Surgical robots, telesurgery, and future technologies

The last two decades have seen an exponential explosion in medical technology. In the early 1980s, laparoscopic cholecystectomy became widespread secondary to the advances in fiber optics and lens technology. New tools like the harmonic scalpel and endoscopic staplers allowed surgeons to perform increasingly complex procedures laparoscopicaIIy. Prior to 1990, Nissen fundoplications and gastric bypasses were not performed laparoscopically, whereas today, approximately 90% of Nissen fundoplications and 40% of gastric bypass are performed laparoscopically. In spite of these advances, the fundamental relationship between the surgeon and his or her tools did not change-the surgeon directly manipulated an instrument to effect a change in the patient’s tissues. During the 1990's, this relationship changed dramatically on an experimental basis. Advances in robotics, communication, and computer software allowed surgeons to perform procedures without directly touching the patient. Today it is possible for a surgeon to perform a procedure halfway around the world with robotic assistance. Potential applications include performing procedures on patients in space (where the cost of return to earth would be prohibitive) and on wounded soldiers (where surgery on the battlefield might endanger the entire operating staff). This technology would also allow centralization---experts in certain disciplines could care for patients across the globe.