Chapter 14: Technology in the Division of Surgery
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Description
In this section Dr. Pollock explains several Division initiatives that are improving surgical processes for the patient.
Dr. Pollock talks about MINTOS (Minimally Invasive & New Technology in Oncologic Surgery), an interdepartmental program that finds technologies to pair with laparoscopic surgery to make oncology surgery is less burdensome on the patient. He also discusses how advances in surgery had enabled a new field, oncoanesthesiology to emerge (he will be speaking on this subject at a conference).
Next Dr. Pollock explains robotic surgical techniques, describing how it helps surgeons perform more accurately. Robotic surgery can also be performed at a distance (tele-surgery), which could influence care in distant areas of Texas and among the medically underserved. Dr. Pollock mentions that Southwest Bell has given MD Anderson a grant of one million dollars to explore tele-surgery and that NASA is also interested.
Dr. Pollock then talks about BrainSuite, an operating suite that is also an imagining unit: MD Anderson is one of the 1st two places in the world where a surgeon can see an image of a tumor as s/he is operating on it. He describes the benefit of this to the patient and the surgeon and talks about the training processes needed to use these new technologies.
Identifier
PollokRE_02_20121010-C14
Publication Date
10-10-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, October 10, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Devices, Drugs, Procedures The Clinician The Researcher Definitions, Explanations, Translations Institutional Processes Devices, Drugs, Procedures Technology and R&D Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Professional Practice The Professional at Work Building/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
So what were some of the activities that the executive committee and you felt you needed to support, and what the overall goal for the division?
Raphael Pollock, MD:
We broke ground on a number of things—established a minimally invasive surgery program, MINTOS.
Tacey Ann Rosolowski, PhD:
Yeah, could you talk about that?
Raphael Pollock, MD:
This was at a time when minimally invasive surgery was just developing—laparoscopic surgery followed in short order by robotic surgery. We developed an interdepartmental program that enabled us to both survey and identify technologies that we wanted to adapt. Each department in the division had a representative. It was a faculty-driven committee. There were no chairs on the committee, just senior faculty, by and large, who were interested and committed and had the training so that they could bring this forward or to the executive group. So that’s an example of something.
Tacey Ann Rosolowski, PhD:
Can you just tell me a little bit more about what practically happens with minimally invasive surgery?
Raphael Pollock, MD:
Oh, instead of having to make big incisions you make small incisions and insert instruments through those small incisions and then operate through those instruments.
Tacey Ann Rosolowski, PhD:
And when did you begin to adapt this program?
Raphael Pollock, MD:
This would have been in the late 1990s.
Tacey Ann Rosolowski, PhD:
And how has the technology for that evolved since then?
Raphael Pollock, MD:
Oh, remarkably—remarkably.
Tacey Ann Rosolowski, PhD:
In what ways? Can you give me some examples?
Raphael Pollock, MD:
There are some procedures that simply are not done as open procedures anymore, and things that are now transitioning into closed procedures that make for much less morbidity from the surgery, much shorter hospitalizations. So there’s a definite financial impact. Fewer complications, servicing a market demand—all of these very positive things—enhanced patient safety.
Tacey Ann Rosolowski, PhD:
I was wondering, too, because your initial research was on surgical stress.
Raphael Pollock, MD:
Well, that also ties to this. Actually, just as a parenthetic, I’d been asked to give a talk at one of the anesthesiology meetings at the end of November on global anesthesiology. I’m given carte blanche to speak on just about anything that I want. I have about a forty-five-minute period of time, and I decided that, with the approval of our anesthesiology people, the talk is going to be entitled Oncoanesthesiology: An Emerging Medical Specialty Who’d Time Has Come. One of the issues it just that. How do we minimize surgical stress as a problem area? And it has been very gratifying, because I’m going back now and catching up on what’s happened in the past twenty-five years in this area that I used to be so very, very involved with. So it’s a lot of fun closing loops and bringing some things full circle. But that’s one of the advantages of the minimally invasive approach.
Tacey Ann Rosolowski, PhD:
And I’ve read, also, that you have the—there are other technical advances, like the Da Vinci Robotic Surgical System.
Raphael Pollock, MD:
Right. That’s all part of the minimally invasive—
Tacey Ann Rosolowski, PhD:
Okay, so it’s sort of a commitment to be as minimally intervening with a patient as possible. So there are these different technologies that allow that to happen. What is the Da Vinci Robotic Surgical System?
Raphael Pollock, MD:
Well, Da Vinci is the trade name, but robotic surgery works on the basis of a console that you put your hands into, and the console drives robotic hands. So you have the same ports of entry, but instead of long instruments that you’re directly controlling, you’re controlling the robot that’s controlling. And the reason that that’s so much more valuable in some ways—in some applications—is that everyone has a small measure of human tremor, for example. The robot does not have a tremor, so you can eliminate that for very, very fine suturing. We can do microvascular suturing using—sewing together vessels that are one-tenth the size we can do with an operating microscope right now, which is going to have huge implications in terms of reconstructive procedures. The other thing about it, which we’re very, very excited about, is now that you have a robot—it’s in the same room as the patient, but it’s twenty-five feet away, but if you put it fifty feet away, or fifty miles away—and so the whole idea of telesurgery now becomes a huge opportunity, particularly in a place like the state of Texas, where we have a lot of patients who come up from the Rio Grande Valley to get what’s very routine surgery simply because they can’t get it at home. So what if we were able to keep these people at home and not strip them out of their own support system—many of them English is not a second language; it’s not spoken—kept them at home, enabled them to get the surgery that they need—particularly reaching out to medically underserved populations—and at the same time potentially freeing up surgical capacity for people who need access to very, very complex, labor-intensive operations that are hard-to-find facilities where those can be performed? So it cuts in a lot of different directions that would be very, very positive.
