Thursday, March 12, 2009

Cutting Remarks

Catherine Mohr excited us with her description of robotic devices that make surgery incredibly less invasive. She mesmerized us with some videos of live surgery (do look for her talk when it is loaded on; it's not there yet.)

Amazing how far we've come. There are remains of patients who were trepanned (had a hole drilled in the skull) as long as 5000-10000 years ago and survived the operation. Old paintings depict the barber performing surgery (without anesthetic) as a spectator sport. It was only in 1847 that ether anaesthesia was first used in Boston General, and 20 years later that Lister introduced carbolic acid as an antiseptic .

Laporoscopy was the big surgical advance of the 1980's. It's wonderful for the patient, as it is done through very small incisions which are less invasive and easier to heal. Laparoscopy was such an advance that now almost 100% of gallbladder operations are done through laparoscopy. And yet laparoscopy deprives a surgeon of their most refined skills, the 3D aspect of surgery which they have trained.

Enter the da Vinci surgical system, which allows surgeons to operate remotely by controlling robotic instruments, returning the sense of 3D vision and touch to them. This system follows the motion of the surgeon's hand - it 'gives them a wrist' as Mohr put it. Using the da Vinci, surgeons can now repair heart valves from inside the heart, without the heart ever stopping beating. This makes another advance on laparoscopy in minimizing the invasiveness of surgery.

There are further advances possible with such these procedures. At this stage, the system is best for an operation in one place, like, say, a prostectomy. For an operation that involves two sites, you'd have to move the whole system and set it up again. The solution is to bring the camera and instruments through one tube.

Other exciting advances can be made by increasing the vision of the surgeon through injection of markers to identify cancer tumours. Another use of such vision would be to check the efficacy of a bypass operation before closing. By inserting a microscope, you could see and operate on very tiny nerves.

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