Da Vinci to the rescue - after 500 years

As we all agree, Leanardo Da Vinci was a rare genius and an enigma. Not only was he a great artist and painter, painting masterpieces such as the Mona Lisa, the last Supper and the anatomical wonder ‘Virtuvian Man’, but also an inventor par excellence. Whenever I leaf through the copy of the book ‘Ancient inventions’ and one that I have checked out over many years, I still marvel at the various things Da Vinci invented…

Of his not so successful experiments, his attempts at flight have prominent mention, though he even took upon himself the task of designing the Galata Bridge over the Golden Horn of Istanbul, in 1500, which would become the longest bridge in the world of that period if constructed. However, the ambitious design did not meet with the Sultan's approval. But one of his less talked about expertise was his understanding of the human anatomy. He wrote a book on the subject after extensive research, studies and dissection of many a human body at hospitals in Florence, Milan and Rome.
Leonardo, in his fervor for knowledge, held countless creepy vigils with the local corpses, and their annoying tendency to decay forced him to work as quickly as possible. He described it as "living through the night hours in the company of quartered and flayed corpses fearful to behold," but as usual his curiosity pushed him ever onward.

His meticulous studies show in the accuracy of his painted subjects. Above all, he jotted his text in mirror image cursive writing, using his left hand (probably for purpose of secrecy or convenience)!! But well, hearing that his mother Caterina may have been a Turkish slave girl, I can imagine that the Arabic text (and writing from right to left) she used had an effect!!

Nevertheless, this is not about Da Vinci, but about Robotic surgery. Some 23 years back, I stood next to the famed Dr Cherian as he performed a complex, but traditional bypass surgery at the Railway hospital - Perambur. Some people would recall Dr Cherian as the pioneer in India’s Bypass surgery history, and my father was also operated on by him!! Watching him perform the painstaking operation over a period of 7 plus hours, was an experience and I even wrote a long article covering every step of the Cabbage (surgical term for bypass surgery – CABG). But today when I read about the Da Vinci robot, I wondered about a future, not many years away, when the child playing on the Xbox, furiously moving his nimble fingers on its controls would graduate, only to find surgical tools like the operating robot, ‘child’s play’…

Strangely the first
humanoid robot was also invented by Da Vinci in 1495!! And so, ‘fittingly’ as a Brit would say, Da Vinci’s name was given to the seven foot high robot designed by NASA and used to re-enable the body’s complex vascular system. Put in other words, the days of the ‘bypass surgery’ are back, but in a less invasive fashion. A report on their use in Cardiac surgery can be found linked here, in the USA today article. Among the successful pioneers of pinhole surgery using the Da Vinci are a brilliant team of Sudhir Srivastava and Valluvan Jeevanadam of the University of Chicago.

The DaVinci has been around for a while now, being used mainly used for prostrate removal & hysterectomy. Manufactured by a company called
Intuitive Surgicals , it provides (in cardiac surgery) HD pictures of the heart and neighboring vascular systems andabout 700 units are in use worldwide!

How did the Da Vinci take birth? When NASA needed designs for its first humanoid robot to man the International Space Station and begin the colonization of Mars, it used the best blueprints available. The wrist, one of the human body's most complicated joints, presented a big challenge to engineers, but Leonardo's principles enabled NASA to build an advanced model. The flexible wrist of the Da Vinci robot makes it superior to older laparoscopic surgery practices…
The NASA group teamed up with mechanical engineers working on robotics from Stanford Research Institute (SRI). Frederic H. Moll, MD, acquired the license to the telepresence robotic surgical system developed by the NASA-SRI teams, and started the company called Intuitive Surgical Inc which went on to develop a master-slave telepresence robotic surgical system they named daVinci®.

Development on this technology continues, surgeons at the Imperial
College are doing even better – A spokesman explained that robotic surgeons are currently completely under the control of the surgeon. The robot responds only to the surgeon's hand movements. "There's a large amount of information that is not being explored at all. That's the human part."Currently, to operate the daVinci machine, a surgeon sits in a console from which she peers into the patient through a fiber optic camera. The doctor manipulates the finely-tuned arms of the device with a set of fingertip controls. What the researchers are adding to the system is an attachment which can track the surgeon’s eye movements and present a three-dimensional map of the area of the patient at which the surgeon is looking. It does this by combining live imagery with a collection of scans of the patient taken prior to the surgery.

