Smooth Operator : Precise, Steady Robotic Arm Assists Doctors in Surgeries

As Teresa Radlinska was rolled into Operating Room 3 on the day before Thanksgiving, she knew that a robot would be part of the medical team removing her gall bladder.

But she didn’t worry about a non-human assistant probing around inside her body, because its precise maneuvers meant she would be out of surgery in only 25 minutes and home in time for Thanksgiving dinner.

The new doctors’ assistant at Verdugo Hills Hospital in Glendale is a large robotic arm called AESOP and used during laparoscopic surgeries, which include gall bladder, hernia, gynecological and intestinal operations. In these types of surgeries, a long, minute camera called a laparoscope is inserted into the body and sends pictures to nearby television screens to guide the doctor through surgery.

Verdugo Hills is one of two hospitals in Southern California--and the first in the San Fernando Valley--to use the robotic arm, which can more steadily guide the laparoscope than a human assistant, surgeons at the hospital said.

Officials at Verdugo Hills said AESOP, which stands for Automated Endoscopic System for Optimal Positioning, is better for patients--recovery is quicker and operating time is reduced. By eliminating the need for assistants to hold the laparoscope, they are free to tend to other patient needs.

“The biggest benefit is that it frees up a set of hands and it holds (the laparoscope) still when you want it to hold still,” said Dr. Steve Gossard, a general surgeon at Verdugo Hills who removed Radlinska’s gall bladder.

Without the robot’s help, the 45-year-old Radlinska would have been in surgery for several hours instead of less than half an hour.

With a hand-held remote control, Gossard guided AESOP’s movement of the laparoscope through Radlinska’s abdominal cavity until it reached her gall bladder. The mini video camera, which was inserted through an incision under her bellybutton, provided him with clear images on the monitors next to the operating table.

Gossard also used the remote control to program the robotic arm to memorize positions near Radlinska’s gall bladder in case he needed to go back to them.

AESOP is an improvement over human hands because it can hold the camera perfectly steady for an extended period of time. When humans do the same job, the picture shakes, somewhat like an amateur cameraman’s home video, making it extremely difficult for surgeons to pinpoint the surgical areas.

With both of his hands free, surgical assistant Dr. Bob Pereyra used other instruments to maneuver Radlinska’s liver and gall bladder so that Gossard could complete the surgery.

“He’s (free to work) the gall bladder around in the positions I need it to be,” said Gossard during the closing minutes of the surgery. As he pulled out Radlinska’s gall bladder, he squeezed the inch-and-a-half-long sack to confirm that it was filled with gallstones. “It’s full of multiple stones . . . a whole bunch of them,” Gossard said.

In the past, either Gossard or Pereyra would have had to use one of their hands to move the laparoscope and the other to maneuver Radlinska’s organs.

“There’s just not enough room around the operating table to get in all the hands you need,” said Dr. Ronald Woodard, a gynecologist who was the first at Verdugo Hills to use AESOP.

The company that created AESOP, Goleta-based Computer Motion, is the only firm in the United States that has received Food and Drug Administration approval to market this technology. UC San Diego Medical Center was the first hospital to begin using AESOP. The company is also developing a voice-activated AESOP that surgeons will be able to command by saying, “AESOP right” or “AESOP down.”

AESOP, however, is not the first use of a robot in surgery. Doctors at UC Davis Medical Center in Sacramento have been using a robot called Robodoc for the past two years to drill holes in hips for replacement operations.

Doctors at Verdugo Hills said patients have expressed confidence about a robot being part of their operations. “The consumer is very technology-conscious,” said Casey Barbiera, director of surgery at Verdugo Hills.

Gossard said there are no known risks in using the arm, which the hospital rents for $595 a month.

Before the laparoscope, doctors removed gall bladders through a four-inch incision that was made under the rib cage. This left patients with large scars that took as long as six weeks to heal. “(Now patients) are home in a day, and they return to work within a week at most,” Barbiera said.

Radlinska left Verdugo Hills with four Band-Aid-size incisions that would heal in no time. She will still be able to wear a bathing suit, with no embarrassing marks, Barbiera said.