When Andrew Feldman works with a young surgeon, one of the first things he asks is: "Are you any good at video games?" Feldman, a Manhattan orthopedic surgeon, said video game players are naturally adept at using the basic surgical tools of the 21st century -- a remote-control joystick and a video monitor.
"Surgery is becoming one big video game and they've got the skills," said Feldman, director of sports medicine at Saint Vincent's Hospital. "All those parents who tell their kids to get away from the Nintendo may want to think twice." As surgery becomes increasingly computerized, doctors are being forced to develop skills long associated with video and computer games like Tomb Raider, Flight Simulator and Super Smash Brothers. Those skills include good hand-eye coordination, fast reflexes and an ability to solve problems in a virtual-reality environment, said Wiley Nifong, a cardiac surgeon who teaches surgical robotics at the East Carolina School of Medicine in Greenville, North Carolina.
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"We've coined a term for it -- video dexterity," said Nifong, 39, who has taught 115 doctors how to use surgical robots.
"The younger the student, the better they seem to do on the robot." Most new surgeries use minimally invasive techniques where fiber-optic cameras and remote-controlled instruments are inserted through small keyholes in a patient's body. In such operations, surgeons don't view their work directly through an open incision. Most of the time, their eyes are focused on video monitors with images of a patient's internal anatomy while their hands work the controls.
Minimally invasive surgical techniques are growing in popularity because they result in fewer infections and seldom require blood transfusions, doctors said. Smaller incisions also take less time to heal.
"They cut recovery times for patients by a third to a half," said Dennis Fowler, director of Minimal Access Surgery at New York-Presbyterian Hospital in Manhattan.
Remote-controlled robots make fewer mistakes because they never experience the hand tremors even seasoned surgeons sometimes get, Fowler said.
Technology is redefining surgery and the traditional role surgeons play in the operating room, researchers said.
"The funny thing about this technology is that a lot of smart people can't do it and lot of not-so-smart people are great at it," said Robert Howe, an engineering professor who teaches robotics at Harvard University.
When Nifong teaches older surgeons how to operate a surgical robot, it often takes them hours, if not days, to master simple maneuvers such as tying sutures, he said.
When he brings in a class of 12 or 13-year-olds to practice on the machine, he finds that many of them are able to tie serviceable surgical knots within 15 minutes of taking the controls.
"It's no big deal to the kids," he said. "They've basically been doing this kind of thing all their lives on games and computers." The mid-career surgeons who are adept at the technology often have a long history with high-tech gadgets and video games.
"Back in the '80s I really thought that Pac-Man was a neat game," said New-York Presbyterian's Fowler, 53.
Dr Michael Argenziano, a 34-year-old surgeon at New York Presbyterian, has a house full of computers, digital cameras and video games, but his favorite gadget is da Vinci, a US$980,000 robot that sits in a corner of the hospital's operating suite, he said.
"Isn't it cool?" said Argenziano, still wearing blue scrubs from a heart transplant he performed the night before. "I've spent hundreds of hours playing with this." The console of the machine, built by Intuitive Surgical Inc of Mountain View, California, is about the same size as an arcade video game. Argenziano slipped off his clogs to work a series of foot pedals, slid his hands into a pair of controllers and leaned forward to peer through the three-dimensional video viewfinder.
The spider-like robot was a couple of meters behind him in a detached unit. Argenziano operated a pair of pincers, each designed to have the same range of motion as a human hand and wrist. He began folding a coffee-stained napkin into elaborate origami shapes.
Argenziano used da Vinci to patch a hole in a patient's heart on July 24, the first time such an operation had been performed in the US without making a surgical incision. "It's better than a video game, because you get to save people's lives with it," he said.
Medical teams around the US are using da Vinci and Zeus, a robot designed by California-based Computer Motion Inc, to perform minimally invasive coronary bypass and heart-valve surgeries.
As technology advances, surgical virtual reality more closely mirrors the real thing.
A team of Harvard researchers is working on an anatomical positioning system that projects a three-dimensional map of a patient's internal anatomy on a monitor -- similar to the pop-up map Flight Simulator game players use to figure out which direction their virtual airplane is flying.
Engineers in the Massachusetts Institute of Technology's Touch Lab are creating a system that adds the sense of touch to surgical robots and medical simulators. "That's what's been missing from all the machines that have been built so far," said MIT researcher James Biggs.
Video game companies have been recruiting many of his colleagues to help design the next generation of video games.
"The programming for games and medical simulators is just about identical," Biggs said.
Hospitals are increasingly using surgical simulation programs with gaming technology to teach young surgeons how to perform minimally invasive operations. Immersion Medical Inc of Gaithersburg, Maryland, introduced AccuTouch, a computer simulator that replicates endoscopic and colonoscopic surgeries.
The simulator, which costs US$70,000, looks like a large personal computer unit, except for the two plastic molds mounted on its side -- a human face and backside.
Dr Adam Levine, an anesthesiologist at Manhattan's Mount Sinai Hospital, uses the simulator to teach his residents how to navigate a patient's windpipe. Working with an endoscope -- a camera attached to a multipurpose probe -- Levine sped down the cyber-patient's windpipe, as if it were an obstacle course, dodging the vocal cords, careening down bronchial tubes and lung branches.
When Levine took a small sample of a tumor, a cloud of blood momentarily muddied the lens. When he collided with the windpipe, his virtual patient let out a hacking cough that Levine quelled with a squirt of virtual anesthetic, just as he would in the operating room.
The computer differs from reality in one critical respect: If a student kills the cyber-patient, the computer resets itself and instantly resurrects the victim.
"Unlike the real world, the kids can make mistakes," said Levine, who runs Mt Sinai's anesthesiology residents program. "It's a lot better for them to screw up here than to practice on patients."
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