02 July 2013

Surgery, the video game

The anesthetized patient on the operating room table had several giant kidney stones that needed urgent removal. The solution was "laser lithotripsy." We threaded an endoscope (thin camera) through his ureter until we could see the stone on a TV screen. Then we threaded a fiber-optic laser into the camera apparatus until it was touching the stone. The surgeon pressed a button that activated the laser for a fraction of a second. Its energy shattered the stone. Then we used a wire basket to retrieve the shards of stone and place them in the bladder, where the patient would have no problem passing them. We repeated this process for about half an hour, until the stones had been fully removed.

Watching the surgery felt like watching a video game, with a first-person shooter element (aiming the laser at the stone and zapping it) plus a tricky kind of arcade game in trapping the stone in the wire basket. With a few modifications, the main portion of this surgery probably could be done remotely from a computer on the other side of the world.

While the lithotripsy portion of the surgery required immense skill, it didn't require that the surgeon know much of anything about medicine. I think that with sufficient practice, a middle-school student could have performed the surgery quite capably.

I also observed ESWL (extracorporeal shock wave lithotripsy) procedures. In these procedures, a device produced loud shock waves that fractured kidney stones. No cutting was needed. Although a urologist was present for brief portions of the procedure, most of it was performed by an expert technician. The urologist was barely needed at all.

I think what I witnessed is a harbinger of the future. I imagine that quite soon, some surgeons will routinely operate on patients who are thousands of miles away. And I imagine that the trend of non-surgeons performing portions of some surgeries will accelerate. What this means for patients, I know not.