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UC Davis Medicine - Logo
The institution's principal publication for alumni, friends and physicians.
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  F E A T U R E S  
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Fall 2003 Issue
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FEATURES
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FINER THAN A SURGEON'S HAND

 "" PHOTO -- Mohamad Ali, UC Davis assistant professor
 
Mohamed Ali, UC Davis assistant professor
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Mohamed Ali doesn't look like he's performing surgery. He's wearing 3-D glasses and sitting in a chair that has movable arms with joysticks on the ends.

And the patient he's operating on is across the room.

Ali talks into a microphone as he watches a TV monitor above his head. "Aesop, move in," he commands. "Stop. Move right. Stop." He moves the chair's arms, manipulating the joysticks. On the television screen is a jumble of bloody tissue, and two pairs of pincers are steadily suturing closed a pouch.

Ali's view is the inside of his patient, who has half a dozen dime- and quarter-sized holes in her abdomen. An instrument has been inserted into each incision: one contains the laparoscope that contains a light and tiny video camera. It provides the images to the TV screen; its movements are controlled by the voice-activated computer, "Aesop."

Two openings hold robotic arms — these are connected by wires to computerized devices that Ali is controlling with the joysticks. (The others contain conventional laparoscopy tools and are manipulated manually by another surgeon.)

PHOTO -- Surgical robotics filter out hand tremors and allows for better accuracy in executing procedures  ""

Surgical robotics filter out hand tremors and allows for better accuracy in executing procedures
 
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Surgical robots are more than high-tech oddities — they are already extending the surgeon's capability to perform suturing techniques, according to Ali, who is the director of minimally invasive surgery at UC Davis Medical Center and has performed more robotic-assisted gastric bypass surgeries with this system than anyone else in the world.

One of the robot's chief advantages is that the joystick controls, while extremely sensitive, filter out hand tremor. A one-centimeter movement from Ali's hand is translated into a 0.1-centimeter movement of the tip of the robotic arm.

Another advantage is that the pincers that grasp the needles are attached to a "wrist" — a movable joint on the robotic arm. Conven- tional laparoscopy tools bear pincers on a stiff joint. This advance provides an additional plane of rotation, allowing greater flexibility, especially important in tight quarters.

"You can't beat it for accuracy," said Ali, who studied engineering before becoming a doctor. "There are angles that you can only negotiate with the robot."

Learning to manipulate robotic arms efficiently takes practice. Ali has honed his skills at UC Davis' Center for Virtual Care, where he has set up a robotics lab. According to Ali, the surgeon must get used to the lack of tactile cues — one can't feel the tension as sutures are pulled tight, for example.

But Ali said that his brain compensates with heightened awareness in his other senses to accommodate his new skill set. "I get visual clues from what my hands can't feel. It sounds strange, but it's as if I feel the tissue."

Ali looks forward to future generations of robots, which he expects will more closely approximate the movement of the human hand and arm, thereby providing even more flexibility. This could have major applications in microsurgery, he said, for procedures like nerve reattachments and small blood vessel reanastomoses.

The new technology also opens up new realms of possibilities in telemedicine, according to Ali. "These wires connecting the controls to the robot could be an Internet connection instead," he said. "This would allow the surgeon to operate on a patient anywhere in the world without leaving home." Hospitals in remote or rural areas could gain access to the surgical skills and expertise found at UC Davis Medical Center.

But benefits to robotic surgery are already here and real, according to Ali. "Better suturing capability ensures the best possible outcome."

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  Surgical robots are more than high-tech oddities —they are already extending the surgeon’s capability to perform suturing techniques.  
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