- The Washington Times - Thursday, July 18, 2002

Some really clever things are going on in surgery but don't get the attention they ought to. I guess people would rather think about computers than incisions. Anyway, the key ideas are robots and tiny holes.

A principle of surgery is that it is better not to cut gaping holes in people if you can think of a better idea. There hasn't always been a better idea. For example, to do heart surgery, it has been necessary to make a massive incision in the patient's chest. The hole is just a way to get access to the heart. It has no other medical utility. It takes a long time to heal, hurts a lot and could lead to complications.

Today, a lot of research goes on in what is called laparoscopic surgery. This means you make a tiny hole and insert a tube with a lens on the end as well as thin metal arms that end in surgical instruments. This lets you do the surgery without opening a wide hole.

The surgeon watches on a computer monitor. He uses grips to manipulate the instruments in the patient's body. I have never seen it live, but it's a curious procedure in photographs. The patient lies on a table in one part of the operating room, and the doctors huddle around the computer console, perhaps in a corner. It looks as if they have started a game of poker.

A company called Computer Motion Inc., which makes surgical robots, points out advantages of robotic surgery that might not be immediately apparent. For example, human hands tremble. The computer can smooth out tremors to provide a perfectly steady motion.

Further, robots can scale movements. The human hand works with reasonable precision on a scale of inches say, peeling a tomato. When the same hand tries to manipulate smaller things, such as blood vessels, it is just too big and its movements too coarse.

The computer driving the robotic arm, however, can be programmed so that when the doctor's hand moves an inch, the arm moves one-tenth of an inch. This, combined with magnification and tremor-smoothing, allows greater precision.

An example of tiny-hole surgery (it has been done for many years now, but it's still pretty slick) is the vitrectomy. This is a surgical procedure to remove the jellylike vitreous humor in the back of the eyeball. I watched one once.

An example of tiny-hole surgery (it has been done for many years now, but it's still pretty slick) is the vitrectomy. This is a surgical procedure to remove the jellylike vitreous humor in the back of the eyeball. I watched one once.

The technique was to insert three tiny tubes into the eyeball. The first was a fiber-optic light pipe, which illuminated the inside of the eye and let the surgeon watch what he was doing through a microscope, the surgeon said.

The second was a tube to inject saline into the eye. The third was a "microvit." This was a tiny combination of a vacuum cleaner and a roto-rooter eliminated the vitreous. Implausibly, it works. No robotics were involved.

A curious thing about robotic surgery is that the surgeon doesn't have to be nearby. There is no reason why he couldn't be in his office on another floor. At this point on the learning curve, things aren't quite so casual. And of course, someone competent is always with the patient. But increasingly, this is only a safety measure.

Doctors at Mount Sinai Medical Center in New York last year asked why the surgeon has to be on the same continent as the patient. As it turned out, he doesn't have to be.

It likely will be a while before such procedures become mainstream. But it looks as if they will.

Which means that an American specialist could do surgery on a Cambodian child in Phnom Penh nice for the child, because Cambodia is short on doctors.

And tiny holes are just much better. Ask someone who has had bypass surgery.


Copyright © 2018 The Washington Times, LLC. Click here for reprint permission.

The Washington Times Comment Policy

The Washington Times welcomes your comments on Spot.im, our third-party provider. Please read our Comment Policy before commenting.

 

Click to Read More and View Comments

Click to Hide