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The big picture

(Photograph) - What's the story?

Photograph by Peter Menzel

The surgeon's clipped request for a scalpel to make that first incision into a dying patient's chest is the stuff of epic television drama.

But in a few decades' time, such scenes might be glimpsed only in period pieces, documentaries and archive repeats. Robots may never have the appeal of a Holby City consultant or an ER heartthrob, but they are already invading the operating theatre. In fact, the first robotic surgeon has reached British shores and has already been used to carry out bowel operations at St Mary's Hospital in London. The doctors who work with it are preparing for their first robotic heart bypass.

The new machine, developed in California, is called a da Vinci Surgical System, in honour of Italian scientist, artist and philosopher Leonardo da Vinci. Surgeons, far from fearing that it will eventually take their jobs, are welcoming its arrival. Their expertise in controlling the robot's every move will be as vital as ever.

The system is straightforward in concept, but needs many advances, such as precision engineering, control technology, virtual reality and display technology, to make its practice feasible.

Three mechanical arms surround the patient, wielding the pencil-thick surgical instruments, as well as an endoscope to give the surgeon a good view of what is happening. He sits away from the operating table, in front of a three-dimensional display of the surgical field, where he makes his decisions. His elbows rest below the monitor, his hands holding instruments that mimic the flexibility of the ones he is familiar with in open surgery.

His every gesture and movement is translated in precise detail to the robotic surgeon, although the system is able o filter-out hand tremors. Those who have worked with da Vinci report that it is not difficult to master. Efforts are already under way to improve the realism of the sensations experienced, so the surgeon "feels" the knife cut the flesh and can respond appropriately. The up-shot is a system that can make incisions barely 1cm long, where previously cuts of up to 30cm would have rent the patient's chest. This means less pain and far faster recovery times. The patient is able to walk within 24 hours of the heart bypass operation, leave hospital after a couple of days, and be back at work within a fortnight.

Other advances are on their way, from computer-assisted orthopaedic surgery for hip replacement operations to three-dimensional displays that let the physician view medical images or computer-enhanced graphics overlaid on the body of the patient. Doctors and surgeons are already able to share their opinions using the internet and camera link-ups with colleagues who are working on difficult cases .

Combine robotic operations with such "telemedicine" and the surgeon might even be able to leave the operating theatre altogether. A consultant with specialist knowledge would be able to work on those who would benefit most from his or her experience no matter where they were. All the doctor needs to do is sit behind a console while the patient lies in a robotic operating theatre elsewhere. Television producers might lose some operating-table tension, but stand to gain a whole world of exotic locations.


The da Vinci Surgical System: www.intuitivesurgical.comhtmldaindex.htmlMedical robotics: Robotics research: Steve Farrar is science reporter for The Times Higher Education Supplement

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