Richard M. Satava
Richard M. Satava Professor, Department of General Surgery at the University of Washington
I think it's going to become an important niche in surgery. Open surgery will not go away. Minimally invasive, laparoscopic, or flexible endoscopic procedures will not go away. Robots aren't going to take over everything. It will have an area where its particular advantages will be able to be used, and we'll go to the next generation.
I think the next generation is manipulating energy and doing it noninvasively instead of invasively. At this time, there happens to be one of those technologies that are out there that I think are pioneering in this direction, and actually, there's a couple of them. One of them happens to be the CyberKnife. The accuracy with which you can guide an X-ray beam down -- right now, the latest research I saw was 0.3 millimeters accurate.
So a radiologist can now guide a beam and destroy cells and tissues with greater accuracy than a surgeon could ever remove them. Before, they would just spray everything, and you'd have collateral damage. That's not the case. And if you combine that with some imaging technologies -- PETs -- so it accurately identifies where the cancer cells are or are not, you can get a precision beyond anything that a surgeon would be able to do. We have high-intensity focused ultrasounds, and we've discovered that many of our forms of energy, the photonics, the lasers, have both the diagnostic at low-level energies and are therapeutic at high level.
And so what you can do is you can use the diagnosis, and as soon as you see what the problem is, you press the button for the therapy and eliminate that. The research project that I have in mind was done by the Department of Defense for hemorrhaging. We know that if you use high-intensity ultrasound, and you focus the beam like they do with the CyberKnife, that you can actually, depending upon the power, either coagulate tissue or you can actually vaporize the tissue. But the coagulation one is of great interest to the military, because it would allow, we believe, the opportunity to stop exsanguinating hemorrhage by not operating on a patient.
The experiment that we had done was we lacerated an internal blood vessel, the iliac artery, of a pig, and then we took the ultrasound that allows us to discover it, the standard Doppler ultrasound, and we looked at it. We said, "OK, there's the area that's bleeding." But this was a special ultrasound that had HIFU built into it, and we pressed the button, because it was co-registered. We pressed the button, and exactly where the bleeding was, we were able to direct the energy and stop the bleeding, and this pig died. What's its relevance? Well, imagine, if you will, we have this -- and it's a portable, handheld device at this point in time.
We would give this to our medic. You have an accident in the field. This person has their liver that is ruptured, and we've done this on livers and spleens, and were able to, out on the highway, able to decide, "This person is bleeding to death," presses the button, and stops the bleeding.
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