Technology in the operating suite.

THE ADVANTAGES OF THE TECHNOLOGY REVOLUTION can be seen and felt in virtually every arena of modern life. Computer microchips now organize the vital events occurring within the basic mechanisms of automobiles, children match their fingers’ reflexes, dance steps, and wits against virtual entities on video screens, and interactions with business colleagues, friends, and family occur electronically at any distance almost instantly. Until recently, the surgical teams in most operating rooms were using tools and techniques little different from those used decades ago. However, that is changing rapidly, and innovation is now invading the operating suite. The laparoscopic revolution that swept over general surgery in the 1990s was born of innovative technology and paved the way for further infiltration of technology into the operating room. The key transformation was the necessary disconnection between the surgeon and the tissue. In laparoscopic surgery, the surgeon could only see tissue by means of technology. This new dependence on images changed surgery in important ways. First, surgery now had a commonality with other procedural-based specialties such as gastroenterology (endoscopy), therapeutic radiology (fluoroscopy), and cardiology (angiography). Second, computer technology could now be used to digitize, enhance, transmit, and otherwise manipulate the image. The interjection of technology between the surgeon and the patient also meant that surgeons could no longer depend solely on their hands to intervene; they needed the assistance of industry to provide the needed technology. The most visually dramatic change in the modern operating room is the arrival of remote computer-assisted telemanipulators, commonly referred to as “robots” (FIGURE). These systems merge industrial robotic technology, 3-dimensional visualization systems, and computer technology. They are not really robots in that they do not function independently of human control and they do not perform automated sequences. The surgical manipulator is a large movable 3or 4-armed device that, when in position, hovers over the operative site of the patient. The arms hold and move up to 2 or 3 instruments in addition to a stereotelescope that transmits 2 independent images. The instruments have 6 degrees of freedom of movement, meaning that they have joints that can move in a manner similar to the human wrist. The surgeon sits at a console separate from the operating table and the patient. With the surgeon’s head in the console, the 3-dimensional image of the operative field is re-created via integration of the right and left camera outputs being viewed separately on individual television screens within the console. The system’s advantages include vivid 3-dimensional visualization of laparoscopic surgery and the ability to manipulate tissue as the surgeon’s hand would in open surgery. Disadvantages of the system include the cost ( $1 million per system), the absence of tactile feedback for the operating surgeon, and the cumbersome size and weight of the system.