Lv Hospital presses further into world of robotic surgery

Dr. Irwin Simon, in the operating room of MountainView Hospital in northwest Las Vegas, carefully manipulates a pair of elongated surgical instruments through two stainless-steel tubes inserted in a patient's abdomen. A third tube holds a tiny fiber optics video camera.

Overhead, a color TV monitor displays the magnified image of the woman's robin-egg blue gallbladder, as Simon carefully scrapes away fat deposits around the organ's exterior.

In less than an hour, Simon will remove the gallbladder. He'll clamp two vessels at both ends of the tiny organ, snip it free and pull it through one of the tubes.

A decade ago, gallbladder surgery was more invasive. It required making a large incision in the abdomen and cutting through major muscle tissue. After the operation, patients had to spend several days in the hospital. Full recovery could take up to six weeks.

But that's all changed today. With just three small incisions, Simon's patient is able to go home in a day and resume normal activities soon thereafter.

Surgery took a quantum leap ahead with laproscopic techniques.

Now it's on the verge of hitting warp speed.

Robots are making laproscopic surgery faster, more efficient and less tiring for doctors and nurses.

MountainView Hospital, 3100 N. Tenaya Way, entered the age of robotic surgery three months ago by purchasing AESOP, an acronym for Automated Endoscopic System for Optimal Position. AESOP is a one-armed piece of high-tech machinery that responds to a doctor's commands via an internal prerecorded voice cassette.

AESOP is merely the first stage of robotic surgery. In the near future a surgeon will be able to control all the machinery in an operating room through voice control. The lights will be turned on by voice, and VCRs, television monitors and even the operating instruments themselves will be robotic -- cutting, moving tissue and removing organs as the physician stands back and gives orders.

For now, AESOP is used as a basic tool to assist the surgeon. It's designed to hold a video camera steady during surgery and is capable of moving in multiple directions.

Because AESOP reacts instantly, Simon is able to anticipate problems and communicate faster via voice command instead of relying on a surgical assistant or nurse to interpret what he sees.

"It has cut down the time in the operating room from 9 to 20 percent, depending on the type of operation," Simon said. "All it takes is a drop of blood on the end of the scope, and it has to be pulled out and cleaned. That takes up time. I can anticipate (blood squirts) and tell the camera to move."

Surgical teams also are less likely to bump into each other in the operating room when maneuvering to move the camera or pull it out to clean the lens, Simon said. AESOP does all that now.

To date, the company that manufactures AESOP -- Computer Motion of Goleta, Calif. -- says more than 45,000 procedures have been assisted by the robotic device. More than 350 hospitals and surgical centers around the world are using AESOP.

MountainView Hospital is the only facility in Nevada using AESOP. At a price of $65,000, surgeons and hospital administrators alike think the purchase was a wise one.

"I just wasn't looking at cost benefits," said Bobbie McCaffrey, vice president of patient services at MountainView Hospital. "AESOP allows the surgical team to function better and more precisely. AESOP allows the team to keep a closer eye on the patient and monitoring equipment."

McCaffrey said MountainView eventually wants to do heart surgery, and she believes robotics will play a large part in developing that program. Currently, the hospital is looking at purchasing the next generation of robotic surgery -- the HERMES Control Center.

HERMES, named after the ancient Greek messenger of the gods, controls not only the laproscopic camera but also operating-room light sources, the video printer, video cassette recorder, shaver and various other robotic devices.

HERMES has been on the commercial market for only two weeks. Dr. Duncan Turner, director of gynecological surgery at the De La Vina Surgical Center Medical Group in Santa Barbara, Calif., has been involved with the system in clinical studies for the last four months.

"This makes life much more easier and more accurate," Turner said. "As you are talking to the machine, the surgeon can be more accurate because there is no human interruption."

Turner said it's important to keep movement at a minimum in the operating room because too much movement will create air currents that could kick up dust and contaminate the patient. He has used HERMES to remove ovarian cysts and for bladder surgery.

Like Simon, Turner said robotics has increased his efficiency in the operating room and allowed the patient to spend less time on the operating table. He's excited about the next generation -- ZEUS -- which is still in development.

ZEUS not only combines the attributes of AESOP and HERMES, but allows the surgeon to manipulate robotic arms in performing the surgery.

Simon said the problem with doing microsurgery is that even the most skilled physician is hampered by unintentional hand movements. With ZEUS, the robotic arms are 100 percent steady and can make minute incisions.

Dr. Harold Tabaie, a surgeon at Sarasota (Fla.) Memorial Hospital's Center for Advanced Surgery, is one of only five physicians in the world who has been experimenting with ZEUS. He has been doing surgery on animals and cadavers and is excited about possibly doing the first human heart-bypass surgery with ZEUS in the near future.

"With ZEUS, you have the knowledge of the surgeon with the precision of robots," an excited Tabaie said. "A lot of surgeons have abandoned laproscopic (heart) surgery because of complications."

To do laproscopic heart surgery today, Tabaie said as many as seven portals must be made into the human body for instruments, the camera and monitoring equipment. The heart must also be arrested.

Surgeons, Tabaie said, have found that too much can happen when attempting laproscopic heart surgery. With ZEUS, only three portals are made in the body -- one for the endoscope and two to accommodate the surgical arms.

Sarasota Memorial, which is awaiting Food and Drug Administration and the hospital's Institutional Review Board approval, is hopeful of doing the first human heart surgery with ZEUS in November or December.

"With this, the future of surgery will be changed forever," Tabaie said. "It is just tremendous what has happened with heart surgery from 20 years ago. I am excited about doing the first bypass surgery. I won't have to open up the chest to do it."

To date, MountainView seems to be the only hospital in Nevada dedicated to developing robotic surgery programs.

Ann Lynch, vice president of community services at Sunrise Hospital and Medical Center, said the high-tech surgery is not on the hospital's immediate agenda.

Trish Lampro, community-relations coordinator at University Medical Center, Clark County's public hospital, said UMC has no plans to pursue it.

Desert Springs Hospital Medical Center also reported no immediate plans to develop robotic programs.

Pam Augusta, assistant director of marketing at Valley Hospital Medical Center, said the hospital administration has decided to study national testing of robots for the next 18 months before making a decision.

Simon is confident robot surgery will eventually become a staple in major hospitals around the world. He thinks NASA, which has influenced virtually every aspect of Americans' lives from computers to clothing, will be the catalyst.

"The first time a person gets appendicitis in a space station, and a surgeon at Mission Control (in Houston) removes the appendix using a robot," Simon predicted, "that's when people will really see the importance."

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