Wed, Aug 01, 2018 - Page 9 News List

The robot will see you now: Could computers take over medicine entirely?

They already perform remotely controlled operations — now robots look set to be the physicians of the future

By Tim Adams  /  The Observer

Illustration: Kevin Sheu

Like all everyday miracles of technology, the longer you watch a robot perform surgery on a human being, the more it begins to look like an inevitable natural wonder.

Earlier this month I was in an operating theater at University College Hospital (UCH) in central London watching a 59-year-old man from Potters Bar, England, having his cancerous prostate gland removed by the four dexterous metal arms of a US-made machine, in what is likely a glimpse of the future of most surgical procedures.

The robot was being controlled by Greg Shaw, a consultant urologist and surgeon sitting in the far corner of the room with his head under the black hood of a 3D monitor, like a Victorian wedding photographer.

Shaw was directing the arms of the remote surgical tool with a fluid mixture of joystick control and foot-pedal pressure and amplified instruction to his theater team standing at the patient’s side.

The surgeon, 43, has performed a thousand such procedures, which are particularly useful for pelvic operations; those, he said, in which you are otherwise “looking down a deep, dark hole with a flashlight.”

The first part of the process had been to “dock the cart on to the human.” After that, three surgical tools and a video camera, each on the end of a 30cm probe, had been inserted through small incisions in the patient’s abdomen. Over the course of an hour or more Shaw then talked me through his actions.

“I’m just going to clip his vas deferens now,” he said and I involuntarily winced a little as a tiny robot pincer hand, magnified 10 times on screens around the operating theater, came into view to permanently cut off sperm supply.

“Now I’m trying to find that sweet spot where the bladder joins the prostate,” Shaw said, as a blunt probe gently stroked aside blood vessels and found its way across the surface of the plump organ on the screen, with very human delicacy.

After that, a mesmerizing rhythm developed of clip and cauterize and cut as the Velociraptor pairing of “monopolar curved scissors” and “fenestrated bipolar forceps” worked in tandem — the surprisingly exaggerated movements of Shaw’s hands and arms separating and sealing tiny blood vessels and crimson connective tissue deep within the patient’s pelvis 3m away.

In this fashion, slowly, the opaque walnut of the prostate emerged on screen through tiny plumes of smoke from the cauterizing process.

The operation was part of a clinical trial of a procedure pioneered in German hospitals that aims to preserve the fine architecture of microscopic nerves around the prostate — and with them the patient’s sexual function.

With the patient still under anaesthetic, the prostate, bagged up internally and removed, would be frozen and couriered to a lab at the main hospital site 1.6km away to determine if cancer exists at its edges.

If it does, it might be necessary for Shaw to cut away some of these critical nerves to make sure all trace of malignancy is removed.

If no cancer is found at the prostate’s margins the nerves can be saved. While the prostate was dispatched across town, Shaw used a minuscule fish hook on a robot arm to deftly sew bladder to urethra.

The Da Vinci robot that Shaw was using for the operation, made by the US firm Intuitive Surgical, is about as “cutting edge” as robotic health gets.

The US$1.97 million machine enables the UCH team to perform 600 prostate operations a year, a four-fold increase on previous, less precise, manual laparoscopic techniques.

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