L.B. Surgeon Uses Robot in Operation

The world’s first robot-assisted operation on a human has been successfully completed at Memorial Medical Center here in a medical breakthrough that hospital officials say will make surgery faster, safer and more accurate.

On April 11, a team composed of a neurosurgeon, an engineer and a computer-operated robotic arm performed a biopsy on a 52-year-old Orange County man who has three malignant brain tumors, Memorial officials revealed Wednesday.

“We are happy to say the operation was a complete success, and the patient was discharged three days later,” said Dr. Ronald Young, the neurosurgeon involved in the operation.

The patient, who has requested anonymity, is undergoing radiation therapy as a result of the information gained from the robot surgery.

Experts at Carnegie-Mellon University in Pittsburgh and Caltech in Pasadena--two of the foremost robotics research facilities in the country--agreed that Memorial’s robot surgery is a technological breakthrough.

‘Definitely a First’

“I’ve never heard of any other such use (of robots),” Todd Simonds, associate director of the Robotics Institute at Carnegie-Mellon, said in an interview. He said he had heard of the Long Beach project “three years ago when it was still an experiment, and it wowed me then. Yes, it is definitely a first.”

Carl Ruoff, a robotics lecturer at Caltech and supervisor of the Jet Propulsion Laboratory’s robotics research group, also agreed. But Ruoff is less enthusiastic about the current use of robots in the health care field.

“I believe that this is the first such use,” Ruoff said in a interview. “It’s the first I’ve heard of. But you have to remember that a robot is not the same thing as having an intelligent assistant.

“I don’t know that it (the Long Beach robotic arm) has backup systems in case one of the motors that activates the arm were to fail,” he said. “If one of those were to go wildly out of control it could do terrible damage to the patient. People have been killed by robots.”

The way the robotic arm is used now, Young contends, there is little fear that it will go out of control. However, he said, “as far as I know there is no backup.”

No Risk to Patient

“We’ve tested it so many times that we are confident with it,” he said. “If there were a failure in the motor we would have to go back to the old way of doing the surgery, but at the present time I can’t see how there can be a risk to the patient the way we do it.”

According to Young, surgical use of the robotic arm will have the greatest impact on the treatment of tumors deep in the brain and brain stem--delicate operations whose success depends on speed, steadiness and accuracy.

“The robotic arm provides greater accuracy and therefore greater safety,” Young said. “The arm also shortens the surgery time.”

The robotic arm--nicknamed Ole after Long Beach philanthropist Svend Olsen, who left much of his wealth to Memorial after his death in March at age 85--is connected to a computer. When a biopsy is to be performed, the patient is first given a CAT scan. The CAT scan gives the surgeons a multidimensional picture of the patient’s brain, highlighting the tissue and any tumors within it.

The CAT scan is displayed on a screen, and the surgeon moves a cursor over the tumor to the exact spot where the biopsy needle, or probe, should go. The computer then transmits this information to the robotic arm, which has six joints to enable it to move in any direction.

Information from the CAT scan is fed into the computer, which calculates how deep the probe must go within the brain and the angle at which the probe must be inserted.

Aligned With Tumor

The patient lies on an operating table with his head in a plastic frame. After a small hole is drilled in his skull, the robotic arm uses the computer-transmitted information to precisely align itself with the hole and the tumor. The arm can position itself to within fractions of a millimeter. The surgeon, using an exact measurement from the computer, inserts the biopsy probe through the robot’s “hand” and into the brain and tumor and takes a small tissue sample.

Ole replaces a very cumbersome--and still widely used--process that relies on the steadiness of the surgeon’s hand and the accuracy of his calculations.

In this process, Young said, the surgeon opens the patient’s skull and, with a catheter placed in the center of the brain, injects dye to highlight the brain and its tissues, including any possible tumor. The dye can be read on an X-ray.

The patient’s head is placed in a frame. The frame has two calibrated arcs that encircle the skull. Using the information from the dye-injection process, the surgeon calculates at what angle, direction and depth the biopsy probe must go into the brain. The arcs are used to help the physician position where and at what angle the probe is to be inserted into the brain.

“The robot is accurate to within .0005 inches, and the computer hits the mark every time,” Young said. “You can’t place a probe on a target within .0005 inches with the human hand.”

Cost $1 Million

Ole was invented by Dr. Yik San Kwoh, director of research in the hospital’s radiology department, and took three years and about $1 million to create and perfect.

Countless tests were done using the robotic arm, but the greatest challenge Ole had faced before the April 11 biopsy on the Orange County man was to find and remove a single BB that had been planted in an overripe watermelon.

Although Ole still needs some fine-tuning, Young and Kwoh say that the robot will be used again and very soon.

“It can be used immediately the way it is,” Young said. “It is quite safe and effective. And we already have a patient we hope to use it on.”

Kwoh said Memorial has received “a few inquiries from major institutions” about using Ole, “but at this point in time we want to use it here for a while first and perfect it.”

Memorial officials have big plans for Ole, guaranteeing the robot a bright future in medicine.

“Our goal is to (use the robotic arm to) biopsy tumors deep within the brain or brain stem that can’t be reached by current techniques,” Young said. In addition, Young said he hopes that Ole can be used in delicate orthopedic surgery on ruptured disks, torn ligaments and cartilage, and eventually be coupled with a laser to excise brain tumors.

Ole, Young said, soon will become state-of-the-art equipment for neurosurgery.