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Robotic Surgery On a Beating Heart

Posted by kdawson on from the got-a-good-beat-you-can-dance-to-it dept.

An anonymous reader writes "Serious heart surgery usually involves stopping the organ and keeping the patient alive with a cardiopulmonary bypass machine. But this risks brain damage and requires a long recuperation. Scientists at Harvard University and Children's Hospital Boston have now developed a device that lets surgeons operate on a beating heart with a steady hand. The 'robotic' device uses 3-D ultrasound images to predict and compensate for the motion of the heart so that the surgeon can work on a faulty valve as it moves. The approach should improve recovery times and give a surgeon instant feedback on the success of the procedure, the researchers say. Here's a (slightly gory) video of the device in action."

54 comments

  1. NOW they tell me! by dazedNconfuzed · · Score: 5, Informative

    I had valve replacement surgery two months ago. While everything went extremely well (thank you Emory hospital), my wife would have appreciated not hearing the words "it's going well, they're stopping his heart now...".

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    1. Re:NOW they tell me! by philspear · · Score: 0, Troll

      Well, it's safer than if they had tried to operate on you using a robot that was running windows.

    2. Re:NOW they tell me! by Anonymous Coward · · Score: 1, Funny

      As opposed to a Mac, where the device draws a cute little Hello Kitty on your chest with stitches?

      You know, now that I think about it, that would be pretty kick-ass.

    3. Re:NOW they tell me! by theaveng · · Score: 4, Interesting

      Pretty soon they'll just use robots (nanites) and won't need a surgeon at all, except to act as a kind of "general" giving orders to the tiny machines.

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    4. Re:NOW they tell me! by Lord_Dweomer · · Score: 1

      Pretty soon they'll just use robots (nanites) and won't need a surgeon at all, except to act as a kind of "general" giving orders to the tiny machines.

      A general? As in a Surgeon General?!?!? Wow...I need to leave work already...

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    5. Re:NOW they tell me! by bar-agent · · Score: 1

      "...In either case, most of the actual surgery will be done by small robots. And as you go forth today remember always your duty is clear: To build and maintain those robots."

      --
      i'd hit it so hard, if you pulled me out you'd be the king of britain [bash.org]
  2. Poe by dasheiff · · Score: 3, Interesting

    Edgar Allan Poe would be proud.

    1. Re:Poe by Anonymous Coward · · Score: 1, Funny

      Only if you could combine the machine and the heart with one of these

    2. Re:Poe by Anonymous Coward · · Score: 0

      Why? Did he need heart surgery at some point?

  3. What if something goes wrong? by WarJolt · · Score: 4, Insightful

    The software can predict where heart tissue will be approximately 70 to 100 milliseconds in the future, so the position of the tip of the handheld surgical tool can be adjusted accordingly.

    In surgery there is always a potential for something to go wrong. Can the software compensate for cardiac arrhythmias which are inherently unpredictable?

    Surgeons typically respond better than machines to unpredicted circumstances.

    1. Re:What if something goes wrong? by TheLazySci-FiAuthor · · Score: 4, Interesting

      ...Surgeons typically respond better than machines to unpredicted circumstances.

      True, and a good point.

      I wonder what the probability is of an event occurring which would require the flexible, though less precise, ability of the Surgeon versus the increased success afforded by the inflexible, but precise, machines.

      in other words, statistically speaking, does the risk of unpredictable events outweigh the benefit of increased quality of operation.

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    2. Re:What if something goes wrong? by Gat0r30y · · Score: 4, Interesting

      It would also seem to me that an arrhythmia would be much more likely to occur during such a procedure, since the heart (and generally the whole body) of the patient is under a significantly higher amount of stress during open heart surgery. But I guess the real answer would lie in the control system designed to predict the future behavior of the organ. Does it use a regular heartbeat to predict future behavior? Or, much more likely in my view, does the software use the ultrasound to predict future behavior independent of any particular "regular" heartbeat? I can say that if I were designing such a control system I would not want a set "regular" heartbeat as an expectation, I would much rather use the ultrasound to feed forward information from each chamber independently, so that even if there were an arrhythmia the compensation would not be directly effected.

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    3. Re:What if something goes wrong? by Ethanol-fueled · · Score: 4, Interesting

      To add to your point, it's not just the increased precision, it's also about not having to rip other stuff open which increases the risk of complication.

      Operations which required 6-inch incisions(think hernias and appendectomies) can be done with half-inch incisions thanks to technology. I'd gladly be touched by a robot as long as it left less of a mess on the way out. Plus, there's less of a risk of the doc leaving instruments inside when he sews you up. It happens, so don't laugh :)

    4. Re:What if something goes wrong? by eln · · Score: 4, Funny

      I'd gladly be touched by a robot as long as it left less of a mess on the way out.

      Pervert.

    5. Re:What if something goes wrong? by The+Gaytriot · · Score: 5, Interesting

      I'd say that's the point of the ultrasound. Otherwise, if the robot simply attempted to predict the position of the heart by it's rhythm alone there would be serious issues.

      Using the ultrasound, which updates the position to a computer (probably updating around 4-5 MHz), means that the robot can compensate for the position close enough to real time that it can avoid mistakes (there is still the tiny delay).

      Any irregularities due to Arrhythmia should not be an issue, the heart will probably not change beating faster than the computer and robot can compensate.

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    6. Re:What if something goes wrong? by Anonymous Coward · · Score: 0

      I would imagine that they can help stabilize arrhythmias simply because there is no reason for them to operate in the same time frame as humans. They can't predict arrhythmias, but they can detect them and react orders of magnitude faster than we can, which will eventually be Good Enough.

    7. Re:What if something goes wrong? by Yvanhoe · · Score: 1

      From what I read, see, infer, I doubt that the prediction happens at the scale of a heartbeat. I think it is more something like a prediction with a 1 ms measure step. A sequence of position, a simple physical system to tune an extrapolation filter should be enough to anticipate any kind of abnormal behavior of the heart. The model may be accurate at 70/100 ms but obviously the tool in the video is moving faster than that. The interest of the machine is not to predict where the tissue will be in 100 ms but where it will be in 1 ms.

      That is what would makes more sense : surgeon do in fact respond better than machines but way slower.

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    8. Re:What if something goes wrong? by whiplashx · · Score: 1

      In the realm of piloting aircraft, the likelihood of pilot failure is far greater than the likelihood of an unforeseen circumstance that the machine can't recover from. (People are still leary of flying without a pilot though which is why you don't see computer-piloted passenger jets, despite the fact that they are less likely to crash.)

      I would expect that this machine will only be allowed to be used when it reliability is at a similar level.

    9. Re:What if something goes wrong? by Trifthen · · Score: 3, Interesting

      I was wondering about that myself. My open-heart surgery in 1984 obviously used the old method of hypothermia to stop the heart, and as expected, required several hours to install a dacron patch to close a ventricular septal defect, close an atrial septal defect, widen my pulmonary artery, and surgically separate my tricuspid and mitral valves... and that was just what they could fix back then. That's a ton of crap, and I have to wonder how effectively a robot could work on a beating heart while having it open and basically re-arranging the entire inside.

      Then again, this seems obviously aimed at things like bypass surgery. I still have to wonder how invasive this technology can get before it gets too risky.

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    10. Re:What if something goes wrong? by WarJolt · · Score: 2, Insightful

      Though machines are more precise, we would need someone to blame if something went wrong. How could you tell someone that your son, daughter or husband would of lived if it was a surgeons hands instead of a machine.
      Airplanes can fly and land more precisely always on autopilot. All the human carrying ones still have pilots behind on-board because we still need someone to blame in case it crashes. We need a soul in control of the machine that has control over our lives. It's just too freaky not to. It may make things more safe, but be careful not to automate too much as computers have never been show to have the decision making skills of people

    11. Re:What if something goes wrong? by Trip6 · · Score: 1

      whatcouldpossiblygowrong?

      --
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    12. Re:What if something goes wrong? by fractoid · · Score: 1

      I wonder what the probability is of an event occurring which would require the flexible, though less precise, ability of the Surgeon versus the increased success afforded by the inflexible, but precise, machines.

      It sounds to me like in this situation, the machine is more flexible than the surgeon.

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    13. Re:What if something goes wrong? by fractoid · · Score: 1

      I've never understood this - people are perfectly happy to accept "human error" or "mechanical failure" as inevitable, but the moment there's a remote chance of a computer screwup they're terrified, even if it's far less likely to happen than either of the others.

      Maybe it's because in the case of human error, the human who made the error probably died in the crash...

