The Washington Post
A team of French surgeons and American engineers reported Wednesday that it had performed the first robot-assisted surgical procedure in which the doctor was outside the operating room.
The operation was performed Sept. 7 by a surgeon manipulating robotic controls in an office in New York City. The patient, a 68-year-old woman, was in a hospital in Strasbourg, France. Her gallbladder was removed using instruments and a small video camera inserted into the abdominal cavity.
“It was the first time we have proved it was possible to do remote surgery,” said Jacques Marescaux, the chairman of intestinal surgery at Louis Pasteur University in Strasbourg, who performed the 54-minute operation. The patient suffered no complications and left the hospital two days later.
Robotic surgery is routine in some places abroad, with the surgeon working at a console near the patient in the operating room. Robotic surgery in which the doctor is distant had been done on pigs, but never on a person. A brief description of the procedure appeared Thursday in the journal Nature.
Marescaux and his engineering colleagues said they believe practical robot-assisted surgery will lead to safer and better operations, better training of surgeons, and more rapid and equitable dissemination of advances in surgical technique.
“This is a proof of concept that shows we have the technology to remove the distance barrier in surgery,” said Steven Butner, a professor of electrical and computer engineering at the University of California at Santa Barbara and a consultant to the project.
Crucial to the operation’s success were very high-speed telecommunications, which minimized the time lag between the surgeon’s hand motion and the response of the robotic instrument 4,000 miles away. In this case, the delay was 155 milliseconds, or slightly more than one-tenth of a second, which made the controls feel essentially normal, Marescaux said.
Robotic surgery is possible only for laparascopic operations, in which the doctor views the surgical field on a television monitor, and instruments for cutting and sewing are inserted into the body through keyhole incisions.
The first laparascopic gallbladder removal was done in the mid-1980s. Today, about 400,000 are performed annually in the United States. In all of them, the surgeon stands at the operating table and manipulates the instruments by hand. In robotic surgery, the surgeon sits at a console and uses remote controls to send a signal to a robot, which moves the instruments.
In the transatlantic operation, a doctor in the operating room in France prepared the patient and inserted the instruments before the surgeon in New York took over.
The robot offers several features that, theoretically at least, improve on hand-driven surgery. For example, it can transform a large motion by the operator into a small motion at the instrument tip. This process (called “scaling”) lets the surgeon manipulate smaller nerves, ducts and blood vessels, and sew smaller stitches. It eliminates hand tremor and permits instruments to be turned in ways not possible by hand. Robotic controls also allow a doctor to sit comfortably during procedures that can take hours.
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