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By Darla Brown
When
you think of robots, images of Star Wars’ R2D2 and 3CPO,
and Rosie from the Jetsons may come to mind. But when it comes
to the operating room, AESOPTM and da VinciTM are with whom you
may have a close encounter.
As surgeries become more microscopic,
the technology used to assist and guide surgeons has become disproportionately
bigger. Large robotic machines guiding tiny tools have jumped
from science fiction to reality, allowing physicians to move with
greater ease and accuracy through robotic arms with downsized
tools inside a patient’s body.
The UT-Houston Physicians pediatric
surgeon team employs a camera-toting robot in the operating room
to ensure precise results. They are the only Medical School group
using Automated Endoscopic System for Optimal Positioning, or
AESOP, a voice-activated robot that controls the camera during
minimally invasive surgeries. AESOP is activated only by the surgeon’s
voice; the surgeon may record up to 20 commands in millimeter
increments.
“Without a robot, a relatively
inexperienced person is controlling the camera during these surgeries,
and with a 3 kilogram baby, there is usually no room for error,”
said Martin Blakely, M.D., associate professor of pediatric surgery.
“This robotic technology is very precise, safer, and quicker.”
The newest robotic-assistance device
for Medical School faculty is da Vinci – an imposing three-armed
machine that includes a separate workstation for the surgeon,
who is seated away from the patient as he controls the surgery
and watches every move in 3-D color. The surgeon operates the
camera arm with a foot pedal and controls the two instrument arms
with his hands, making movements that translate to the endoscopic
operation on the nearby patient. A 2-D monitor allows others in
the room to have a good view of the surgery.
In addition to the standard team
of professionals in the operating room, a
robot technician attends all surgeries involving da Vinci.
“The robot gives us all of
the benefits we normally have with minimally invasive surgery
– smaller incisions, quicker recovery, and less pain for
the patient,” said Erik Wilson, M.D., assistant professor
of surgery. “But the da Vinci instruments offer much more
flexibility and dexterity, moving like a human wrist, unlike the
traditional laparoscopic tools.”
“We are limited by our own
arms using da Vinci during surgery because the robotic arm has
a greater range of motion than the human arm,” added Eyal
E. Porat, M.D., assistant professor in the Department of Cardiothoracic
and Vascular Surgery.
The incisions on the patients are
8 and 12 mm in length and are created for the placement of the
surgical ports, which are connected to the robot’s arms.
The instruments are being retooled so that the incisions can be
even smaller, and a fourth arm will soon be available to assist
in retraction during surgery.
Dr. Porat along with the Department
of Cardiothoracic and Vascular Surgery led the charge in bringing
da Vinci to UT-Houston, which has been in operation at Memorial
Hermann Hospital since July.
“I first became interested
in minimally invasive surgery and robotics during my surgery training
in Israel. When I came to the Medical School, I saw that the cardiac
procedures were highly advanced, however the technology was lagging
behind,” said Dr. Porat, the medical director of Memorial
Hermann Hospital’s new Institute for Cardiovascular Research
and Robotic Technology. Hazim J. Safi, M.D., chairman of the Department
of Cardiothoracic and Vascular Surgery, has been very supportive
of the department’s leadership into the field of robotics,
Dr. Porat added. “Without his support, the program would
not have materialized.”
After researching the types of surgery-assisted robots available,
Dr. Porat made his case to Memorial Hermann Hospital for da Vinci.
The hospital purchased two such robots – one for training
and research and one for clinical use. The hospital is one of
only five official training centers in the country and welcomes
surgeons, operating room nurses, and scrub technicians from around
the state and beyond to learn about this advanced technology.
“Robotics are helping us take the next step in cardiovascular
surgery,” Dr. Porat said. “The technology allows us
to perform keyhole surgeries (using small incisions) on intracardiac
procedures. We are minimizing patient trauma with this technology.”
While da Vinci is FDA-approved for any intracardiac operation,
Dr. Porat and his colleagues are using it primarily for internal
mammary artery take-down., This procedure involves the removal
of a primary artery to be used later in coronary artery bypass
surgery. Using the robot allows a much smaller incision compared
to the traditional surgery for the artery removal.
“Dr. Porat has the largest experience in the Texas Medical
Center using robotics this way,” Dr. Safi said. “No
one is doing what he is doing.”
In the near future, one of the primary objectives will be to use
da Vinci for a mitral valve repair surgery. Dr. Porat said he
would also like to add other surgical procedures to da Vinci’s
repertoire and currently is working on a robot-assisted minimally
invasive aortic procedure.
“We need to learn and develop more procedures to take advantage
of this technology,” Dr. Porat said. “The institute
is dedicated to expanding minimally invasive surgery and robotics.
We’re going to bring in more vendors and more technology
to facilitate other procedures.”
The operating room staff also has contributed greatly to the advancement
of this technology. “They have definitely done their part
in learning about the system and making the transition to its
use much easier,” Dr. Porat said. “This has been facilitated
by a key member of the team, Peter Herrera, who has assisted in
training and helping to get the training center set up and running.”
Research is key in creating new applications for this technology,
however Dr. Porat and his colleagues are advancing cautiously.
“Right now we are going slow, taking care not to rush this
technology,” Dr. Porat said. “Patient safety is our
main concern, and we can abort a procedure during the case if
necessary.”
While the focus of da Vinci is on cardiac surgery, the Department
of Cardiothoracic and Vascular Surgery has allowed other departments
to use da Vinci. The Department of Surgery faculty has used the
robot to assist in hernia surgery and plans to expand its use
to include gastric bypass surgery and gallbladder removal.
While the primary downside of using robotic-assisted devices is
the learning curve, the technology is paving the way to benefit
patients and surgeons.
“I am confident that robotics will develop to do these procedures
better and faster,” said Terry Scarborough, M.D., assistant
professor of surgery.
Such positive outcomes will make robots in the operating room
more common and will change the nature of surgery.
“Cardiac surgery is such a young surgical subspecialty,
but it has come so far. In the future our patients will have a
shorter hospital stay and will go home the next day after heart
surgery,” Dr. Porat said.
Robotics also has made it possible for surgeons to operate across
the room, or even across the world, from the patient. An example
of this has already been demonstrated by a surgical procedure
performed by a surgeon in New York on a patient in France. “NASA
and the Pentagon are putting a lot of money into this technology,
which one day may allow a surgeon on Earth to operate on an astronaut
in space, or on a patient in a submarine,” Dr. Porat said.
Dr. Wilson predicted that in 10 years, the vast majority of surgeries
will be done with robotic assistance, and in 20 years all surgeries
will have such mechanical intervention.
“Eventually, there will be no cords in the way – this
is the first step, using small instruments inside the body,”
Dr. Wilson said. “In the future, we’ll make just one
incision and nanotechnology instruments will drive themselves
around and fix things. These robots will be able to adapt to specific
situations and even reproduce.”
Stay tuned … the future may not be as far away as you think.
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