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A robot that performs surgical miracles
Cyborg operates with steady hands upon doctor's command

BY TOM BALDWIN
GANNETT STATE BUREAU

NEWARK -- Steady is the hand of the surgeon -- one hopes.

That is precisely one of the benefits springing from what surgeons call a development in their toil -- a new robot to perform surgery.

The idea of robotic surgery began years ago when the Pentagon explored technology hoping to enable surgeons behind lines of combat to treat battlefield wounds.

Now, the forefront --"cutting edge" is just too apt a cliche here -- of that thinking exists in Newark Beth Israel Medical Center.

There, Dr. Dennis Bordan, chairman of the surgery department, said the robotics of the latest da Vinci Surgical Systems advance surgery as much as did anesthesia and antibiotics.

"Even preceding 'doing' is to 'do no harm,'" Bordan emphasized.

Today's trend, urged on by medicine and demanded by patients, is minimally invasive surgery. Incisions are smaller, so the scar is reduced. Pain can be less. Patients usually mend faster.

The latest version of the da Vinci fills that bill, say surgeons who are using Beth Israel's newest da Vinci. It is one of only three in the nation, with the others being at Methodist Hospital in Houston and at the manufacturer's Sunnyvale, Calif., headquarters.

The name, by the way, comes from Leonardo da Vinci, the genius Italian artist and scholar of the late 1400s who theorized about robots.

The da Vinci enhances the surgeon's handiwork as well as vision.

As Bordan said, "The surgeon now has a three-dimensional view of what he or she is doing. Depth perception is part of the surgical repertoire. The instruments used in the robot are articulated just like the human hand and wrist."

He added that the machine is decidedly more steady than even the most assured surgical hands, though this may not be visible to the human eye.

"It's a big deal," said Bordan.

He said, "One of the great operations for this technology has been prostate surgery,"where one slightly errant snip means erectile failure.

From miles away

The surgeon works on a console, gazing into a screen. The robot maneuvers at the surgeon's command, baring cutting tools and snips, above the patient.

In theory, the patient could be miles away, such as on a battlefield, or even aboard a space station. "That eventually is going to come," Bordan said.

The surgeon sees a magnified, three-dimensional view of the patient's insides, moving the robot by way of grip controls.

"It translates the movement of the surgeon through some instruments into the patient,"said Bordan. "Nothing is interceding that is computerized."

The robotics can make twists and turns impossible for the human hand, but it can do nothing the surgeon does not do. In other words, there is no computer program to do the surgery.

Training on the $1.5 million robot, which Beth Israel offers, is a challenge.

Bordan said doctors have to be proficient in the particular type of surgery. They then watch da Vinci procedures. They take a course to learn how to manipulate the controls. They practice on animals. Then they work under a proctor.

An earlier da Vinci system appeared in 2000 and is widely used. This new version is less than a year on the market.

Surgeons use it for heart, prostate, oncology, obstetrical, gynecological and head-neck procedures.

Updated: April 8, 2007 by D Savatta, MD

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