Wednesday, January 16, 2002

Steady hand on the camera

By Tim Bonfield
The Cincinnati Enquirer

        In a bustling operating room Tuesday, Dr. Fred Ryckman watched his progress on an overhead video monitor as he carefully burned away webs of connective tissue from a kidney destined to be transplanted from a mother to her daughter.

        Using tools he could not see without looking at the video screen, Dr. Ryckman needed to adjust the camera inside his patient's abdomen to get a better view.

[photo] Dr. Fred Ryckman adjusts an instrument held by AESOP, a robotic arm, as surgery gets under way to remove a mother's kidney for transplanting into her daughter.
(Dick Swaim photo)
| ZOOM |
        Speaking into a headset, Dr. Ryckman called out, “AESOP?'

        “Bling!” came the mechanical response.

        “Move forward,” the surgeon commanded.

        The view on the overhead monitor promptly shifted to reveal a bit more of the dark gray spleen that Dr. Ryckman needed to move out of the way to reach the kidney.

        Rather than being held by human hands, a slender tube tipped with a tiny fiber-optic camera lens was held and moved by a $90,000 robot named AESOP, one of the latest advances in operating room technology to be acquired by Cincinnati Children's Hospital Medical Center.

        The robotic arm, made by California-based Computer Motion Inc., looks like a mini-version of the industrial robot arms used in auto manufacturing. Nationwide, several hundred adult hospitals, including Christ Hospital in 1997, have added the robot arm to their operating room arsenals.

        Cincinnati Children's announced last week it has become one of the few pediatric medical centers nationwide to buy the robot. The hospital has two of the devices, which surgeons expect to use nearly every day for making repairs to kidneys, livers, spleens and colons.

        On Tuesday, the robot was used during the first part of a day-long living-donor kidney transplant.

        In the morning, Dr. Ryckman removed a kidney from Donna Cash, a 53-year-old resident of Corbin, Ky. The organ was rushed to the next operating room to be transplanted by Dr. Maria Alonso into Mrs. Cash's 22-year-old daughter, Lauren Litton, also of Corbin. Ms. Litton has suffered from kidney disease for years.

        As of Tuesday evening, the double-surgery appeared to be a success, doctors said.

        During long surgeries, holding the camera is an important-yet-boring job that some say is ideal for a voice-controlled robot. Unlike humans, robots don't tremble after holding the camera for hours at a time. They don't sneeze, or get distracted, or need to use the bathroom.

        “This type of robot works best for tedious procedures,” Dr. Ryckman said. “In some ways, it's relatively primitive. All it does is hold the camera. But like computers, every generation gets a whole lot better. I think this kind of technology will open a lot of doors for minimally invasive surgery.”

        The robot arm enhances the growing trend of performing ever-more-complex laparoscopic surgeries. In more situations, surgeons work on patients from the outside using long, thin instruments poked through tiny holes rather than making large incisions needed to use standard tools.

        Just a few years ago, a person donating a kidney to a relative faced spending four days in the hospital and six weeks at home to recover from an incision starting near the spine and stretching nearly halfway around the body.

        With laparoscopic techniques, donors can go home in two days and be back to work in two weeks, Dr. Alonso said.

        Beyond AESOP, more sophisticated robotic systems actually do some of the surgery. Computer Motion makes a remote surgical tool called Zeus. Meanwhile, Intuitive Surgical Inc. makes a robot named da Vinci, which has been installed at Ohio State University.

        Someday, robotic surgical systems may allow doctors to stay in their hometowns while remotely operating on wounded soldiers, injured astronauts, or people in Third World nations.

        But doctors say it will be a long time before robots can actually replace a surgeon.

        If there was any doubt such high-tech devices can be fallible, it was removed Tuesday. After functioning properly early in Mrs. Cash's surgery, the robot would not move the camera to a position that Dr. Ryckman wanted.

        After the robot repeatedly chirped “Lower limit!” and “Shoulder limit!” in response to commands, doctors decided to wheel AESOP away. Dr. Greg Tiao, already there to provide more sophisticated assistance, finished the job.


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