Dr. Marcelo Obando, of Kaiser Medical Center, used a robotic arm and voice recognition software during sinus surgery Tuesday. This allowed use of both hands for what previously was normally a one-handed procedure.

Robotic arm may
revolutionize sinus surgery

2 Kaiser doctors develop
a technique that has potential
for other types of surgery

By Helen Altonn

A unique sinus surgical procedure developed by two doctors at Kaiser Moanalua Medical Center is turning heads in the medical community.

The procedure uses a robotic arm and has helped people like Mark Hada, who said he had trouble breathing for about two years until he had the operation.

"The robot is wonderful stuff," he said. "If I had a problem with my nostril in the future, I wouldn't hesitate to get this procedure again."

Hada, 51, became in February 2001 the eighth patient to have sinus surgery performed by Dr. Marcelo Obando of Kaiser's ENT (Ears Nose Throat) Department with a voice-directed robotic arm.

Obando and Dr. John Payne, general surgeon at Kaiser, developed the technique using the AESOP (Automatic Endoscopic System for Optimal Positioning) robotic arm.

Hada, who works at the airport post office, said his breathing became worse with New Year's fireworks smoke in 1998 and 1999. He said he tried medication for about a year, but it did not work.

Obando found a cyst in his sinus that had to be removed, and explained how he would operate using a robotic arm as a "third hand," Hada said.

"I thought that was pretty wonderful," he said.

Obando performed his 24th and 25th endoscopic sinus procedures with AESOP the past two days.

Endoscopy involves use of an endoscope, an instrument that allows a surgeon to see images of the body's internal structures through very small incisions.

In traditional endoscopic sinus surgery, the surgeon holds the endoscopic lenses with one hand while operating with the other hand, or a surgical assistant holds the endoscope.

Both methods have problems, Obando said.

He said he watched several operations by Payne, one of the first at Kaiser to use the robotic arm for abdominal surgery.

"I said, 'John, I'd like to apply this,' and he said, 'Let's go try.' So, we try," Obando said.

Payne taught Obando how to adapt the robotic arm for endoscopic sinus surgery and work with the company Computer Motion to design the equipment.

The Santa Barbara, Calif., firm pioneers in medical computers and robotics and produced AESOP.

Obando and Payne began experimenting in 1999 with a closed-circuit system, applying a catheter and balloon in the nose with a holder for the lenses to replace the surgical assistant.

However, they had to stop the operation every time they wanted to move the knobs and change the angle of the holder, Obando said. The robotic arm eliminated that obstacle.

Chuck Vivian, Computer Motion executive vice president of sales, and Scott Hammond, vice president for market development, observed Obando's sinus operation with AESOP Tuesday.

Vivian said the robotic arm is widely used for different surgical purposes, but "no one else is using it for sinus operations."

Obando did the first cases in the world the past two years and lectured at many scientific meetings about the procedure.

He said a medical school in Shreveport, La., heard one of his presentations and has started a robotic arm project.

Obando also has begun using AESOP for some tonsillectomies and is teaching Kaiser neurosurgeon Leon Liem how to adapt the arm to perform certain neurosurgical procedures.

Watching Obando at work in the operating room, Vivian said: "We're learning how it's done. It could revolutionize the way surgery is applied. ... He (Obando) is one of the thought leaders in ENT. This is a creative application that, frankly, we never thought of."

"He's doing cutting-edge," Hammond added, explaining the company wants to use Obando's expertise for future developments. "He feels the robot does a better job."

Obando said, "The most important part is, you can use both hands with the robotic."

The surgeon's voice is taped onto a magnetic card, and the robotic arm responds only to him as he directs, "AESOP, move back" or "AESOP, move right." It can also be controlled by hand or a foot pedal.

The surgeon has direct control with the extra arm and a more precise, "rock steady" image of the surgical area on the video screen than is possible by hand-holding the endoscope, Obando said.

He said the closed-circuit system with AESOP keeps the endoscope lenses clean so the instrument does not have to be removed and cleaned.

The system also controls bleeding and aspiration of secretions and local anesthesia from the nasal area, so nasal packing is rarely needed after surgery, he said.

The AESOP arm costs about $100,000 but saves time, money and manpower because it is available 24 hours a day and replaces a surgical assistant, Obando said.

The robot's movements are limited, so there is no danger of the robot harming the patient, he said. "It also has a memory," he said, explaining it can be directed to return to an earlier surgical level.

Kaiser Permanente Hawaii
Computer Motion

E-mail to City Desk


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