Image: MIT
DOUBLE VISION. Magnetic resonance image of the area to be operated on is precisely superimposed on the patient during an operation.
Coming changes in hospital technology may within a few years make television dramas like ER less exciting but should help operating rooms become healthier places for patients. The tense crowd gathered around the operating table is likely to be replaced by a silent robot cutting and suturing through an incision less than an inch long. The surgeon doing the operation will not be standing over the patient but seated at a console peering deep into the body through a virtual reality headset that combines the actual image of the patient with up-to-date diagnostic images showing the precise location of the problem. He may even have rehearsed the operation in cyberspace before the incision was made. The manipulators that control the surgical tools will be capable of the tiniest, most precise motions--and they will compensate for any tremors in the surgeon's hand.

The first generation of these "silicon surgeons" is now taking up residencies at major medical centers. They are guiding surgeons in delicate brain surgery and helping to replace broken hip bones. And soon, the patient may not even have to be in the same room as the surgeon. Teleoperation systems, such as those being developed by NASA and the University of California, Berkeley, promise to make it possible for the most skilled surgeons to operate on patients in distant cities--or on bases on the moon. With this electronic help, experts believe that surgery will be safer and more precise, yet less costly. And the patient will far more likely to recover quickly.

Because of the promise, the National Science Foundation recently anted up $12.9 million to form a five-year cooperative to bring several leaders of the effort together in an Engineering Research Center in Computer-Integrated Surgical Systems and Technology, to be headed by the Johns Hopkins University. Overall funding, including sources such as industry, is expected to be about $35 million over the five-year period.

Image: KEITH WELLER, Johns Hopkins
COMPUTER SCIENTIST Russell H. Taylor of Johns Hopkins heads a new center to develop advanced surgical systems, such as this "robot resident."

The collaboration includes the Hopkins School of Medicine and the Johns Hopkins Applied Physics Laboratory, the Massachusetts Institute of Technology's Project on Image Guided Surgery and its collaborator, the Surgical Planning Group at Harvard University's Brigham and Women's Hospital, and Carnegie Mellon University and its affiliate, Shadyside Hospital.

The goal is that, by combining highly advanced information technology with surgical expertise, the center will usher in dramatic changes in medical care--specifically less invasive surgery and lower costs. "Computer-integrated surgical systems and technology will have the same effect on health care in the next 20 years that computer-integrated manufacturing had on industrial production over the past 20 years and for many of the same reasons," says Russell H. Taylor, a Johns Hopkins University computer scientist whose present research is aimed at developing "basic techniques for combining machine skill with human judgment to do tasks that neither could do alone."

The new research center will be set up in new and renovated space at Hopkins' Homewood and medical campuses in Baltimore. It will draw upon experts in computer science and robotics, electrical, mechanical and biomedical engineering, as well as physicians specializing in fields such as radiology, neurosurgery, urology, orthopedics, ophthalmology and many other surgical disciplines.

The Carnegie Mellon team--led by Takeo Kanade, co-director of CMU's Medical Robotics and Computer Assisted Surgery Center--will focus on the development and applications of computer vision, sensors and robotic devices for computer-assisted surgery. Projects already underway there include: HipNav, a computer-based surgical assistant that helps surgeons more accurately plan and place the socket portion of a hip implant; image overlay systems; and error compensation systems to solve the problem of imprecision in microsurgery due to physiological hand tremor.

MIT will contribute computer models to plan and guide the surgery. "We take medical scans of a patient and use them to create a graphical reconstruction of the patient's internal anatomy," says Eric L. Grimson, MIT's principal investigator for the center and a professor in the department of electrical engineering and computer science. A prototype of the MIT system has been in almost daily use at Brigham and Women's Hospital since 1997.

Human surgeons far surpass machines in adaptability and, most important, judgment. But human hands need a large opening in which to work. They sometimes experience tremors and fatigue and may have difficulty manipulating very small objects. Also, humans can be harmed by the radiation used in some medical treatments. A mechanical "hand," skillfully directed by a surgeon, could overcome these drawbacks. "You could transcend human limitations in the execution of surgical tasks," says Taylor.

Image: Carnegie Mellon
HIP REPLACEMENT developed at Carnegie Mellon uses images to determine the proper placement of the prosthesis and then guides doctors during surgery.

If the effort pans out, before a scalpel even touches the patient a surgeon will be able use advanced imaging and modeling equipment to plan the operation on a computer screen. "Then, in the operating room," Taylor says, "we will be able to match the virtual reality of this plan with the actual reality of the surgery."