So is it not a brilliant use of fiber optics and robotics that makes life simpler? Yes and no. The risks are lower, to start with. While it takes the same time to complete a surgery and costs a bit more, the aftercare costs are much lower and the recuperation time is a mere 5 days compared to weeks after a traditional bypass surgery. The biggest and toughest demand however is on the surgeon who needs extreme skill operating by looking at the screen and twiddling his thumbs. But imagine this, in a foreseeable future, today’s child who is an expert with game controllers much akin to the controllers of the Da Vinci will find it easier to perform a surgery. So heed to it when kids ask for more Xbox & PS2 gaming time; they are hopefully training to be the next robotic surgeons or operators of other types of day to day robots!!

Da Vinci won’t and should not leave us, such is his brilliance.
Recently a prominent surgeon stated that his mitral valve operations are being fine tuned after studies of Da Vinci’s drawings of the heart and explanations of the valve movements, all documented 500 years ago by a person who never had any medical training!!

P.S - Imagine, the brilliant genius with his many failings, still coming to the help of mankind all these years later!! But well, like all others Da Vinci too made big mistakes, for example, he believed even with his superior knowledge of human anatomy that male semen came from the brain via the spinal cord (source – Vinci drawing Copulation and notes therein) during coitus!! Some feel however, that he deliberately distorted his view to fit popular Galenic perception at that time.

Other daVinci robotic surgeon references:
Science daily article
ABC news article
Video - Robotic bypass surgery, Da Vinci system at work

daVinci robot pic - website of manufacturer


Sreejith Panickar said...

Great information! A good blog here Maddy... Came from Kerala blog roll

Unknown said...

Great post! Da Vinci was truly a multi-faceted genius.

Unknown said...

Great post! Da Vinci was truly a multi-faceted genius.

Nanditha Prabhu said...

very informative and wonderful post as usual.
wow! you stood thro a whole 7 hour operation?

Happy Kitten said...

A great post..

and it tells me yet again that nothing is new in this world of ours.. we are just re-inventing..there were more Da Vinci's and his likes even earlier.

Praveen Krishnan said...

Brilliant article! What a way to connect the dots. I had bookmarked this post on my reader, and since it was long, hadn't read it until now. Very informative and nice to know of the new development plans in the offing in the complicated field of surgery!!!

Super post!!!

Kurt said...

Excellent post. I am researching the topic of Robot-assisted medicine, and you seem to have a significant grasp on your subject.

I have some questions on the use and future direction of such devices. For instance, wouldn't the use of such device greatly increase dexterity and accuracy in sptie of the physiscian, rendering physical capabilities less important as compared to knowledge and experience?

Can I send you an email with more questions?

Thank you.

Bhel Puri & Seekh Kabab said...

The book "The agony and the ecstasy" talks about Michelangelo and the friendly competition between him and Leonardo. Michelangelo was always in envy of Leonardo's commercial success, and also indulged in the practice of dissecting corpses to study anatomy. Although you don't mention it, you obviously know that those days dissection was a hanging offense (heresy according to the Church).

Also have to echo Nanditha- you stood through a 7 hour op? :0

Maddy said...

sreejit, narendra, nanditha, HK, praveen - thanks a lot and sreejit & praveen thanks for dropping by, do visit often!!

BPSK..I have not read the book you mention, but yes, they risked death and it was vesalius who first published an anatomy book. however i would assume michaelangelo's & da vainci's notes saw light much later..

nanditha & BPSK - yes, it was a little longer than 7 hours, i still remember it, I had to take our shoes off and it was freezing in the OT..finally we got off for a smoke and dr Cherian asked 'what do u think as an engineer'. i murmured some stupid answer and he said, 'well, this is just glorified tailoring'...That was the eminence and humility of the great doc!!

Maddy said...

kurt - pls feel free to mail me - i will provide whatever info I can, based on my layman's perspective tempered with an engineering background.....

Yes - it does increase accuracy, though not necessarily dexterity- there is still no replacement for the human wrist & touch and also the effective feedback control that the human touch can execute. But robots being unaffected by emotions will do repetitive actions e.g. stiches very precisely and with higher reslution and are unaffected by fatigue, worry, other tensions such as fear of failure etc.. on the other hand the robotic arm is still controlled by a human in this case..

the big disadvantage is still the lack of 3D & feel. Probably you have chanced on the mention in my post of how the UK researchers are improving on the daVinci..

but feel free to continue discussing this.

Anonymous said...

Once again...Hats Off to you.So how come you managed to sneak into OT.You are another multi-faceted genius.So "New Keywords" for Google....Search Started...:-)

Maddy said...

come on aravind - jack of many trades, master of none is probably a better way to put it..but thanks pal - as for getting into the OR, all I did was ask and the good doctor said 'of course, if you are brave enough..'