Doctors map the future of medicine at new center

Idan Ivri
Published: Sunday, September 22, 2002

Robotic surgery has stepped out of science fiction and into reality.

On Aug. 30, UCLA announced the opening of the Center for Advanced Surgical and Interventional Technology.

CASIT will feature new surgical tools, simulators to train doctors, offices for corporate partners in medical technology and a control center that will receive and broadcast messages around the world.

The center will primarily function as a hub for technology-related medical science at UCLA.

The center comes at a critical time, as new medical technologies are coming into practice and demanding more knowledge from physicians than ever before, according to Dr. Peter Schulam, associate professor of urology and co-director of the center.

“We realize that surgical training as we have been doing it is not adequate for new technologies,” he said. “(The center) fills the void that is coming to bear because of these new tools.”

To narrow this gap, the center will act as a liaison between the university and the world of medical engineering.

Running the center will be a joint effort involving UCLA doctors from the departments of surgery, radiology, neurosurgery, urology, and medical engineering, along with support from several private corporations.

Schulam believes CASIT’s strength is in its adaptability to new developments in technology.

One of the most promising aspects of CASIT today is the ZEUS Robotic Surgical System, a remote controlled medical robot. ZEUS can be operated by a doctor in the next room or as far away as another continent, as its cameras allow a full range of vision to the surgeon in control.

To perform the surgery, ZEUS has three robotic arms which replicate the intricate hand movements of the surgeon.

ZEUS’s biggest advantage over traditional surgery is in ‘minimally invasive’ techniques.

Traditionally, surgeons cut large incisions on a patient during major surgery to allow them to see and operate. ZEUS, on the other hand, only requires tiny holes on the patient for its thin robotic arms. Some of the arms are outfitted with cameras, some with surgical tools.

Dr. Joseph Hines, assistant professor of surgery and director of the UCLA Heartburn Treatment Center, used CASIT’s ZEUS Robotic Surgical System in August to operate on patient David Ritchie, a 52-year-old school bus driver who suffered from severe acid reflux disease.

Acid reflux is a severe form of heartburn in which acidic food and fluid rises from the stomach into the esophagus, causing great pain. Most cases of acid reflux disease, which afflicts about 40 million Americans, can be treated by medication.

Ritchie’s case, however, was even more extreme.

Before the surgery, Ritchie couldn’t sleep or eat comfortably. “Medicine lowers the amount of acid in the stomach, but the food can continue to reflux,” Hines explained.

The surgical procedure to treat acid reflux is called Nissen fundoplication. The procedure tightens the passageway from the stomach to the esophagus, keeping food from rising, or refluxing, once it has been ingested.

CASIT is participating in a study that will involve the performance of 10 robotic Nissen surgeries, of which Ritchie’s was the first.

“There is a fair amount of sewing that the robot helps us with because it articulates all degrees of freedom; it makes suturing and tying the knots easier,” Hines said.

After the surgery, Ritchie only had a few small incisions on his body instead of a long cut with many stitches, the traditional sign of a non-robotic Nissen procedure.

Agreeing with Schulam, Hines said that the ZEUS system can function as a teaching tool for doctors, much like a flight-simulator trains airline pilots before they fly for real.

With ZEUS, the student and teacher surgeons don’t even have to be located in the same country.

Among doctors in various other fields of medicine, heart surgeons are interested in ZEUS as a way to avoid opening the entire chest during heart surgery.

Since the robotic arms can twist like a human wrist, there may be dozens more types of surgery that can be similarly transformed into less invasive alternatives.

Each ZEUS system is priced at about $1 million, making it an expensive investment. The initial seed money for CASIT was secured largely due to the efforts of Dr. Gerald S. Levey, provost of medical sciences and dean of the UCLA School of Medicine.