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Doctors were able to operate robots in remote surgery

17 tele-surgeries were performed by doctors from the USA on patients in Italy. The experiments were crowned with success

Avi Blizovsky

Specialist surgeons can now safely use robots and computers to help them perform surgeries remotely anywhere in the world. This is claimed in a new study.
Researchers at the Johns Hopkins Medical Center said at the American Association of Urologists conference held in Arnhem, California in early June 2001 that they were able to perform 17 "teleoperations" on patients in Rome.
Since these are automatic devices, there is no longer any need to adjust them to the hands of the surgeons and it is possible to minimize and perform treatments inside the body, like in the movie "The Wonderful Journey", says Dr. Dan Stianovitz, director of the Uro-Robotic Laboratory at Johns Hopkins. He was referring to a 1996 film about a group of surgeons who miniaturize themselves inside a sick person's body to fight germs.
Between September 1998 and July 2000, teams at Johns Hopkins tested combinations of computers, communication systems, contract conferencing systems, and advanced surgical robots to guide the performance of operations at the Policlino Casilino University Hospital in Rome.
Surgical robots can increase the surgeon's capabilities by reducing the level of movement, providing XNUMXD images, and renouncing the natural vibrations of the hand. The robotic systems also contain a console for viewing and controlling the robot, as well as a cart with robotic arms attached to the patient's bed.

14 of the 17 remote surgeries were laparoscopic, meaning they contained a microscope on top of an optical fiber that was inserted into the body. Eight of the surgeries were on men's sperm tubes, three surgeries were for the purpose of removing kidneys that were not functioning, two surgeries were for the purpose of taking biopsy samples from the kidneys, and one surgery even corrected the function of the kidney. Since laparoscopic surgeries are performed with minimal penetration, patients suffer less pain and lose blood, and their ability to recover is faster than in conventional surgery.
However, the surgeons need a lot of training to use this technology that was developed only to show surgeons in remote areas how to perform the operation. The researchers say that all surgeries were performed successfully without any side effects. Still there were glitches. In seven of the surgeries, the fiber optic connection was interrupted and the doctors in Rome had to intervene and continue the surgery. In two cases it was necessary to open the abdomen, and in one case it was necessary to transfer the robot to manual management.
"This is an experimental project. As the robots improve, we will be able to do more with them," says Stoyanovich. According to him, the technology has the potential to be used on the battlefield and even in space.
If robotics improves, and we can really perform many types of surgeries, the vision of a surgeon sitting in a control center and moving from surgery to surgery at sites around the world with the push of a button will be there." He concludes.
And "the scientist adds" that in such a case it will be necessary to train these surgeons to understand that at the other end are real surgeons, and this is not a computer game."

^^Israeli development: video XNUMXD microscope for surgeries^^

A XNUMXD video-microscope system, the first of its kind in the world called IO, intended for microsurgical and neurosurgical operations was developed in Israel by Sergi-Vision and is now undergoing initial trials at the "Shiva" medical center in Tel Hashomer. In the first experiment tiny blood vessels (of a mouse) were sewn.

The equipment incorporates a navigation system, a display for the surgeon and his staff, and a system that receives information from various cameras. The navigation system is also the workstation - the first in the world for neurosurgeons. Data for surgeons is also obtained from MRI.

The surgeons see everything necessary in 98D glasses that they wear - and thus their hands remain free. The need for such systems has increased since XNUMX percent of US hospitals where neurosurgical operating rooms currently lack microscopes and navigation systems.

The surgeon was sitting in New York and operated on a patient who was hospitalized in France

For the first time: a robot controlled by a surgeon from thousands of miles away performed a full operation

by Tamara Traubman

Photo: IP the robot removes the gall bladder at the hospital in Strasbourg

A patient from France, who needed an operation to remove her gallbladder, underwent a somewhat strange operation: she was anesthetized and laid on an operating table at the "Civil Hospital" in Strasbourg in eastern France, but no one touched her. Instead, robotic metal arms, controlled from across the ocean by a New York surgeon, made small incisions in her stomach and removed her gallbladder.
The surgery was performed on September 7, and yesterday it was reported for the first time. Doctors from Johns Hopkins University did indeed use a robot in the past to perform part of a kidney operation on a patient in Rome. However, this is the first time that a complete surgery is performed, from start to finish, using a robot that is guided by a doctor who is thousands of kilometers away from the patient. This is according to the members of the team, which included doctors and engineers. A scientific report describing the surgical procedure will be published next week in the scientific journal Nature.

Photo: Reuters
Dr. Marceau directs the surgical robot from New York

Doctors hope that robotic surgeries performed remotely will allow them to operate on soldiers on the battlefield in the future; patients living in remote areas; And maybe even astronauts staying in space. In this way, experts say, patients will be able to be operated on by leading surgeons, without having to travel long distances to reach them.

During the operation on the 68-year-old French patient, surgeon Dr. Jacques Marceau sat in a room at Mount Sinai Hospital in New York, directing the movements of the robot in France. The robot was equipped with surgical knives and a laparoscope. The laparoscope is made of a tiny tube, at the end of which a camera and a collector (for collecting tissue samples) were installed. The device was inserted into the body through a small incision in the abdomen, allowing doctors to observe the patient's internal organs.

Dr. Marceau said the operation lasted 45 minutes. According to him, the operated woman did not suffer any complications during or after the operation, and she was released to her home two days later. Steven Bettner, a professor of electrical and computer engineering at the University of California at Santa Barbara, and one of the partners in the project, said yesterday at a press conference that the analysis is "proof of principle that we have the technology that will allow us to remove the distance limit in the analysis."

According to Prof. Bettner, the great challenge in remote surgeries is to improve the quality and speed of information transfer: "To perform a remote surgery successfully, means of communication are needed that will allow the surgeons to see clear images of the surgery being performed; And it is necessary to eliminate the time gaps that exist from the moment the surgeon gives the command to the robot to move, until the robot executes it."

In the current analysis, the problem was solved by using optical fibers developed in the laboratories of "France Telecom". The fibers transmit information arriving with a delay of 150 milliseconds.

The robotic system for the surgery in Strasbourg, known as "Zeus", was developed by a Californian company called "Computer Motion." According to Dr. Marceau, in gallbladder surgeries, and in other surgeries that require minimal invasion of the operated body, "robots have several characteristics that can improve, at least in terms of Theoretically, the surgeries performed by flesh and blood surgeons". For example, Dr. Marceau points out that robots can turn large movements of the surgeon into tiny movements, which makes it possible to reach a superhuman level of precision.

In this way, it may be possible to use robots to perform microsurgery on the nervous system, on blood vessels, and to sew tiny stitches. "Robots never have hand tremors," concludes Dr. Marceau.

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