do not give the surgeon tactile feedback, "it's not nearly as bad as I thought it would be when I first started using them. I think the reason for that is that with the better visualization you have with these systems, you actually can compensate for the loss of [touch] feedback."

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