Topical themes


Welcome to the Operating Theatre of the Future. You are about to undergo an operation but will have no scars to show for it. The surgeon will not be hovering over you with a scalpel: he (or she) will be working from a console using joysticks. On the monitor, he will be able to see your stomach, intestines, gallbladder or whatever he is operating on in glorious full colour. If the University of Twente has its way, this style of surgery will soon become the norm.

The Operating Theatre of the Future uses robots to perform surgical procedures. Surgery is about to enter a new era. Robots can perform extremely precise movements, even in places which are less accessible for a human surgeon. Robots are likely to prove particularly useful in various forms of laparoscopic procedure, commonly known as 'keyhole' surgery.

University of Twente has appointed Prof. Ivo Broeders, himself a surgeon, to explore the possibilities for the Operating Theatre of the Future. His Robotics and Minimally Invasive Surgery department, part of the MIRA institute, researches technical innovations in this specialist field.

Minimally invasive surgical techniques have been in use for several decades. At first, they were largely confined to 'exploratory' procedures, giving surgeons the ability to look inside the patient's body without having to make large incisions, and thus arrive at a diagnosis. A camera attached to a thin optical fibre tube is introduced into the patient's body, and the surgeon watches the output on a monitor alongside the operating table. Today, minimally invasive techniques are no longer confined to just looking: it is possible to remove part of the meniscus of the knee or even the entire gallbladder 'through the keyhole'.

The past, present and future of keyhole surgery
The 'old-fashioned' method used for a relatively straightforward operation in the abdominal cavity entails making three or four small incisions. The surgeon can then approach the organs from various angles. Although the incisions are indeed very small, they do leave some minor scars.

Flexible instruments have now made it possible to conduct routine operations through the patient's navel. One very small incision is enough and any scarring is practically invisible. Nevertheless, this innovation does have its drawbacks. The position the surgeon must adopt to perform the operation is so uncomfortable that he cannot be expected to work like this every day, and certainly not for the 35 years of a full career.

The advantages which robots can offer are obvious. Robots can hold the flexible instruments, while the surgeon controls all movements from his computer console using joysticks. Modern high-definition colour monitors clearly show the difference between healthy tissue and that which must be removed.

Everyone will benefit from the introduction of surgical techniques which use robot-controlled flexible instruments. The patient will have no scarring, while surgeons will be able to work in far greater comfort and thus perform a greater number of operations. This will in turn help to keep staffing costs in check.

Advice and training
University of Twente is not only involved in the development of the technique, but is also helping to design and equip the operating theatres in which it will be used. In association with the Health Technology and Services Research department, Prof. Broeders advises hospitals on how best to structure complex working environments such as the operating theatre. A new generation of surgeons is to be trained in operating the surgical robots. Students from the university's Technical Medicine programme (the only one of its kind in the Netherlands) have already been introduced to the Operating Theatre of the Future as part of their practical coursework. Within a few years, the new-style surgical environment will welcome its first patients.

Benefits for both surgeon and patient