The Doctor Is (Plugged) In

Surgeons at UC San Diego Medical Center announced Thursday that the hospital is the first in the nation to use an experimental robot called AESOP on patients in what they hope is a major step toward an interactive relationship between doctors and robots in the operating room.

The goal is to reduce risk, cost and length of surgery by reducing the human factor.

Using AESOP, doctors have completed two gallbladder operations and a hysterectomy in the last week. By year’s end, nine other hospitals, including some of the nation’s most prestigious, are expected to be using AESOP robots in surgery.

Dr. Jonathan Sackier, associate professor of surgery at UCSD, said the robot marks a revolution in laparoscopy, a surgical method used for nearly 1 million operations a year nationwide, including gallbladder removal, hernia repair, gynecological surgery, urological surgery, orthopedic surgery and neurosurgery.

In laparoscopic procedures, the surgeon makes only a tiny incision and inserts an optical tube with a miniature camera on the end. The image is projected onto a video screen, allowing the surgeon to know where to cut, rearrange and stitch.

AESOP, which stands for Automated Endoscopic System for Optimal Positioning, allows surgeons to get a sharper view. Instead of a camera operator holding the laparoscopic tube inside the patient, the tube is controlled by a foot pedal operated by the surgeon.

An arm from AESOP moves the tiny camera wherever the surgeon wants. Eliminating the camera operator means less chance of miscommunication when the surgeon asks for the camera to be shifted.

“AESOP allows a stable view when you’re doing delicate work,” Sackier said. Watching blurry images on the television screen and trying to communicate to a camera operator can distract surgeons and increase the chance of error and postoperative complications, he said.

The robot was developed by Computer Motion of Goleta, which has produced robots for several government agencies. Approval to market the robot, which is expected to cost $20,000 to $30,000, beyond the 10 test hospitals is pending before the U.S. Food and Drug Administration.

Dr. Richard Satava, an Army surgeon at Walter Reed Medical Center and special assistant in biomedical technology for the Advanced Research Project Agency within the Department of Defense, said the robot is “the first example of the general surgeon accepting the role of robots in actual surgery.”

It is not, however, the first use of robots in surgery. Surgeons at the UC Davis Medical Center in Sacramento have been using Robodoc for the last year to drill holes into bone for hip replacement surgery.

“The difference is that Robodoc is really just a smart Black and Decker drill,” Satava said. “You program it and it can drill a hole to a tolerance that a surgeon couldn’t. AESOP works interactively with the surgeon and has far greater uses in many more types of operations.”

Robots may someday be holding surgical clamps and performing other chores, Satava said.

Dr. James Cochran, chief of staff at Presbyterian Hospital in Dallas and a member of a training committee of the American Urological Assn., said the robot will enhance the safety of surgeons and patients.

“I’d stop short of calling it a huge breakthrough,” he said. “But I do believe it’s a very significant step in the whole telerobotic surgery field, the whole concept of using computers and letting robots do the work of men in the operating room.”

Sackier, director of clinical studies for AESOP, said further refinements might allow the robot to be voice-activated or even to anticipate what the surgeon needs to see. He said the robot shows the emerging “symbiotic relationship between human beings and a machine.”

Marjorie Yelton, 69, of San Diego, who had her gallbladder removed last week with the help of AESOP, has no complaints.

“The doctor said the robot would only do what he (the doctor) wanted,” she said, “so I felt safe.”