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Robo Doc–from cut and sew to hi-tech surgery

A Malibu doctor receives a $2 million federal grant to explore new horizons in surgery.

By Kim Devore/Staff Writer

Dr. Peter Schulam is on the cutting edge of a revolution–literally. The Malibu doctor, who serves as the chief of UCLA’s division of endourology and laparoscopy, is spearheading an effort to develop minimally invasive surgery techniques through hi-tech training and robotics. Schulam will serve as the lead clinical investigator of a $2 million federal grant that could help turn complicated medical practices into routine procedures.

Born in New Haven, Conn., Schulam worked on the East Coast and in Houston before moving his family to Malibu a year-and-a-half ago.

On a blustery Saturday afternoon at Starbucks, he thinks back to his early days at Johns Hopkins Hospital. He remembers how the walls were lined with grainy photographs depicting crude turn-of-the-century medical procedures. Even though times have changed, some of the techniques have not.

“Granted there have been major advances,” he says. “But when you see those old surgery photos from the 1900s, they don’t look much different from what we do right now.”

During his time at Johns Hopkins, he worked under a doctor who performed the first laparoscopic kidney removal and became fascinated with its implications. (Laparoscopy is a type of surgical procedure in which a small incision is made, usually in the navel, through which a viewing tube (laparoscope) is inserted. The viewing tube has a small camera on the eyepiece, which allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube.)

Schulam sees a time when the traditional operating room will be a thing of the past. The old hands-on cut-and-sew procedure, using scalpels and sutures, will be replaced by widely used robotic surgery, which will be more effective, more efficient and more precise.

Instead of slicing up a patient, poking around and leaving a big scar, doctors will make just a few small incisions and direct tiny instruments as they watch on a video screen. Some minimally invasive micro surgical procedures are already in use, resulting in improved survival, fewer complications and better results.

“Less invasive surgery brings significant benefits to the patients including faster recovery times and reduced pain and trauma,” says Schulam.

The idea has raised a few knowledgeable brows, even at UCLA.

“There was a lot of resistance and there still is,” he explains. “It’s only been in the last three years or so that we don’t have people going around shaking their heads.”

If some members of the medical and academic community remain unconvinced, patients are not, and many are lining up for new procedures. “Patients are demanding it,” he says, “and now, for the first time, we are forced to ask, ‘How can we cure you with the least amount of pain?’ “

That enthusiasm has created a pressing need for doctors to keep up with the latest advances. The problem is there are only so many specially trained physicians to go around.

“The demand for surgeon training far outpaces the time that experts have to do it,” explains the doctor.

Schulam hopes to change all that and share his knowledge with doctors around the world by creating a breakthrough system in surgical training.

His device operates much like a flight simulator. It has two consoles sharing control over a single set of arms, which are used to perform an operation. What’s more, the inclusion of “haptic” feedback will enable surgeons in-training to actually feel their mentor’s actions and experience the surgery through the hands of an expert.

As Schulam sees it, this kind of team training will help level the playing field and improve the quality of care.

“We don’t want to limit this technology to just a few surgeons,” he says. “We need to think of ways we can make it more accessible to everyone.”

There is little doubt the medical profession is on the verge of a revolution and the doctor’s new training device could play a pivotal role.

Once the basis for “Fantastic Voyage” style B-movies, microsurgery is becoming a reality. “[It] brings the doctor inside the patient” in a way that was once unimaginable,” says Schulam.

“Ten years ago, people would have laughed,” muses Schulam. “They’re still laughing, but not as hard.”

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