Over the last year as I have shifted my research focus more towards the in vivo aspect of experiments I have begun to get more intimate with surgical techniques. Under supervision of my colleagues and my boss in the lab I have learnt how to perform laminectomies, inject into the brain and perform spinal cord lesions. All of this is done in rats in a controlled, regulated situation, under standard procedures. None of these techniques are difficult once you learn the neuroanatomy, you find the right tools to use at every step and you know how the animal reacts to anaesthesia. But the fright of dealing with injecting a panicked animal or having botched a surgery for the first time haunts you none the less. Furthermore, if an animal suffers from complications, dies or does not undergo quite the right procedure you can easily end up losing 3-6 months of valuable experiment time. In doing these surgeries I have become fascinated by the unusual mindset that a surgeon must have when he or she first cuts into flesh, while balancing the importance of the work with the dangers of killing the subject. I suspect that for surgeons who work on actual patients in the hospital, whatever fealings I have must be exaggerated a thousand fold for them to function on a daily basis.

    Wondering about what real neurosurgeons would do, I read a couple of books written by preeminent surgeons on their profession. The first one was Do No Harm, by Henry Marsh. Marsh is a celebrated British neurosurgeon who works for the NHS at St Georges Hospital in London. In the early 1990s he went to Kiev Ukraine to set up a humanitarian collaboration with their surgeons. He wanted to improve and revamp some of their ailing medical facilities, by bringing more state of the art equipment to treat, what Western countries would have considered, simple cases. A documentary film was made of his work in 2004 featuring one such visit to Ukraine. In his book Marsh detailed some of the most interesting but graphic surgeries he carried out over his career by dividing each chapter according to a specific brain condition - usually a type of tumor or stroke. The second one I read was When the Air Hits Your Brain, by Frank Vertosick. Vertosick was a consultant to the old TV show Chicago Hope and used to work in Pittsburgh before he had to retire from surgery ironically suffering from Parkinsons Disease. In the book he describes his adventures growing from a neurosurgery intern to a resident, dealing with some harrowing cases in the ER, paediatric and trauma units.



    Both these neurosurgeons share common threads of behavior, such as a sense of superiority over other medical disciplines, a morbid sense of humor, an itch to constantly make and fix things with their hands and an overwhelming feeling of responsibility for their patients. But what strikes me is their fear of the sheer uncertainty in the surgical procedure itself. Surgery, more than any other process in the biomedical and medical field is prone to human error. The slight misplacement of the scalpel results, in my case, in a lost experiment and a few wasted months. But in the case of Marsh and Vertosick it would cause a loss of life or the livelihoods of many people.

    This brings me to the crux of this blog. A couple of weeks ago a research paper came out in science magazine detailing a new robot that could perform flawless surgery. It is called Smart Tissue Autonomous Robot (STAR). It is the latest gadget to come out of Sheikh Zayed Institute for Pediatric Surgical Institute in Washington DC that uses a fully automated system to perform soft tissue surgery. The authors report that the robot can perform a linear suture and an end-to-end anastomosis, resulting in the successful removal of a pig's appendix. This is all guided by a novel algorithm commanding a phlenoptic 3D near infra-red fluorescence (NIRF) scanner which helps the robotic arms position accurately and sense weight and pressure changes. In this procedure the robot was automated 60% of the time but 40% of it still required minor adjustments. The animals survived the surgery with no complications. If all goes well, such a robot could be programmed to do increasingly more complex surgeries with accurate repetition that even the most skilled human would struggle with. It could drastically cut the risk of invasive surgeries in future, although it would not completely replace the need for a human surgeon - someone still has to operate the executive programs. It does herald a future in which surgery will inspire less fear and experiments can be more consistent.

    A video from AAAS about the STAR surgery robot:

    The research paper from Science: