The health care industry has come under increasing fire over the last few years for the impersonal, detached relationship that it's created between doctors and their patients. Now a team of engineers at the University of California at Berkeley has developed a technology that may make doctors even less personal, but also less traumatic.
Shankar Sastry and his Berkeley colleagues have developed a robotic finger -- about the size of an average index finger -- that can be used by surgeons during laparoscopic surgery, in which instruments are inserted through small incisions. The primary advantage to this is the potential reduction in trauma to the patient during an operation.
"The bigger the incision, the greater the trauma to the patient," said Sastry. "The overall dream of laparoscopic surgery is to cut the patient less and less, which also reduces recovery time, time in the hospital, and loss of productivity."
Until now, laparoscopic surgical tools were fairly ungainly and crude. The tools consisted mainly of graspers (to handle tissues), scissors, and staplers (to close incisions or attach blood vessels). "Surgeons would compare the feeling to trying to operate with chopsticks," said Sastry.
Surgeons couldn't use these tools to suture, tie knots, and other complicated tasks. So laparoscopic surgery had been confined mostly to simple operations, like the removal of a gallbladder.
But the robotic finger that Sastry and his colleagues have designed will change all that. The system consists of two joysticks the surgeon moves to operate the robotic fingers, a computer, and right- and left-hand "end effectors," the robotic instruments that slip into the body to perform the surgery.
The end effectors are hydraulically powered single digits, less than half-an-inch wide, and three to four inches long. The digit has four joints that swivel, rotate, swing back and forth, and it also has a grasper on the end.
"It mimics the ordinary actions of the human hand," said Dr. Lawrence Way, director of videoscopic surgery in the department of surgery at the University of California at San Francisco. "And even though the surgeon is using joysticks to operate the fingers, it is reasonably intuitive," said Way, who was brought in as an independent co-investigator to help judge the efficacy of the instrument during surgery.
The design also has a force feedback system, which relays to surgeons the response of the patient's muscle and tissue as they operate. "This helps make it feel more like normal surgery to the surgeon," said Frank Tedrick, a bioengineer in the department of surgery at UCSF and a member of the tool's design team. The team is currently trying to develop tactile sensors that will transmit the feeling of tissue to the surgeon's fingertips, so that he may differentiate between different surfaces -- like between a tumor and normal tissue.
"One of the ultimate goals with this instrument is to perform cardiac surgery with the heart still beating," said Sastry. "Currently, 75 percent of the trauma of this type of surgery comes from the stopping and starting of the heart and cracking open of the rib cage to get to the heart. If you could perform the surgery laparoscopically, you could avoid this trauma."
In the meantime, the Berkeley team will set its sights on more modest goals. Surgeons at UCSF plan to conduct their first animal trials sometime in August, using the tool to perform colectomies on pigs. If all goes well, Sastry says, and the FDA approves, clinical trials on humans could begin early next year.
As a surgeon, Way remains optimistic, but cautious, until the results of the trials. "Technology has been a trend in medicine that has been around for 15 years or so," Way said. "Any time you introduce something new, you introduce new risks.
"We have to be careful not to reach to act like the gods," he said. "But if it is proven that we can do existing operations better with these new tools, most surgeons will instinctively embrace it."
