U doctors use robots to advance safer surgery

When it comes to open-heart surgery, University professor and surgeon Kenneth Liao said he believes in less chest destruction.

Standard heart surgeries involve breaking a patient’s breastbone and sometimes spreading or even cutting out a rib, he said.

But a new technique involving surgical robotics is helping surgeons such as Liao minimize the effects of some operations.

Surgical robotics is an emerging technology that offers the same benefits of conventional surgery, but is less invasive, Liao said.

The technology – currently used for some operations at Fairview-University Medical Center – consists of two large robotic arms and a control monitor. Small surgical instruments are attached to the arms, and surgeries that once required large incisions can now be done through smaller holes.

“It is like Nintendo,” Liao said. “I am operating a joystick.”

A surgeon uses his or her index finger and thumb as a joystick to control the tools attached to the end of the machine’s arms, said Michael Maddaus, director of the University’s Center for Minimally Invasive Surgery, where the machine is based.

The joystick is hooked up to a three-dimensional monitor that broadcasts images from two cameras inserted near the operation site.

The “robot,” as it is known in surgical circles, is a step up from standard minimally invasive surgical procedures, Maddaus said.

Previous technology involved rigid rods that were not as maneuverable as a surgeon’s hands. The robot offers greater range of movement.

The robot also brings a stronger visual depth perception previously impossible in two-dimensional minimally invasive procedures.

Fairview and the University have operated the $1 million robot jointly for about six months, Maddaus said.

Another robot sits in a University research lab for training purposes.

The robots were purchased from California-based Intuitive Surgical, the only company that currently sells surgical robotics, Maddaus said.

More than 200 robots are in operation worldwide, according to the company’s Web site.

The University trains outside physicians in surgical robots to help recoup the robot’s cost, he said. More than 20 surgeons have been trained in the technology so far.

Right now, the robot’s arms and console have to be carted to each surgery room, Maddaus said. Setting it up and learning the instrumentation has been the biggest obstacle.

Maddaus said he thinks the technology will become smaller with innovations, and that a surgical robot could one day be as commonplace in hospitals as X-ray machines.

“We have become early adapters, because we are convinced that there was merit to this concept,” he said.

The technology, which adjusts for involuntary tremors in a surgeon’s hands, is also used for operations not previously possible, he said.

“You can sew really fine things,” he said. “You can sew the urethra back together without tearing it apart, and you can repair a valve in the heart that you could not do without a robot.”

Urologic surgery professor Manoj Monga said he can use the robot to make less-painful surgical incisions when operating on the kidneys or prostate. The robot also makes it easier to make post-surgical repairs or reconnections.

Monga said the robot cannot yet account for the pressure or resistance a surgeon’s own hand could feel.

“With the robot, you do not know pressure,” he said. “For the moment, part of the training process is just following visual cues.”

Liao said robotic surgery minimizes the chance of infection and quickens recovery time.

While still in its early phases, Liao said, he thinks the robot technology will increase in popularity as doctors and patients learn it is available.

“We should take advantage of this,” he said. “Physicians and the people should be aware that it is available to them.”