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PAGING DR. DA VINCI:
Scissors? Check. // Forceps? Check. // Cameras? Check. // The newest doctor can remove prostates, repair heart valves and reattach tissues. And it’s not even human. Meet...

The Robot Surgeon

By Charles Slack // Additional reporting by Andrea Appleton //

Photographs by Max Aguilera-Hellweg // Winter 2007
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Da Vinci robotic surgery system

In addition to being a marvel of engineering and, according to its proponents, a harbinger of the future of surgery, the da Vinci robotic surgery system is just plain cool. Even watching a video of a procedure in Ashutosh Tewari’s ninth-floor office at Weill Cornell–New York Hospital in Manhattan requires special equipment. “Put these on,” Tewari says, handing over a pair of 3-D glasses not unlike those distributed to audiences at science-fiction movies during the 1950s.

On the screen, the lower abdominal cavity of a man undergoing a radical prostatectomy—removal of a cancerous prostate—is illuminated like the interior of an animated red-walled cave. About the size of a walnut, the prostate gland, which produces seminal fluid, is located under the bladder and surrounds the urethra. Removing it is a delicate procedure, compounded by the gland’s proximity to bundles of nerves and tissues controlling continence and sexual function. In the video, tiny silver forceps, the size of a dime, gently clasp pieces of fibrous tissue enclosing the prostate, while miniature scissors carefully snip away, slowly exposing the prostate. Finally, the offending gland is cut off and removed. With movements just as delicate and precise, the urethra, which had to be cut along with the prostate, is surgically reattached to the bladder.

What isn’t visible on the video are the fingers of Tewari, a urologic oncologist and director of Weill Cornell’s robotic prostatectomy program. That’s because, instead of bending over the patient, as in conventional surgery, Tewari remained on the other side of the room, peering through a 3-D viewer while manipulating the robot’s controls with his hands and feet.

During a robotic prostatectomy, only support personnel—nurses, an anesthesiologist and a surgical assistant—stand near the patient. In place of the surgeon’s hands are robotic arms, angling down toward the patient. At the surgeon’s instruction, the assistant carefully inserts the slender rods at the ends of the robotic arms into five small incisions forming a semicircle on the patient’s abdomen. Each rod carries a separate tool—forceps, scissors, various blades—which the surgeon manipulates at the console, each hand movement precisely mimicked inside the patient. The machine softens any unintentional hand motions or tremors, while the surgeon’s foot controls the camera arm. The image is magnified 10 times, with side-by-side lenses creating a 3-D view. Because the console is connected to the robotic arms only by wires, the surgeon, with the proper electrical connections, could be in another room—or another country.

The robot at Weill Cornell is one of 382 in the United States, and 509 worldwide, as of late 2006, all of them manufactured by Intuitive Surgical of Irvine, Calif. Dubbed da Vinci (to honor Leonardo da Vinci, who designed a robot more than 500 years ago), it is the only surgical robot currently in use. The Food and Drug Administration approved the da Vinci for radical prostatectomies in May 2001, and it has caught on rapidly, now handling more than a third of those procedures in this country, compared with just 2% in 2002. Since 2001, the da Vinci has also been approved for several other procedures, including mitral valve repairs and cystectomies.

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The Costs and Rewards

How do hospitals decided if robotic surgery technology is worth the hefty price?

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1. “Robotics in Urologic Surgery: An Evolving New Technology,” by Fatih Atug et al., International Journal of Urology, July 2006. A comprehensive discussion of the development of robotic surgery.

2.“Endoscopic robotic mitral valve surgery,” by Douglas A. Murphy et al., Journal of Thoracic and Cardiovascular Surgery, October 2006. A study that finds robot-assisted surgery to be “safe and effective” for 127 heart patients needing mitral valve repairs.

3.“Robotic Radical Retropubic Prostatectomy,” by M. Menon, British Journal of Urology, February 2003. A report on open, laparoscopic and robotic surgeries that provides evidence that patients suffer the least blood loss and endure the shortest hospital stays after robotic surgery.

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