If your idea of surgery comes mainly from TV-doctor dramas, you'll find this operating suite at the Henry Ford Hospital in Detroit a bit disorienting. There's a major surgery in progress that's what they tell you, anyway but you can't see a patient. For that matter, you can't see the surgeon. There must be a scalpel wielder here somewhere, but all you can see is people sitting at machines in near darkness. The largest of the machines is a weird behemoth in the center of the room, spiderlike, shrouded in plastic sleeves and protective drapery. Next to it, incongruously, are several lounge chairs facing a wall of enormous flat-screen monitors. The place is half alien spaceship, half man cave. Plus, people are wearing 3-D glasses.
In the tones of his native India, Dr. Mani Menon, medical pioneer, explains that the patient is lying in the center of the shrouded behemoth which, it turns out, is a surgical robot. Beneath those drapes, the robot has its skinny arms buried deep in the patient's abdomen, busily lifting and cutting and cauterizing with its tiny instrument-hands, guided by a man at the far side of the room his face peering into a console, his hands operating a pair of souped-up joysticks, his stocking feet pressing pedals more in the manner of an organist than a doctor. Every move of the robot is visible, in real time, on the flat screens: pictures from the belly of the sleeping patient, brilliantly lit, magnificently magnified and startlingly vivid in high def.
"The robot is just a tool," says Menon, director of the Vattikuti Urology Institute at Henry Ford. But that's like saying a Gulfstream jet is just a way to get from here to there. "Just a tool" suggests a No. 7 hemostat clamp, perhaps, or a pair of mosquito forceps. A million-dollar robot executing every movement of a delicate kidney surgery: that's not a tool; it's a revolution. And it is one that is shaking the surgical world. For an increasing variety of surgeries, robot-assisted techniques are now or soon will be standard operating procedure.
Menon is a founding father of the revolution. In 2000 he was the first surgeon in the U.S to remove a cancerous prostate gland using a robot. His path to such an improbable feat went like this: as a protg of the renowned surgeon Dr. Patrick Walsh of Johns Hopkins University, Menon had mastered Walsh's great breakthrough, an approach to prostate surgery that spared delicate nerves and offered patients the hope of a cancer cure that did not render them impotent and incontinent. Walsh's technique, for all its elegance, starts with a 4-to-6-in. (10 to 15 cm) incision carved with a handheld scalpel; it soon finds the surgeon's fingers inside the patient's pelvis. Menon wondered whether advances in laparoscopy could be applied to this delicate and complex surgery. Laparoscopy involves a set of surgical implements, a light source and a camera, each small enough to be inserted through relatively tiny incisions and manipulated by the surgeon from outside the patient's body like knitting needles. Because smaller incisions typically mean shorter hospital stays, less pain and quicker recoveries, laparoscopy had become, by the 1990s, the standard approach in many common abdominal procedures.
But as Menon was exploring laparoscopy, along came the robot. The instrument grew out of a U.S. Armysponsored project in the 1980s to develop a remote-controlled laparoscopic robot for battlefield surgery. That project is still a futurist's fantasy. But a couple of companies saw the commercial applications, and in 1999 the first surgical robots were introduced as the next phase in minimally invasive surgery.
Their inventors touted the power of robots to eliminate even the ghostliest of hand tremors. The machines could be calibrated to translate relatively large motions at the controller's console into tiny, ultrafine actions by the instruments. Best of all, perhaps, the robotic camera offered an unsurpassed view of previously claustrophobic surgical fields, magnified tenfold. Before the robot, a prostate surgeon like Menon had to learn parts of the craft by feel, because fingers in the pelvic cavity obstruct the line of sight. One highly experienced surgeon, on first seeing a robot's-eye vista of his longtime field of battle, marveled, "So that's what it looks like!"
Menon quickly became a believer. "For a surgeon, if you see better and there's less blood, you do a better job," he says. He found minimally invasive surgery was much easier with the help of a robot, and with a little practice it became easier than the Walsh-style open surgery too. In 2000, Menon established the nation's first center for robotic prostatectomy at Henry Ford and soon reported cure rates equal to those achieved with the Walsh method. Drawn by the promise of less intrusive surgery and easier healing, hundreds and then thousands of men came to Detroit, while surgeons across the country hustled to master Menon's breakthrough.
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