      --
      Rampant carbon sequestration destroyed the Dinosaurs' tropical paradise. I'm here to help repair the damage.
    14. Re:What if something goes wrong? by Anonymous Coward · · Score: 0

      One thing to note is that the heart can be paced quite effectively during surgical procedures, making arrhythmias less of a problem than one might suspect.

    15. Re:What if something goes wrong? by cgenman · · Score: 1

      Can the software compensate for cardiac arrhythmias which are inherently unpredictable?

      If it is going on the current motion of the heart, depending on the sampling rate it should be able to compensate for "unexpected" motions far better than any human doctor would. Most humans have a 200 ms response time anyway, which sounds significantly higher than this machine's.

      A parallel would be Lasik: the laser compensates for your eye position every 100th of a second. I've seen studies where a stand-in eye glanced around quickly during the procedure, and came out nearly perfect anyway. Machines tend to compensate better than Man to instantaneous unpredicted circumstances.

      Where you're completely right is in the question "so the patient has some Cardiac Arrhythmia... what do you do?" However, as the surgeon is actually in control of the procedure the entire time (you'll notice his hand in the video, holding the contraption), it seems like he should have the same response time directing the team's response.

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    16. Re:What if something goes wrong? by j_sp_r · · Score: 1

      Mostly gauzes.You can't tell them apart from blood/tissue.

    17. Re:What if something goes wrong? by CRCulver · · Score: 1

      Airplanes can fly and land more precisely always on autopilot.

      I'm curious, do you have any documentation that planes can land safely on autopilot? All the praise I've heard of autopilots is that they take a great load off the pilot's shoulders during flight, but a skilled human pilot is still vital in take-off and landing.

    18. Re:What if something goes wrong? by AngryUndead · · Score: 3, Informative

      http://www.airliners.net/aviation-forums/general_aviation/read.main/1882971/

      Basically, airplanes can land just fine by themselves. It is vital that they are able to do so in no visibility situations.

      --
      I wear the ring.
    19. Re:What if something goes wrong? by Kent+Recal · · Score: 1

      I would think that starts and landings are *the* situations where we would benefit the most from auto-pilot. Ofcourse there should always be an "override" button for when shit really hits the fan.

      But in the general case (i.e. landings in heavy weather and with zero sight) a computer should be able to compensate much faster and more accurately than a human. There are no real decisions to make in those situations, it's all about reaction time. Furthermore a computer can "see" and "feel" much better than a human, given a wide enough array of sensors. For example, a ground station could report unpredictable turbulences to the plane before they even arrive there and the plane would prepare to compensate - all in a subsecond timeframe.

      As for your question: I know for sure that unmanned drones can start and land safely in auto-pilot. I *think* I have even watched a TV-documentary where they claimed that civil aircraft (with passengers on board) would commonly land (partially?) on auto-pilot, but I'm not entirely sure on that last one.

      I'm sure a real pilot can clear this up :)

    20. Re:What if something goes wrong? by WarJolt · · Score: 1

      Even the space shuttle, essentially a flying brick, can land by itself. It's never been tested in the real world because it's tradition to turn it off on final approach. I would assume that pilots and surgeons can find a little bit of common ground. Thats why I like the analogy. Us pilots think we can do better than machines.

  4. But... by sydney+troz · · Score: 0, Redundant

    Does it run Linux?

    All cliches aside, what are the repercussions if this thing BSODs (or equivalent) during surgery?

    1. Re:But... by Babbster · · Score: 4, Informative

      All cliches aside, what are the repercussions if this thing BSODs (or equivalent) during surgery?

      Probably minimal. Even with total failure, the solution would be to pull the needle and switch to a standard valve replacement surgery. Once that happens, anything done by the machine can be reversed and damage repaired, if necessary. Of course, something more terrible could happen (I'll save the descriptions for a horror screenplay) but the more catastrophic potential complications are far more likely to be operator error than a problem with the software of the device.

    2. Re:But... by Godji · · Score: 4, Funny

      Your question contains the answer. What would happen is a blue screen of, you know, death.

      Seriously though, even if the software were written to be somehow provably correct, hardware can always fail. So can the surgeon.

    3. Re:But... by moogied · · Score: 3, Funny

      ...the repercussions are a more literal translation of BSOD then we generally want..

