Forceps! Scalpel! Robot!

We're going to take real good care of you, you know that?" says Dr. Robert Michler, as he fixes his dark blue eyes on the 79-year-old patient to whom he's about to give a heart bypass. "I know that," answers Paul Oaks with a placid smile, as he lies on a gurney in a thin gown and floppy hospital cap.

Oaks has good reason to trust his surgeon. With more than 3,000 open-heart operations and some 400 transplants under his belt, Michler, chief of cardiothoracic surgery at Ohio State University Medical Center in Columbus, is no novice. Then again, today's procedure will be no ordinary bypass. It will be one of the first in the country to replace the surgeon's hands with 2-ft.-long robotic arms. The metallic limbs will enter the patient's body through the narrow gaps between the ribs, cutting holes no bigger than a nickel--a far cry from the usual 6-in. to 8-in. incisions sawed straight through the breastbone. Besides eliminating a can't-miss scar, the robotic approach promises to reduce the trauma to the body, speed recovery and minimize the risk of infection.

"There is no question in my mind that the future of heart surgery is in robotics," says Michler, whose team at OSUMC headed up the clinical trials that led this spring to the first Food and Drug Administration approval of a robotic partial-bypass procedure. Originally studied in the late 1950s as a way for Army surgeons to operate remotely on wounded soldiers on the battlefield, robotic surgery is just finding its way into leading medical centers across the U.S. With more than 500,000 heart-bypass operations performed each year in the U.S. alone, surgeons are eager for ways to improve the procedure.

Back in the operating room, Michler prepares for the first incision--a small round hole through which the robotic arm will enter the left side of Oaks' chest. First goes the camera, then the miniature forceps and finally a tool called a cautery, which will be used to isolate the artery that the surgeons plan to attach to the heart to restore proper blood flow. As Michler steps back, the robot springs to life. Looking like the legs of an oversize metallic spider, the long black arms start to gyrate--both outside and deep inside the patient's body.

This robot--a da Vinci model made by Intuitive Surgical of Mountain View, Calif.--doesn't exactly have a mind of its own. About 15 ft. away from the operating table, Dr. Randall Wolf sits hunched over a console that looks as if it came straight out of a video-game arcade. Instead of blasting imaginary bad guys, Wolf is peering into a 3-D display that gives him a surprisingly clear view, magnified up to 10 times, inside the patient's chest. He can see the top of the beating heart, the bulge of every rib and the outline of the artery he needs to reposition. As a dozen nurses, technicians and doctors stand motionless in the darkened operating room gazing at the overhead monitors, Wolf places his thumbs and forefingers into small controls inside the console. Then, moving his hands much as he would if he were actually holding the instruments, he shows the robot how to grab a piece of flesh with the forceps and begin peeling it away from the chest wall.

An hour later, several inches of the artery are dangling from the chest. While Michler and his team have the go-ahead from the FDA to attach the artery robotically to the beating heart, Michler's team is waiting for a better instrument to stabilize a small area on the heart so they can more precisely attach the artery. But even though they will finish the job by hand today, there's no need for a giant incision. Instead, they will work between the ribs in a hole no wider than a tennis ball to reattach the artery. About five hours after the patient was wheeled into the operating room, Michler is back with Oaks' family, giving them the good news.

While so far only this bypass procedure has received the FDA's blessing, trials are under way to robotically repair the heart's valves, place pacemaker wires and stabilize irregular heartbeats. In Canada, a rival system from Computer Motion in Santa Barbara, Calif., is being tested for fetal-heart surgery. Douglas Boyd, who heads the National Center for Advanced Surgery and Robotics in London, Ont., believes that robots' minimally invasive techniques could vastly improve fetal surgery's current 90% failure rate, which he says is primarily a result of the trauma placed on the womb by traditional surgical techniques. "Robots aren't just million-dollar sewing machines," says Boyd. "They are bringing a real revolution in heart surgery."

Paul Oaks didn't need a revolution. He just wanted to get back to Rachel, his wife of 59 years, and return to his home-repair business in De Graff, Ohio. "I'm not going to sit around," he said, wide awake the morning after surgery. Not to worry. Oaks went back to work last Monday, just three weeks after his operation.