Remote Control Surgery

Gretel H. Schueller

A patient lies on a narrow operating table. Three spidery robotic arms, each 0.9 meter (3 feet) long, loom above him. Slender tubes from the robot's metal wrists pierce his chest. Several feet away at a monitoring console, a surgeon peers at images inside the patient's body—a beating heart and tangle of blood vessels, magnified 10 times on a computer screen. Grasping two pencil-sized control sticks, he maneuvers the steel robotic arms to perform heart surgery.

Sound like a sci-fi episode of ER? It's actually an operating room at the London Health Sciences Centre in London, Ontario. And with the help of the three-armed robot, Dr. Douglas Boyd, director of the Minimally Invasive Cardiac Surgery Program, performs remote control heart surgery. "This is a very exciting time for medicine," Boyd says.

Remote control isn't just for your TV anymore. Today, a handful of doctors around the world perform surgery without ever touching their patients. One day, remote control technology may let surgeons operate on people thousands of miles away in another country, or even on astronauts in outer space.

Fighting Heart Disease

How does remote control surgery differ from conventional surgery? Take a coronary bypass operation, for example. More than 450,000 Americans undergo bypass surgery each year—heart disease is the nation's leading killer. And one new study shows that boys as young as 15 can start to experience clogged coronary arteries, blood vessels that supply vital oxygen-rich blood to the heart.

In a coronary bypass operation, surgeons graft a segment of a blood vessel taken from another part of the body, like the leg, onto a clogged coronary vessel. Their aim: to reroute or "bypass" blood flow around the blockage—like a detour around a traffic jam.

In conventional bypass surgery, a doctor cuts a 30.5-centimeter (12-inch) incision from neck to abdomen, then saws into the breastbone and cracks open the ribcage to expose the heart. "We make such big incisions because we need to get our big hands inside," says Dr. Randall Wolf, director of minimally invasive cardiac surgery at Ohio State University.

In contrast to human hands, a robot's steel hands feature fully rotating wrists; attached to each wrist is a single dainty "finger," thin as a string bean. At the "fingertips," surgical tools like scalpels (thin surgical knifes), scissors, needles, and staplers—some no longer than a pinkie nail—fit into incisions the diameter of a pen.

During conventional bypass surgery, a doctor actually stops the heart and inserts a tube that diverts blood flow to a heart-lung machine. The size of a truck engine, the machine keeps blood warm, adds oxygen, then pumps blood back into an artery after surgery.

In remote control surgery, doctors don't stop the heart, and no such machine is needed because surgeons don't open the chest cavity—with much less blood loss as the result. All this means less pain for the patient and much faster recovery time.

The Hole Story

Since the 1980s, doctors have used tiny incisions in abdominal surgeries known as laparoscopy. But such operations don't entail the microsurgery of heart operations, which involve cutting and sewing minute blood vessels. Doctors couldn't perform delicate microsurgery without making large incisions and putting their hands directly in patients' bodies. The development of precision-honed robots has allowed them to "bypass" such obstacles.

One tool that has aided remote control surgery is a tiny camera called an endoscope. Developed in the '80s, the camera is attached to a flexible tube made of glass fibers as fine as cats' whiskers. Some fibers pipe light into body tissue, while other fibers transmit images back to a monitor; the endoscope serves as the surgeon's eyes inside the body.

In remote control surgery, a doctor sits comfortably at a computer rather than bending over a patient for hours. The only tools he or she wields are two pencil-sized control handles designed to look and feel like surgical instruments. The computer translates the surgeon's control-panel movements into a robot's precise micromotions inside the body. Electrical cables flash computer commands to each robotic arm at a rate of up to 400 times per second.

The surgeon usually makes four small incisions between the patient's ribs. The endoscope snakes through one hole and the doctor controls the camera's path, using a foot pedal or microphone that relays vocal commands to the endoscope. Another incision holds a forklike prong to steady the heart surface. The last two incisions let the tiny surgical instruments enter the body and perform the "blood and guts" of microsurgery.

Initially, a harmonic scalpel, a knife that vibrates so fast it liquefies tissue, slices a clogged artery. "When you cut arteries they bleed, and that's a big problem in a closed chest," Boyd explains. In order to avoid massive internal bleeding, the vibrating scalpel also causes blood vessels around a cut to seal off. Then the robotic arms graft a healthy artery onto a blocked one, and stitch the graft with a needle shorter than a hyphen.

Out-Of-Sight Future

At the end of conventional heart bypass surgery, a surgeon restarts the heart with an electric shock and wires cracked rib bones together. The patient leaves the hospital in extreme discomfort, with a track of staples from neck to navel, and the possibility of infection and stroke. Average recovery time: six weeks.

After remote control surgery, patients need only a few Band-Aids on their small incisions. One of the first patients to undergo remote control surgery, Canadian dairy farmer John Penner, was back working on his farm less than a week after his operation last September. "I knew I'd been a part of history in the making, and I felt grateful," he says.

"The field is very new, but the potential is huge," says Wolf. Surgical robots cost $1 million, but doctors have already begun experimental remote control surgery on the hearts of 5-month-old infants as well as on the human brain. One day, doctors won't even have to be in the same room, the same country, or even on the same planet as the patient! Says Boyd: "I can operate on a patient eight feet away. I could be 80 feet away—and then eight miles or 80 miles away. And then maybe we could perform surgery on astronauts in outer space."

Appendix:

Blood Supply to the Heart

Coronary arteries: Blood is fueled to the heart by two thick arteries branching off from the aorta, the body's largest artery.

Coronary veins: These veins shuttle blood and harmful waste products away from the heart.

Capillaries: The heart's smallest veins and arteries are connected by a network of tiny blood vessels. Their thin walls allow nutrients to pass from blood into surrounding tissue.

Your heart, a fist-sized muscle, pumps blood 60 to 80 times per minute. Blood flows through a network of veins and arteries, supplying life-sustaining oxygen to your body's 50 billion cells. When heart cells don't get enough oxygen, they stop working. The result: a heart attack, or sudden death of part of the heart.

From Science World, November 13, 2000