Use of surgical robots on rise in operating rooms

HOW IT WORKS

• The anesthetized patient lies on a surgical table with the massive, four-armed da Vinci Surgical System hovering above and a human surgeon sitting at a computer console on the other side of the room.

• The surgeon peers into a monitor that provides a full-color, 3D, natural-depth-of-field picture of the inside of the body, magnified 10 times. He or she operates the machine by controls cuffed to each finger

• Four dime-sized incisions are made between the patient's ribs. Three of the robot's arms insert tiny rods with ``EndoWrist'' attachments that exceed the natural range of motion of the human hand. Those wrists hold surgical instruments for grasping, cutting, cauterizing, sewing and stapling. The robot's fourth arm slips a camera and light inside the body.

• For particularly delicate procedures, the surgeon can tell the robot to ``scale down'' its movements for greater accuracy. For example, when the surgeon's fingers move five centimeters, the cutting instrument might move only one centimeter.

• The robot does nothing on its own; it only carries out the surgeon's fingertip instructions. A surgeon's assistant stands beside the patient holding a long, thin tube that enters the body through another small incision to suck out blood.

The latest-model da Vinci robots cost $1.4 million, with annual maintenance costs of $140,000.

Surgical robots won FDA approval in 2000, and there are now 1,395 of them in 860 hospitals worldwide, performing more than 200,000 operations a year.

Advocates say robots do surgery with greater precision, reducing pain and blood loss, shortening hospital stays and getting patients back to work more quickly.

But critics say that despite its meteoric growth -- or maybe because of it -- robotic surgery lacks an adequate body of solid scientific studies demonstrating that it is better than traditional open surgery or regular laparoscopic surgery.