A surgeon who operates virtually 3D, a hyper-performance computer screen, and a robot that actually does the work on the patient. This is the new face of the operating block.
“Is not a robot working for you, it’s me”. And at the outset, Pr Daniel Loisance, heart surgeon (hospital Henri Mondor, Creteil) presents the clocks at the time with his patients: it’s the “robot” which is the assistant to the surgeon, not the other way around.
A wizard that is revolutionizing surgery, cardiology as in other specialties. The goal of this new computer assisted surgery? Simply operations without incision, without scars, but without pain, and fatigue… Finally almost.
Chopsticks as instruments
Since its inception in the 1970s, surgery with colonoscopy (under control of an endoscopic camera) has allowed thousands of interventions, including gastrointestinal and gynaecological, with simplified surgical suites and small scars. Problem: it is inapplicable to the heart, body perpetually on the move because of its beats.
Classic cardiac surgery, the chest is wide open and said the blood flow temporarily diverted by a complex system of cardiopulmonary bypass (CPB). The results are excellent for the price of a good size, and a long convalescent scar. “A patient in great shape takes three to four weeks to recover from a Thoracotomy, but the average is about 3 to 6 months, or a year”, argues Prof. Loisance. Where the enthusiasm of specialists for less aggressive techniques, time to recovery in a few days if the chest is not open.
Advances in cardiopulmonary bypass, the first bypass of coronary arteries in colonoscopy may begin in 1995. A new technique, known as CEC device, allows indeed to bypass traffic by introducing the system in the femoral artery (at the level of the groin), then classical CEC to intervene directly at the level of the heart by a large incision. Under control of cameras in two dimensions, the surgeon operates with instruments very long, as if he was holding the chopsticks. The intervention can even be “beating heart”. But the technique is far from perfect.
The operation is long and, above all, it is difficult for a surgeon, even led to very specific sutures. A funny flat for procedures such as coronary bypass, where the quality of the suture determines the result.
A surgeon behind his console, private sensations
Fortunately, technology continues to evolve, thanks in part to computer progress. Thus, the 3D cameras now allow a completely realistic view of the operative field.
Finally, more and more, a robot insinuates itself between the hand of the surgeon and the patient, to improve the precision of the gesture. In France, two programs of “surgical robots” are thus being tested. The first, Zeus, is already widely used. Most recent one that tests the PR. Loisance, the Da Vinci System, includes two innovations: an artificial wrist (still much better than the surgeon’s hand!) and a 3D camera. Behind its console, the surgeon makes virtually the intervention with small levers.