Video games in the operating room is the future of surgery. A new machine, similarly shaped to an arcade racing car game, is now being used to do complicated operations. The doctor can sit in the console and move the robotic arms that are working with the patient. While the patient is in a relaxed state the doctor will create incisions and begin the operation, sometimes without being in the same room, according to Leslie Chupp, M.D., F.A.C.O.G, and Regional Director of Laura W. Bush Institute for Women’s Health.
Gamers, robots and the history of the evolution of surgical techniques were the focus of the first of MC’s First Friday Brown Bag Lunch Seminar, given by Chupp.
Teachers encouraged students to go to the seminar for extra credit, but even students who went only for the extra credit learned some interesting aspects of the mechanics and the evolution of surgery. After signing in at a table in front of the Carrasco Room in the Scharbauer Student Center, students took a seat to listen to what they may have expected to be a boring presentation.
Chupp had spoken on this topic before at MC, but was happy to be invited back, she said. Administrators asked her to be cautious of putting graphic pictures of surgery in her presentation. She warned the crowd before presenting.
“Some of them [pictures] do show surgical procedures and blood, so if that makes you uncomfortable, there aren’t that many, but you may just turn your head. I don’t want to lose any of you,” Chupp said.
Her presentation started with a slide showing a photograph of surgeons in 1869 surrounding a patient and preparing to operate. During this time they sprayed carbolic acid, believing it to kill germs, and eventually discovering it lowered infection rates in patients. The picture showed one surgeon making incisions by hand, which was how it was done until the 1970s, according to Chupp.
“We can still do the hands-on surgery,” Chupp said, “This is an open procedure where we can actually see tissue and move things with our hands. Though we are limited by the size of our hands this kind of surgery takes a lot of physical stamina. When I was training, surgeries could take up to 15 hours, limiting people who cannot stand for long periods of time.”
Chupp then proceeded to describe the downside of hands-on surgery, such as an increased number of infections. Sometimes hernias would form and the incisions caused pain. Prolonged postulation would make them bedridden for a few weeks. Being bedridden has the potential to create hernias in the lower body because the body requires movement. Without movement, the body will create hernias on its own.
The next step was the use oddly shaped scissors that allow cuts to be easier and cleaner. “They can be curved or sharp, and were the main instrument, still used today,” Chupp said. “Also, retractors are used to separate the incisions so we can actually see what we are doing. You can imagine this puts a lot of tension on the skin, so again, we would have pain.”
But the advantages, according to Chupp, are good. These types of surgeries tend to be very fast. The instruments are less expensive than the newer technology, and are easily accessible to places where doctors can’t afford anything more.
Finally, a new technology that was minimally invasive was being tested in the 1970s on animals. Eventually it was used on people. With this invention, surgeons could watch themselves on a monitor.
“We started doing this for certain procedures like getting your tubes tied,” Chupp said. “It is a simple procedure, but the incision hurts. With this, we make a small cut and insert a camera. You could be out the same day, or even a few hours later. We would have less problems with complications because the wounds were smaller. The drawback is that you don’t have as much flexibility.”
Soon after, another machine was created that could stabilize the camera. In 1994, AESOP was released, which was a voice-activated camera. “It was slow and cumbersome,” Chupp said. “Doctors could tell their assistants to do the same thing, so it didn’t really take off. This evolved into the DaVinci system, which I am trained to do.”
The DaVinci replicates the wrist movement eliminates the need to stand. “The surgeon doesn’t even have to be in the same room, but usually they are,” Chupp said. “There are these optical lenses, which allow you to see, even if you are nearsighted. The machine acts as your eyes. There is a foot pedal, which activates an electrical current to make cuts. There is a lot of coordination that goes on, it’s actually kind of fun. I think one of the reasons most people like this is because the machine moves with your controls. There is a little bit of lag time, but now it is less than a second. I personally have done 200 surgeries on this machine.”
While the machine has many advantages, it does not allow the surgeon to feel the insides as they used to. “It is cumbersome,” Chupp said. “I call it the 747 because it requires a lot of room. Once it is in place, it stays there.”
There is a training simulation everyone goes through to work the machine. Instead of watching others do surgery, the trainees will spend hours on the simulation machine. There is a teaching console allows an experienced surgeon to switch with the trainee. The teaching console will allow the experienced surgeon to take the surgery back at any point.
“Video games probably aren’t such a bad idea,” Chupp said. “People that have these skills from video games can adapt to modern surgery easier. You still have to have highly trained people to work these machines, which is expensive.”
The brown bag lunches are every first Friday of a month and will have a variety of topics.