Imagine undergoing a surgical procedure that is guided by a virtual computer simulation, or entering an operating room that contains only a surgeon, anesthesiologist, nurse and a set of robotic arms instead of a dozen or so medical professionals. Two recently developed technologies indicate that these scenarios are not too far off, especially as more patients and purchasers opt for technological solutions for dealing with the limits of human efficiency.

The Self-Evolving Brain Model
British scientists have created an advanced three-dimensional modeling system that can chart changing conditions in the human brain, reports New Scientist magazine (subscription required). The technology has already been applied to cardiovascular procedures, helping surgeons steer through an intricate network of cerebral blood vessels.

The extreme complexity of blood flow in the brain normally makes a surgeon's decisions quite risky. "The goal is to enhance the ability of clinicians to make these decisions through information technology and high-performance computing," Peter Coveney, one of the system's developers, tells New Scientist (via BBC News).

The grid-enabled neurosurgical imaging simulation, humbly named "Genius," combines two-dimensional scanning with the processing capacity of nearly twenty supercomputers scattered across the country to project a continuously updated map of the brain's arterial network. Developed by researchers at University College London, Genius technology may be revolutionary in its potential to predict the blood pressure changes resulting from a surgeon's actions mid-operation.

"Modelling has the potential to make these procedures more like chess and less like poker," Dr. Stefan Brew, another developer, said (via UK Telegraph).

In addition to making dynamic predictions, brain modeling may provide significant research opportunities. According to the Genius project's grant proposal, "[s]imulation offers the clinician the possibility of performing non-invasive virtual experiments in order to plan and study the effects of certain courses of treatment with no danger to the patient."

By reducing medical uncertainty and paving the way for new types of experimentation, 3D brain modeling technology may be the first step toward computer-guided virtual surgery.

Robotic Surgery
Robotic surgical device manufacturing is at the burgeoning intersection of the automation industry and the medical instrumentation field. Although the current-day technology has existed since the early 2000s, the last couple of years have seen a large upswing in robotic surgery procedures.

The market for robot-assisted medical systems grew from $626.5 million in 2007 to an estimated $1 billion in 2008, according to a report published by Research and Markets. At the current rate, it is forecast to expand to $14 billion by 2014.

Much of this growth has been driven by sales of the "da Vinci" robotic system, developed by Intuitive Surgical. According to Barron's, the number of patients who underwent da Vinci surgery last year soared to 85,000, an increase of 75 percent from 2006. System sales rose by 42 percent over the same period.

Part of the increase stems from the expansion of robotic surgery's capabilities. While initially focusing on prostate operations, automated systems can now be found in hysterectomy procedures, fibroid removal and, most recently, heart surgery.

These devices are often touted for their convenience. "There was no cutting, slicing or dicing," a coronary bypass patient recently told the Boston Herald. "They didn't have to cut the rib cage at all. They didn't have to stop the heart. I didn't need transfusions."

The system's tiny robot arms are able to go places where human hands cannot, such as between the ribs in order to access the heart. The arms follow commands given by a surgeon in another room, who monitors the operation on a magnified screen. This process is particularly helpful for high-risk patients who would normally be considered poor candidates for intensive surgery.

A year after having robotically assisted coronary bypass surgery, "99 percent of the patients still had clear arteries, compared with the 80 percent of patients who had conventional 'open' bypass surgery," ABC News reports.

But automated surgery also has its share of critics. At approximately $1.3 million per unit and more than $100,000 in annual maintenance fees, some observers find robotic surgery machines to be impractical.

"Does a robot really improve things?" medical technology analyst Wini Hayes told ABC News. "It's a big investment for a hospital to put in a robotic device, and it might be wise to slow the pace of dissemination until some of these things are sorted out," Hayes continued.

There is also skepticism about robotic surgery's potential for success in foreign markets. Of the roughly 800 da Vinci units installed worldwide, three-quarters are located in North America.

An article late last year in an Indian journal examining India's receptiveness to the new technology claims that "the scope for robotics in India is limited because of cost considerations" and that "robotic surgery is still a distant dream in India."

The prospect of limited appeal and availability in emerging markets has not, however, changed the rapid domestic growth in robotic surgery devices. And with automation and computerization on the rise, it may be only a matter of time before the Hippocratic Oath must be downloaded rather than recited.

Resources

3D Models Take the Guesswork Out of Brain Surgery (subscription required)
by Nic Fleming
New Scientist, Sept. 3, 2008

Test Predicts Vessel Op Response
BBC News, Sept. 3, 2008

Three Dimensional Scans Could Revolutionise Brain Surgery
by Kate Devlin
Telegraph, Sept. 3, 2008

Surgical, Healthcare, Assistive, and Campus Robot Market Strategy, Market Shares, and Market Forecasts, 2008-2014
Wintergreen Research, Inc., January 2008

Robot Dreams
by Bill Alpert
Barron's, July 28, 2008

Bot's a Smooth Operator
by Jessica Fargen
Boston Herald, May 25, 2008

Scalpel, Sponge, Robot Arm Please
by Ned Potter
ABC News, May 27, 2008

Robotic Surgery: India is Not Ready Yet
by Girish G. Nelivigi
Indian Journal of Urology, 2007