News Releases
Doctor Robot lends an arm
Mechanical device assists in 2-year-old's heart surgery
For Release: September 18, 2000
SAN JOSE, Calif -- One day, Alexander Cumming can tell his friends that a robot operated on him when he was 2.Alexander's congenital heart defect was repaired last week by Dr. Michael Black, chief of cardiac surgery at Lucile Salter Packard Children's Hospital at Stanford, with the help of a robot named Aesop. The robot is simple, just a black plastic arm with a fiber-optic camera on a rod thinner than a swizzle stick. It obeys Black's voice commands, sees things Black can't and transmits images to a video monitor.
This enhanced view allows Black to perform open-heart surgery on children and infants through an almost unbelievably small incision. A smaller incision means a less invasive -- and therefore safer -- operation, less pain and a much shorter hospital stay. Some kids go home the same day they have surgery. And it leaves a tiny scar, no small matter for a child. Scars grow as children grow.
"The kids are happy; they go home with a small incision,'' Black said. "It's remarkable. I'm still amazed, and we've done several hundred patients.''
Surgeons around the United States are using Aesop, which was the world's first robot approved by the Food and Drug Administration for surgery. But Black is one of just a few surgeons in the world using robotics regularly on children.
And Aesop is only the first step. The next generation of robots, developed by Santa Barbara-based Computer Motion Inc., the creators of Aesop, and Mountain View's Intuitive Surgical Inc., will operate on a patient practically by themselves. While the surgeon sits across the room, controlling the robot from a laptop, Computer Motion's three-armed Zeus will be both the eyes and the hands of the surgeon.
"I could operate from a computer in my office using a joystick, and the patient and the robot could be in Cleveland,'' Black said.
Intuitive Surgical's da Vinci robot was approved by the FDA in July, and Zeus is expected to be approved this fall. It will cost about $875,000. Black will be the principal investigator studying Zeus for pediatric surgery, said Yulan Wang, founder and technical officer of Computer Motion.
"Ultimately, we want to eliminate incisions altogether and have the robot's arms go through ports smaller than the tip of your pinkie,'' Wang said.
Black has been interested in minimally invasive surgery throughout his career. He said some doctors called him crazy for trying to fix hearts through smaller and smaller holes.
"When I first started doing small incisions on children, I was criticized,'' said Black, who came to Stanford two years ago from Toronto's Hospital for Sick Children. Some older doctors think it's too hard and therefore unsafe to maneuver through a small hole.
Robotics are another tough sell for some established doctors.
"It's hard to say to a 50-year-old surgeon, 'Here, play Nintendo in the O.R.,' '' said Black, who is 40.
But robots are catching on in the field of surgery. More than 500 centers around the country are using Aesop, which costs $100,000, Wang said.
"But it's quite new in cardiac surgery, and very new in pediatrics,'' Wang said.
Some surgeons say Aesop's benefits are only minor: Most children's hospitals get excellent results with traditional heart surgery. But it's the future that's exciting.
"I'm sure the public thinks we go out and get a new tool and things are instantly better, but it's not that way,'' said Dr. Timothy Bricker, chief of pediatric cardiology at Texas Children's Hospital. "When you think of the potentials of robotics, minimally invasive surgery could wind up being just a minor benefit.''
Robots can make very precise movements, much smoother than a human's, he said. The usefulness of such precision can't be overstated.
"What if heart defects that kill babies in utero could be fixed in the unborn baby before delivery?'' Bricker said. "For now, that's science fiction, but that's the reason we need people to conduct research and push the envelope.''
In the operating room last week, Black made a two-inch incision down the middle of Alexander's chest. Normally, surgeons cut from the neck to the belly when operating on the heart. Black, on the other hand, uses Aesop like a detachable eyeball to see up and under the incision. What Aesop sees is broadcast on a video monitor across the operating table from Black. The picture of the child's pumping heart is perfect -- not blurry or shaky the way laparoscopic images can be. Black tapes these surgeries so they can be used for teaching.
"The surgeon has to be talented to work out of such a small hole,'' said Dr. Greg Hammer, the anesthesiologist who worked with Black. Hammer's innovative combination of an epidural and light general anesthesia will contribute to Alexander's quick recovery. Traditionally, only general anesthesia is used in pediatric heart surgeries. Hammer's method, used only a few places in the world, results in less post-operative pain.
Black looks like a combination pop singer and robot when he operates: He wears headgear outfitted with magnifying lenses and a microphone for barking orders to Aesop. Black likes to say he looks like Janet Jackson.
The robot responds only to Black's voice.
"Aesop,'' Black said, and the robot responds with a hi-tech ring. "Move up. Stop. Move down. Stop.'' Aesop obeyed.
The nurses kidded around with Aesop, treating "him'' like a living being. When its chrome camera arm came out of sterilization too hot, someone said, "Did Aesop say 'ouch'?''
The operation was over in three hours, and Alexander began to wake up. He needed no breathing machine, his cheeks were rosy, and the only clue that he had just undergone open-heart surgery was a small piece of tape the size of a Band-Aid on his chest. Three days later, he went home. Kids having traditional heart surgery remain in the hospital five to seven days.
Alexander's parents, Susan Peacock and Albert Cumming, held the boy's hands and watched him anxiously as he recovered from his life-saving surgery.
"I'm quite pleased with how small the incision is,'' Peacock said. "It looks good.''
Black looks forward to the day when the entire O.R. obeys his commands. He'll be able to move the lights, the bed and the robot with his voice or with a computer. He also hopes to develop a camera that sees through blood.
"It won't be long until it's like 'Star Trek,' where we're like Bones waving a wand over people to heal them,'' Black said, only half joking.
Learn more about our Children's Heart Center.
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