'Remote' surgery turning point (original) (raw)
A PIONEERING study by British doctors has revealed that a robot is better than a human surgeon at carrying out a complex kidney operation - even when the robot is controlled by doctors 4,000 miles away.
The breakthrough paves the way for thousands of operations to be performed with robotic engineering, which appears to be safer and more accurate than conventional procedures. Unlike humans, robot 'arms' do not shake when they target a small piece of tissue or organ.
Surgeons at Guy's Hospital in London, working with colleagues in the US, have completed the first controlled trial comparing the performance of a robot with that of a human surgeon.
The robot, whom staff have nicknamed Rachmaninov, is controlled remotely by a doctor using a computer-linked joystick. It can be controlled from the next room, or from thousands of miles away, using high-tech video and phone links.
'We believe this is a landmark,' said Prokar Dasgupta, consultant urologist at Guy's, who led the study. 'We now have this firm evidence that robots can give us an amazing level of precision which it would be foolish to ignore.'
Earlier this year, resear- chers tested the device on a silicone dummy. Its task was to cut through the 'skin' of the dummy and target kidney stones embedded in a model kidney before breaking up and extracting them.
The study, which began in June and has just been completed, compares the results of 152 operations carried out by robots with results from 152 procedures conducted by urologists. Both groups performed a keyhole surgery procedure, known as a percutaneous nephrolithotomy, or PCNL, to relieve patients of kidney stones.
The dummy was filled with material which feels to a surgeon exactly like a cross-section of a person's lower back.
The robot's task was to insert a long needle into the dummy with X-rays guiding it to the kidney. A surgeon guided the robot's arm using a joystick linked to a computer, which processed information about the size and depth of the organ.
Once the robot had reached the hard kidney stone within, the inner tube of the needle was removed, leaving the outer tube, and a wire was threaded through to dilate it, forming a channel from the organ to the skin. A tiny telescope was guided down the channel to look at the organ, and then instruments were used to break up the stone and extract the remnants.
The trial produced impres sive results. They show that although the robot took a few seconds longer than a human to locate the stone, the device took significantly fewer attempts to hit the right spot. On most occasions, the robot needed only one attempt to reach the stone.
Even less experienced surgeons controlling the robot produced a better result than their more experienced counterparts. For patients, that would mean far less chance of suffering a complication such as blood loss or damage to a nearby organ.
Dasgupta said: 'For the first time, this provides clear scientific evidence that robots are more accurate, and ultimately safer, than human beings. We wanted to show that there is a scientific basis for using this technology, and that it can be performed as well by a doctor sitting in his room 5,000 miles away as it can by a doctor sitting right next to the patient.'
The first patients to undergo robotic surgery will not do so until next year, but before this can happen Dasgupta and his team must overcome ethical hurdles in order to gain approval from the hospital's committee of experts.
There have been several attempts to use robotics in surgery, but until now there has been no international clinical trial proving they are more effective. The study's results, which have been submitted for publication, also show the safety of tele-surgery, where operations are performed remotely across continents by doctors using computers, broadband links and a plethora of newly-engineered tools.
In the Sixties Nasa worked on technology that it believed could be used not only in space, but in remote war zones. However, because it has taken so long to develop fast, reliable phone links, it is only now that companies and surgeons are able to see the potential for real-time sur-gery performed across international boundaries.
But patients should not be worried that they are going to be left in a room with a robot cutting into them, with the surgeon miles away. A surgeon would always be on hand, along with an anaesthetist by the patient's side in case a mechanical failure occurred.