Tacey Ann Rosolowski, PhD:
So what are the discussions like about the telesurgery, as you’re describing it? Is the department talking about it?
Raphael Pollock, MD:
Oh, yeah. The MINTOS group went out and got a $1 million grant from Southwestern Bell, so they’re very interested in working with us. There is a collaboration that is—Bobby Satcher, who is the only surgeon astronaut, I think, in the United States—certainly the only one that’s ever been employed here. He’s one of our orthopedic oncologists. He’s been very interested in championing the telesurgery program. So NASA, for obvious reasons, is very, very interested in that, so they’re part of this collaborative effort as well. So that’s a neat thing that is going to be developing.
Tacey Ann Rosolowski, PhD:
What’s BrainSuite?
Raphael Pollock, MD:
And the BrainSuite is also another area I was going to mention in terms of technology advances. It’s no longer a unique environment, but we were one of the two first places in the world. This is an operating room that is also a fully-configured MRI suite, so that you can image the tumor as you are operating on the patient. That’s very, very important because not only navigating through very critical parts of the brain to get to a deep-seated tumor, but after you have removed the tumor you can then image it while the patient is still open and in the operating room and anesthetized to see if your deep margins are good, which is a very commonplace where failure takes place. And if there’s any problem, you can take more tissue, again, under this direct image division. It’s a game changer for neurosurgery.
Tacey Ann Rosolowski, PhD:
Now, can that also be combined with telesurgery?
Raphael Pollock, MD:
Yeah. Yeah, that can be combined with telesurgery. The optoelectronic display systems in telesurgery, no matter what your vision is, it can make your vision 20/15. The resolution is spectacular. It’s like the highest high-density television that you can see, so structures that— In an open operation, maybe this far away, you can bring this close. And because of the mechanical advantage of the arm, if you take an arch that’s a meter wide, you can micro that down. You can move your arm a meter and the robot arm moves a millimeter. You can macro it, micro it, so it gives you total control. The robotic wrist, unlike standard laparoscopic surgery, where you’ve got basically a crossed effect—you have to operate like this because it’s not direct extension.
Tacey Ann Rosolowski, PhD:
With your hands crossing one another.
Raphael Pollock, MD:
Yeah. The robot is a direct extension of your hand. The reticulating instruments are such that they totally mirror the movement in seven different planes of the human wrist. So these are tremendous advantages.
Tacey Ann Rosolowski, PhD:
I was going to ask about the training process to accustom surgeons to operating through prosthesis.
Raphael Pollock, MD:
There’s a learning curve, and the MINTOS program has been set up to accommodate that learning curve. So we have our own training programs that people have to pass. It’s a proctored mentored type system. You’re not allowed to do this until you—I think it’s twenty-five or thirty cases under direct partnering supervision. So it’s faculty being supervised by other faculty. People embrace it. We’re bringing this into our training programs now. We have minimally invasive surgery, wet clinics, using dog labs and things of this sort that everyone in the division agrees on two Fridays a year the trainees will all be released to participate in those programs because it’s so integral to where we’re going.
Tacey Ann Rosolowski, PhD:
So as a surgeon—I mean—you were saying you have to have performed a certain number of cases before you can use the technological extension. Is that so you have a sense of your own body basically and how your own movements work? What’s the reason for that?
Raphael Pollock, MD:
Yeah. Hand/eye coordination, and the other aspect that you don’t have with the robot—when you’re operating you have a direct sense of touch. If this is a tumor, I can reach out and I get what’s called haptic feedback. You don’t have that because you’ve got these interposed instruments. So learning how to compensate for the haptic feedback, and part of it, again, is because you can macro or micro the motions and because the visualization is so incredibly good. And there are actually people who are working on pressure sensor systems so you’d have sensors in your glove that would be like artificial haptic feedback but haptic feedback nonetheless.
Tacey Ann Rosolowski, PhD:
I was curious about that—if there were any— It seems like the advantages are so amazing for this surgery, but if there was any downside that you could see, I was wondering if the lack of touch—but they’re working on that.
Raphael Pollock, MD:
Yeah, so this is very exciting.
Tacey Ann Rosolowski, PhD:
Very exciting. It’s really fascinating. We’re just about at 4:55, and I actually do need to leave pretty much on time today. Is it okay if we stop for today and then maybe schedule a final session?
Raphael Pollock, MD:
I would be happy to do that.
Tacey Ann Rosolowski, PhD:
That’s great. Okay. Thank you very much for your time today.
Raphael Pollock, MD:
Of course.
Tacey Ann Rosolowski, PhD:
I’m turning off the recorder at 4:55. (End of Audio Session 2)
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 14: Technology in the Division of Surgery" (2012). Interview Chapters. 1326.
https://openworks.mdanderson.org/mchv_interviewchapters/1326
Conditions Governing Access
Open
