It sounds like something out of science fiction: surgeons in North America removing the gall bladder of a 68-year-old woman in France using a remote-controlled robot. But that’s exactly what happened earlier this month, ushering in an exciting new era of telesurgery that holds promise of saving lives all over Earth–and even off of it.
Just like “television” can be translated “far-off-vision,” so telesurgery is “far-off-surgery”–surgery performed over a distance.
In the September 7 operation, Dr. Michel Gagner, 41, a Canadian, and Dr. Jacques Marescaux, a Frenchman, sat in a room in Manhattan in front of a computerized control panel and a giant television screen and manipulated robot arms located in an operating room in Strasbourg University Hospital in France, to perform the hour-long surgery. They were just the “stars” of a production that actually involve 40 people, from doctors to telecommunications engineers to robotic system specialists.
Back in June, patients at Rome’s Policlinico Casilino University underwent minor surgery under the guidance of experts at the Johns Hopkins University in Baltimore. The difference between that and what happened September 7 was that in that case the operation was really carried out by surgeons in Rome; the experts in Baltimore only watched what was going on and advised.
This time, the only involvement of a doctor on the European side of the Atlantic was to pump the patient’s belly full of carbon dioxide (which gave the surgeons more room to maneuver) and make the four initial incisions, none larger in diameter than a pencil.
The experiment, called Operation Lindbergh because of its transatlantic aspect, was history-making because, much like the Spirit of St. Louis’s flight, many experts thought it couldn’t be done. They thought that while doctors thousands of miles away might be able to advise on-site surgeons, as in the June experiment, any attempt to carry out the surgery themselves would be doomed to failure because of the unavoidable lag time involved in transmitting the visual signal to the surgeons and the control signals to the robots. Too much lag time would make surgery dangerous because the surgeon couldn’t react quickly enough to a sudden emergency–unexpected bleeding, for instance.
Computer engineers were able to get around that problem. The surgical robot was split into two parts, the control part in Manhattan and the operating part in France. Each part was hooked up to a computer. The two computers then talked to each other over a secure, fibre-optic digital telecommunications network–NOT the standard Internet, where data transmission times are notoriously unstable. The result was a lag time of no more 200 milliseconds (one fifth of a second); noticeable, but manageable. (The estimated safe time lag was 330 milliseconds.)
In Manhattan, Dr. Gagner, a pioneer of robotic surgery who used to be at the University of Montreal but is now head of laparoscopic surgery at Mount Sinai, and Dr. Jacques Marsecaux of Louis Pasteur University in Strasbourg, could see their patient’s insides using a voice-activated video camera. They used handheld joystick-like controls to move the robotic arms in Strasbourg, and watched their actions on a monitor.
They had previously practiced the procedure on a pig, which, Dr. Gagner points out, was actually harder than working on a human, because pig parts are smaller. They decided to do a gallbladder removal because it’s a routine, low-risk procedure that uses relatively simple instruments.
Telesurgery didn’t arise full-blown out of nothing. It’s actually the result of two previous surgical breakthroughs in the last 13 years.
The first was the development in 1988 of minimally invasive surgery, in which procedures are performed inside the body through a small incision with the help of a tiny video camera, rather than by cutting a huge opening in the body so the surgeon can see what he or she is doing.
The second was the development of computer-assisted robot surgery in 1996. Surgical robots like the California-made ZEUS system used in Operation Lindbergh cost about $1 million each, but provide enormous benefits to both surgeon and patient. On the surgeon’s side, the robotic arms eliminate tremors and improve dexterity. (“I can have five Tim Horton’s and still be rock steady,” is the way one surgeon puts it.) All inputs by the surgeon are analyzed by a computer and are not passed on to the robotic arms if the computer judges them to be dangerous–so if the doctor’s hand slips on the controls, the robot won’t suddenly slice open the patient. Computer-assisted surgery can also be used to scale down motions so that, with the help of a microscope, a surgeon can perform incredibly delicate repairs that would otherwise be impossible. On the patient’s side, this means less damage to the body and quicker recovery times.
Dr. Douglas Boyd, director of the National Centre for Advanced Surgery and Robotics at the London Health Sciences Centre in London, Ontario, has used the ZEUS system to conduct bypass surgery on more than 80 patients over the past two years without opening their chests and splitting their breastbones, as is done in traditional bypass surgery. The result is patients who are out of the hospital in two or three days instead of a week, who suffer fewer complications, and who are able to look after themselves sooner.
Dr. Boyd has likened this first transatlantic telesurgery to the first powered flight by Orville and Wilbur Wright, because the potential advantages or so huge:
A team of top surgeons from around the world could be assembled to perform an operation without any of them having to travel from their home cities.
Surgeons could be given “hands-on” training anywhere by teachers located thousands of miles away.
Surgery could be carried out in remote locations where surgeons are in short supply, from battlefields to developing nations to the far north to outer space to rural Saskatchewan.
And further down the road, robotic surgery could be combined with artificial intelligence and virtual reality to produce machines capable of carrying out basic surgery without a human surgeon being involved at all.
Now that really sounds like science fiction!