Growing up, Dr. Soliman was enthralled with Inspector Gadget, the children’s cartoon about a bumbling cyborg detective whose body is outfitted with a seemingly endless number of high-tech, crime-fighting gadgets.
Rocket-powered boots. A propeller that extends from his hat, turning him into a human helicopter. A screwdriver embedded in his finger.
But now, as a colon and rectal surgeon at AdventHealth, Soliman gets to realize his childhood dream of being half-man, half-machine.
“When I do robotic surgery, I get to have the robotic arms become an extension of me.”
Dr. Soliman
Soliman is one of many surgeons at the forefront of robotic surgery, a medical technology innovation that seeks to reduce the margin of error for invasive surgery, helping to make surgical procedures safer and more precise.
“Once you’ve taken these big imprecise hands of ours, scaled them down and put them inside the patient, we can achieve a level of precision that simply isn’t possible for the human body alone to do,” says Jonathan Conta, VP of product management at Intuitive, a manufacturer of robotic surgery equipment.
Rather than having his hands directly on a patient, robotic surgery allows Soliman to conduct surgery from a remote console that provides him with an immersive, 3DHD view of the targeted anatomy.
The surgeon uses a pair of grips to manipulate a separate robotic surgical system and conduct his various surgical maneuvers.
Robotic surgery can help reduce errors
“There are lives at stake when you perform surgery. Any miscalculated movement… bad things can happen,” Soliman says, his pause alluding to the debilitating, sometimes even fatal consequences, of a slip-up in surgery.
But Soliman says robotic surgery eases his anxiety about any such potential mistakes. “Anytime I operate robotically, I feel like I’m so much more calm and I have full control of the operation.”
No matter how advanced the technology may be, it still pales in comparison to the minutiae of the human hand.
An effective robotic surgery system must be able to gauge how open or closed a surgeon’s grip is, how much pressure they’re applying, the rotations of the wrist and how their hands move in, out, up, down, sideways and in between in three-dimensional space.
“Once those sensors have captured those vectors in 3-D space, that information is sent to the vision cart,” Conta says. “The vision cart then applies algorithms on top of that to translate those big, gross motions in the surgeon’s hands into microscopic motions inside the patient.
“On the other side of the room, those series of algorithms control a series of motors and cables, which in turn control the instrument tips inside a patient.”
Developing the hardware and software in such a system took tens of thousands of hours of engineering work, Conta adds.
Challenges of robotic surgery
One of the biggest challenges in robotic surgery is latency, the amount of time between a surgeon performing a maneuver at the surgeon console and that maneuver happening in a patient. The greater the lag between those two events, the greater the margin for error.
Even the most sophisticated computer networks have a certain amount of latency. (Much like there’s a tiny bit of lag between our brains making a decision and our body parts carrying out that action.) But for robotic surgery to work well, the latency has to be infinitesimally small.
“Latency needs to be measured in milliseconds for things to be safe.”
Jonathan Conta
“When I’m operating, I may see some tissue bleeding, and if I don’t react to that tissue bleeding by stopping it somehow, by grasping it and cauterizing it, that could be a serious problem.”
Intuitive has employed a number of strategies to remove latency from its system, including using high-speed fiber optic cables to deliver messages as quickly as possible and simplifying the code in its software.
Another challenge is depth perception. As any serious gamer can tell you, one of the biggest challenges of manipulating a remote object via a screen is depth perception. That’s why Intuitive developed a 3-D display for its surgeon console. Taking inspiration from the Renaissance painter who pioneered the use of depth in his paintings and created one of the earliest robots, Intuitive named its surgical system da Vinci.
“Doing an operation on da Vinci is completely different than doing an operation with laparoscopy because I was able to regain that three-dimensional experience and see how structures would look in a visual world,” Conta says. (Laparoscopy is a minimally invasive form of surgery, also sometimes referred to as “keyhole surgery,” on the abdomen.)
Robotic surgery offers an arguably better visual experience for surgeons than standard, open surgery. Intuitive’s system can make use of Firefly fluorescence imaging, which uses a near-infrared light that operates at a specific wavelength on the color spectrum.
Prior to surgery, the patient is injected with the imaging agent indocyanine green (ICG for short) that binds with the patient’s blood. The light then excites the molecule, reflecting back a bright green color, thus indicating where blood is located.
“It’s like night vision for surgeons,” Conta says. “All the lights go dark and I’m seeing a big green glow of tissue.”
In the immediate future, Intuitive is focused on additional innovations to make surgeries even safer and less invasive.
That’s a future that would make Inspector Gadget proud.