It was a routine surgical procedure conducted in the most fantastic fashion.
A 68-year-old woman lay unconscious in an operating room at Strasbourg Civil Hospital, in Strasbourg, France, undergoing the removal of her gall bladder. But her surgeons were not within arms’ reach. In fact, they weren’t even in the building; not even the same country. Instead, her surgeons were 4,000 miles away in New York City, performing a remote trans-Atlantic surgical operation previously deemed impossible. It sounds like a product of some screenwriter’s imagination: it took place on September 7, 2011.
Carol Reiley is a 28-year-old doctoral student in the Computational Interaction and Robotics Laboratory in the Department of Computer Science at Johns Hopkins University. Her work focuses on the development of robotic systems that can help people better complete skilled tasks.
“Fact is,” notes Reiley, “we’re not there yet for robots to perform teleoperated surgeries at a distance on their own. The particular procedure from New York to France had tons of extra staff monitoring in case something goes wrong. I’ve seen doctors stop a robotic surgery halfway to switch to open surgery because they felt more comfortable.”
But getting there–enabling surgeons to achieve teleoperated surgery without live monitoring–is one of her team’s goals.
I meet Carol at her lab on a rainy spring afternoon, alongside twenty or so other eager spectators. She and her colleagues guide us through a menagerie of scientific wonder and accomplishment. Not an understatement: The students at the Computational Interaction and Robotics Laboratory are always going to be the smartest kids in the room. They spend long days pursuing every relevant experimental step Reily and her colleagues can think up and put into practice.
“There’s a huge evolution in terms of how surgery has been changing,” explains Reiley. “Minimal evasive surgery means that a surgeon can cut small keyhole incisions and insert instruments and a camera… It’s great for a patient because you have less scarring and a faster healing time.”
Tian Xia, another Ph.D. student in Computer Science agrees. “Minimally invasive surgery,” says Xia, “was a big step. You don’t have to do a lot of cutting through the body, leaving scars. People don’t like big scars. Now, with invasive surgery you might scar just a little.”
Computer-assisted surgery has been around for several years, but how do you augment it, improve upon it? These are the questions that Reiley and Xia are attempting to answer.
While surgical advancement has been great for patients, it has made life more difficult for surgeons.
“It’s hard for a surgeon,” explains Reiley “because now you have lost the hand-eye coordination: There’s a 2-D monitor somewhere far away, and you’re operating with a chopstick-like instrument.”
The Zeus Robotic Surgical System, created by the now defunct Computer Motion, which was used to conduct the original 2001 telesurgery, suffered from these very limitations. But Reily and Xia are experimenting with the superior da Vinci Surgical System designed and developed by Intuitive Surgical, Inc.
“The da Vinci Surgical System,” notes Reiley “has made it very intuitive for surgeons. Now, they have 3-D vision and wrist-like motion.”
Xia explains that the robotic system standing before us is multi-million dollar equipment, with numerous individual components costing in excess of one-thousand dollars each. The da Vinci Surgical System itself is composed of two extremely significant parts, rather unfortunately named: the master’s console and the slave device.
The master’s console allows the surgeon to operate the slave device at a distance. It is remarkably simple and resembles an arcade entertainment system. The doc places her head into the control console, from which she is able to see through and operate a camera attached to the robot/slave device using thumbs and fingers. The latter device has three primary components: a highly-sophisticated camera that renders images into 3-D and two robotic arms that are available to perform surgery. (A nurse or similarly qualified health care professional must be near the slave device at all times, so that surgical instruments can be attached to and removed from the robotic arms according to the needs of the surgery.)
What measurable value does combining human intelligence with robots have? Reiley sees many nuanced layers of worth. For example, surgeons utilizing the da Vinci Surgical System can perform procedures with micrometer accuracy, effectively correcting human error.
And, as Reiley explains, this isn’t about autonomous robotics performing surgical procedures. While that direction has been attempted in the past, Reily notes that the medical industry is “nervous” about taking that route. “Surgeons,” explains Reily “like the control.”
Marcin Balicki, another doctoral engineering student, sees one more promise of robotic systems in surgery: extended career spans for surgeons. “Surgeons, older surgeons, recognize now that their skills might be fading a bit, because of age or whatever. So if they can extend their career by, say, ten years, with the robot…”
And while robots are increasingly being used in hospitals as sophisticated tools, Reiley envisions opportunities where expert surgeons are able to reach patients from across the world, often in hazardous or poverty stricken areas, from the comforts of their local hospital.
Reiley believes that we are moving into a world where robotics are increasingly becoming the future, and sees much promise.
“Why even have any incisions?” she asks. “Now we are kind of starting to see this advancement toward natural orifice surgery… You can operate by sticking snake-like instruments down someone’s throat and performing that surgery.”
Surgeons exacting procedures without the need to cut incisions. Doctors attending to patients thousands of miles away through the use of robots. These aren’t sci-fi story lines, but rather, aspects of a medical revolution already in rapid progress.
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