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    4. Re:But... by moderatorrater · · Score: 1

      It was compensating for the heart beat, which means that if it just stopped it would nick the heart unless it was already at the maximum distance from the heart. I wonder if there could be a hardware failsafe where losing power or direction from the software would make it pull back an inch from the heart.

      Even with the risks of a BSOD, though, it's a much better alternative than being put on a bypass machine and having human hands in there. With properly built hardware and software, the failure rate should be much lower than even the best trained human.

    5. Re:But... by evanbd · · Score: 1

      I'd probably rather have this thing working on me than the normal procedure -- bypass is definitely something I'd rather avoid. But, if this thing manages to make a large mistake and tear something, that might be a *big* problem. Note that software has certainly cause medical problems before -- see the Therac-25 for example. It's rare, but software mistakes can and do happen. Caution is obviously warranted, but this probably represents a vast improvement on the current state of the art.

    6. Re:But... by amrik98 · · Score: 1

      Consider the Therac 25. The repercussions were nowhere near "minimal". These machines can do irreparable damage if the software or hardware fails in a catastrophic way.

  5. Human surgeons are buggy too by Anonymous Coward · · Score: 3, Insightful

    What are the repercussions if your human surgeon has a transient ischemic attack during surgery?

  6. OOOHH NOES!!!! by Anonymous Coward · · Score: 5, Funny

    NOW THEY'RE DISSECTING US!

  7. I Am Sure Glad They Provided Video! by BigAssRat · · Score: 2, Funny

    Otherwise I would have had NO idea what this thing does!! Am I the only one that got 2 seconds of what looks like a hypodermic and a back massager?

    1. Re:I Am Sure Glad They Provided Video! by sexconker · · Score: 0, Troll

      That's what I got, but it was 4 seconds.

    2. Re:I Am Sure Glad They Provided Video! by Anonymous Coward · · Score: 1, Funny

      it thought the video was just the new id logo, but i had no idea of how it got there

  8. Sat in on one once... by angrytuna · · Score: 5, Interesting

    I was able to sit in on an open heart surgery at one point in my life. After the surgeon cracked the chest open, he inserted a surgical glove full of (I think) normal saline, tied off at the wrist. Called it a 'helping hand'. The heart continued to beat merrily away on top of it, and they used a device called an octopus to hold the pertinent section of the heart still.

    To date, remains one of the coolest things I have ever seen.

    --

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    1. Re:Sat in on one once... by Lord_Dweomer · · Score: 1

      I don't get the purpose of the hand...was it so that the beating heart wouldn't move vertically but would instead push on the glove which would expand horizontally?

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  9. I for one by vldragon · · Score: 1

    I for one welcome the day when our robotic overloards will be able to heal us after working and or beating us with in an inch of our life! Although I'm sure with robitic precision they can get that inch down to at least with in 1cm of a life.

    --
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  10. Robot vs. Reboot by thewiz · · Score: 2, Interesting

    I, for one, would be happy to have a robot operate on me if I ever have a fourth open-heart surgery. The three surgeries I've had required that I be attached to a cardiopulmonary bypass machine, have my heart stopped by electric shock, sternum cut and rib cage spread open, and be restarted by another electric shock when they were done.

    Trust me, hot-swap is much better than a cold reboot!

    --
    If "disco" means "I learn" in Latin, does "discothèque" mean "I learn technology"?
    1. Re:Robot vs. Reboot by Anonymous Coward · · Score: 0

      Bah! I want redundancy and load balancing. No, seriously, why don't they throw in a spare heart at some point, with electroelastomers and glucose power cell and get it over with?

    2. Re:Robot vs. Reboot by badkarmadayaccount · · Score: 1
      Why did /. post this anon when I didn't tell it to? Whatever. Here is the post again for the mods:

      Bah! I want redundancy and load balancing. No, seriously, why don't they throw in a spare heart at some point, with electroelastomers and glucose power cell and get it over with?

      --
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  11. Looks like segway when it first appeared by heroine · · Score: 1

    Modern machine control, sensors, & servos are so advanced, it creates sights that look like they shouldn't be possible. Eventually surgery on marathon runners during a marathon will look as normal as segways. Too bad there aren't any jobs in machine control.

  12. That depends... by patio11 · · Score: 1

    ... on how fast the attending nurses are able to shoot the ischemic.

    Hadn't heard of that terrorist group, incidentally. What is it, the Holy Party of Ischem?

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