Doing Surgery By Remote Control

by Kathleen Scalise

Forget M*A*S*H and its scenes of battlefield surgeons rocked by enemy shells, say Berkeley engineers and UCSF physicians. The MASH of the future will dispatch robots to the front lines so surgeons can operate on injured soldiers by remote control.

The first prototypes of the new robots were demonstrated March 13 at Soda Hall's Hewlett-Packard Auditorium at the campus's annual Industrial Liaison Program conference, which shares Berkeley's research with business and industry.

"It is space age medicine, using minimally invasive surgery to enter the body," said S. Shankar Sastry, director of the Electronics Research Laboratory and a professor of electrical engineering and computer sciences, "and it's here to stay."

The new technique will be useful for surgical care of astronauts, urban trauma care and rural health care. The key, says Sastry, is to use remote "telesurgery" to provide medical intervention in the "golden hour" immediately following trauma, even if the doctor is not yet on the scene.

The lab prototypes are composed of two types of robots. The first, termed a "holding" robot, holds instruments that can be wheeled to the patient's side. Then, driven remotely by surgeons using joystick-like controls, the holding robots grasp tiny companion robots. These tiny robots, on the scale of millimeters, are inserted into the body and do the actual surgical work in the body cavity. They can be used for a variety of surgical tasks requiring dexterity, such as suturing and dissection, said Sastry.

All instruments are designed to enter the body through tiny orifices, usually from 10 to 20 mm. in diameter -- or about the diameter of a dime or less -- to minimize damage to muscle and surrounding tissue.

But what really makes the difference for battlefield medicine is the robots don't have to be hardwired to doctor's controls. Rather, they can be plugged into computer networks so doctors can do remote surgery even if the patient is far away.

"We don't advocate using the Internet," said Sastry. "The Japanese showed something in December using the Internet. But we believe you just can't have unpredictable time lags when you are in the middle of surgery. That could be very bad. I think it would have to be a dedicated link, perhaps a wireless one."

A unique feature of the Berkeley robots is a new device that enables doctors to "feel" the body as they operate, developed by Berkeley Professor Ronald Fearing. "It's like a microscope for touch," Fearing said.

This is important, for instance, in cancer surgery. "The difference between cancerous and non-cancerous tissue can be felt," said Sastry. "If it vibrates, it's what we call motile; if not, it's cancerous."

"It's sort of augmented reality. It gives surgeons a sense of texture and how much pressure they're exerting," he said.

All of these new robot developments are useful in trauma care, said Sastry, where the first 60 minutes is the so-called "golden hour," when intervention is most likely to pay off. "Typically much of that golden hour is spent in transit. If you can operate on patients while they are in ambulances -- at least rudimentary surgery, suturing, etc. -- the outcome would be better," said Sastry.

The research team will begin trials of the machines later this year and expect several subsequent years of review for certification by the Food and Drug Administration before any such products will be on the market.

Those participating in the robot development from Berkeley are Sastry, Fearing and graduate students Michael Cohn, Lara Crawford, Jeff Wendlandt, Ujjwal Singh, Gabe Moy, Murat Cenk Cavusoglu and Joseph Yan. Researchers from UCSF are professors Lawrence Way and Frank Tendick.

In other highlights from the Industrial Liaison Program conference:

  • A new patent is pending on an apparatus that checks for breakdowns and damage in reinforced concrete, the main ingredient in Cali-fornia's dams, roads and bridges. The device allows early detection of such problems as ice damage and rebar corrosion, say developers Paulo Monteiro, professor of civil and environmental engineering, and Frank Morrison, professor of mineral engineering. Expected cost savings are significant. The bill to repair the U.S. infrastructure now stands at $100 billion.

  • Baseball fans can now track the standing of their favorite teams daily, with a new software program that analyzes results of each day's games and automatically recalculates standings, including the number of games each team must win to clinch playoff spots.

    Developers are professors Ilan Adler and Dorit Hochbaum and graduate students Eli Olinick and Alan Erera of Industrial Engineering and Operations Research. See it all at struments that can be wheeled to the patient's side. Then, driven remotely by surgeons using joystick-like controls, the holding robots grasp tiny companion robots. These tiny robots, on the scale of millimeters, are inserted into the body and do the act>


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