MECHANICAL MEDICINE ROBOTS LEND A HAND TO AID DOCTORS WITH SURGERIES.

Byline: Evan Henerson Staff Writer

``Paging Dr. D2. Would Dr. R2-D2 please report to the operating room stat without stopping for refueling, reprogramming or an electrical tune- up?''

It's not as far-fetched as it sounds. For your next surgery, the surgeon may handle the questions and consultation, but a robot could be the one stitching you up. Where the very thought of doctors using computerized equipment once seemed like something out of an Arthur C. Clarke fantasy, medicine has now gone a step further. Claiming advanced technology benefits both surgeon and patient, doctors throughout Europe and at a handful of hospitals throughout the United States are using robots to surgically correct heartburn, affect weight loss, gall bladder removals and certain gynecological procedures.

The robotic instruments also have been used for select cardiac surgeries - such as heart bypass - in Europe and as part of a clinical study in the United States. In the future, robotics will likely assist in prostate surgery, beating heart bypass and anything else that involves a lot of delicate movement, which tiny robot fingers - as guided by a human being - are well-equipped to do.

As the operating surgeon watches an enhanced 3-D image on a computer monitor, the robotic arm inserts a tiny camera inside small incisions. Tiny surgical tools are then used to reroute the flow of blood or repair a damaged valve as the case may be.

Doctors and patients alike will benefit, proponents say.

For the patient, the term ``minimally invasive surgery'' (MIS) will become even more true to its name. Smaller, pencil hole-sized incisions will mean minimal scarring, swifter recovery time and, ultimately, less financial cost. For surgeons: no more concern about trembling hands or tired wrists. A robotic arm, controlled by the operating doctor to mimic his or her own wrist movements, will be ultra efficient in laying sutures and tying knots. Nurses and assistants will no longer experience the fatigue of having to hold a camera in a fixed position for long periods of time. A robot-controlled camera placement system moves the camera in response to the surgeon's voice commands. And robots don't get tired.

Welcome to the operating room no longer of the future but of the present, say doctors who liken the experience of operating the device to playing a high-tech video game.

``It's very comfortable and immersive. It makes you feel like you've climbed inside the patient in a way that you don't get from traditional means,'' says Dr. Barry N. Gardiner, director of minimally invasive surgery at San Ramon Regional Medical Center.

SRRMC is the only California hospital and one of five in the nation cleared to use the newly FDA-approved da Vinci Surgical System manufactured by Intuitive Surgical. Several others - many in Northern California - use Aesop, the robotic, voice-activated camera placement system manufactured by Intuitive rival, Computer Motion of Santa Barbara. The company's Zeus system, a three-armed robotic system similar to da Vinci, has not yet received clearance from the U.S. Food and Drug Administration for procedures on human beings.

There's been a barrage of publicity since the FDA cleared Intuitive's da Vinci Surgical System last month and the first operation - a gall bladder removal - using the device was performed in Virginia, quickly followed by other such surgeries. Still, the technology is in its infancy. Critics argue that the machinery is expensive ($65,000 to $1 million), largely untested and best used on procedures that even a surgeon without access to robotics would find easy to perform.

But those who have been at the controls of a robot say the technology's benefits are immeasurable.

``You're more ergonomically comfortable, you see better, you have more flexibility, dexterity, precision, control and accuracy,'' Gardiner says. ``I would contend those are good things.''

The Zeus system at Loma Linda University Medical Center has been used exclusively in lab trials and never on human beings. Although the hospital's administration hopes to use the Zeus for beating heart bypass surgery, Dr. Steven Gundry, head of the division of cardiothoracic surgery, says the machinery - for all its potential advantages - won't be brought into the operating room until all of the kinks have been worked out. Gundry cited a hospital in Canada that has performed a number of beating heart coronary bypass surgeries using the Zeus.

``The main thing they're encountering right now is the incredible length of time that operation takes,'' says Gundry. ``The patient is under general anesthetic for 7-10 hours to do a single coronary bypass, and that's clearly unacceptable. You could do a single bypass using a small incision in about an hour.

``Unless we can make this technology more friendly to the patient in terms of how long he will be under general anesthesia, we can do a lot more in the laboratory,'' he adds. ``We're not in any rush.''

Officials at USC Medical Center, which is exploring avenues of tele- medicine and virtual reality, say they are watching the advancement of robotic medicine with considerable interest.

``I see a lot of hype now. I haven't seen a lot of science,'' says Dr. Namir Katkhouda, professor of surgery and chief of minimally invasive surgery at USC. ``I'm not saying it won't have a role, but we need to define where it sits.''

Katkhouda has discussed robotic devices with Dr. Vaughn Starnes, chief of USC Medical School's division of cardiothoracic surgery with the thought of different medical divisions using the equipment for different procedures. SRRMC's Bay Area Heart Institute expects to use the facility's da Vinci when the FDA approves the technology for cardiac surgery.

On Friday, Charlene Olden of Richmond, Calif., became the first patient in the United States to have a reverse tubal ligation via robot. ``It wasn't something that made me scared,'' says Olden, speaking a few days before she was scheduled to undergo the procedure at San Ramon Regional Medical Center. ``The recovery time seems to be a lot faster, and the risk factors are just about the same as if it was done normally.''

Considering that, with robotics, the operating doctor never actually touches the patient, medical researchers say the implications are far reaching. If through Zeus or da Vinci, a surgeon can be seated a few feet away from his patient, guiding the robotic arm with a joystick and watching and watching the action on a video monitor, why does he even need to be in the same room with the patient? Or the same city? Or even necessarily the same country?

Using the Internet and tele-conferencing, doctors are already able to consult in operating rooms halfway around the world. A logical next step would be to have a doctor performing a long-distance operation, although doctors say there would likely always need to be at least one human being present in the operating room acting as an interface between doctor and robot.

Such a scenario would require a greater comfort level with robotics from patients, says USC's Katkhouda.

``When you're boarding a plane, you don't want the plane to be on autopilot,'' Katkhouda says. ``If I was a patient, I would be more comfortable having the surgeon sitting 6 feet away and relying on the machine to do the job.''

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5 photos

Photo:

(1 -- cover -- color) Dr. Droid Robots are revolutionizing surgical procedures, making them less invasive and more precise. (2 -- 3) EndoWrist Instruments, inset, help transform a surgeon's hands and wrists into tools. The da Vinci robot moves like a human hand, above, which makes it ideal for such procedures.

(4) Dr. Barry Gardiner, left, who was instrumental in developing the da Vinci robot, watches as Kathie Shea, RN, participates during a simulation at the San Ramon Regional Medical Center.

Jane Tyska/Herald News

(5) London Health Sciences cardiovascular surgeon Dr. Douglas Boyd sits at a computerized robotic console, which was used in a successful, six-hour closed-chest beating-heart bypass.

Suzanne Bird/Associated Press