Archives: 7/2005
With all the recent talk about robots encroaching on the domain of surgeons, we thought it’d be fun to take a look back to the beginning of the field.
The earliest known historical text on surgery is the Edwin Smith papyrus. Dating to 1600 BC, it is, in fact, the oldest known medical document. The practical material in the Edwin Smith papyrus stands in stark contrast to the magical incantations in another celebrated Egyptian medical text, the Ebers Papyrus.
There’s some speculation that all surgery began as military surgery, specifically, the careful removal of arrows and darts. Fittingly, the material in the Edwin Smith Papyrus deals mostly with trauma.
Every surgeon knows the most important decision he or she makes is when NOT to operate. The Egyptians seemed to recognize this, too — many of the ailments in the Edwin Smith papyrus are deemed untreatable.
Through the wonders of the web, you can play along at home, clicking on the various injuries and guessing Imhotep’s recommendations. One favorite is ailment #47, “Instructions concerning a gaping wound in his shoulder,” excerpted below:
If thou examinest a man having a gaping wound in his shoulder its flesh being laid back and its sides separated, while he suffers with swelling (in) his shoulder blade, thou shouldst palpate his wound, shouldst thou find its gash separated from its sides in his wound, as a roll of linen is unrolled, (and) it is painful when he raises his arm on account of it, thou shouldst draw together for him his gash with stitching.
Thou shouldst say concerning him: “One having a gaping wound in his shoulder, its flesh being laid back and its sides separated while he suffers with swelling in his shoulder blade: An ailment which I will treat.”
Thou shouldst bind it with fresh meat the first day.
You couldn’t ask for a better assessment and plan. And Day 2 has some other interesting ingredients in store. In fact, we found another site that speculates on the Egyptian tendencies toward employing meat, honey, and grease, and lint:
Lint was a form of vegetable fiber, and grease was some form of vegetable oil. The grease could also be snake grease, or other grease from an animal. Honey was the most widely used of the three, in over 900 remedies. Such a mixture of grease and honey prevents bacteria from growing in an open wound, and thus decreases the risk of an infection. The lint would then cover up the wound. The meat was used as a clotting agent in the bleeding wound. It is thought that the Ancient Egyptians used fresh meat in some wound treatments because of the idea of “flesh healing flesh,” like the old cliche of putting meat on a black eye.
The Edwin Papyrus is currently housed in the New York Academy of Medicine. Much more on ancient surgery, specifically approaches to wounds, can be found in Dr. Guido Majno‘s book, The Healing Hand.
That concludes our week. Thank you for stopping by!
The OR continues to be crowded by giant robots. Hot on the heels of the Penelope Surgical Instrument Server comes the new da Vinci Surgical System, from Intuitive Surgical:
“The robot takes us a big step beyond traditional laparoscopy. It allows us to operate more naturally, the way we do in open surgeries, but still preserve a minimally invasive approach with small incisions.”
…After sleeve placement, the robot, much like a post with three arms, is wheeled over and its center arm docked to a port that holds the camera and the other arms docked to the instrument ports.
However, surgery with the da Vinci does not mean close proximity to the patient. Unlike with laparoscopy, the surgeon is seated across the room from the patient, with arms inserted into the nearby console, fingers on stirrup-like holders and eyes fixed on lenses for sharp magnified images of the surgical site. Focus is adjusted via foot pedals.
While laparoscopy allows manipulation of instruments up, down and side-to-side, surgery with the da Vinci allows more natural wrist movement.
The robot’s arms have wrists with eight degrees of freedom that allow the surgeon “to bend around corners and work in ways that are much more natural,” said Boggess. This allows full range of motion and the ability to rotate instruments 360 degrees through tiny incisions. Direct and natural hand-eye instrument alignment is similar to open surgery, with “all-around” vision and the ability to zoom in and out.
Another advantage with da Vinci is the elimination of tremor…
Professor Boggess says patients who’ve been operated on with the robotic system have shorter hospital stays, require fewer pain meds, and return to normal activities more quickly. We suspect robotic patients would fare even better.
More at Intuitive Surgical…
Flashback: Robotic Surgery for Female Infertility.
Scientists at MIT have developed an anklebot that can help stroke patients to recover through a robotic-assisted rehab faster. In addition, MIT is now eyeing a robotic gym that will be “full of machines targeted at different parts of the body [that] will significantly improve stroke patients’ movement in arms, wrists, hands, legs and ankles.”
More from the MIT press office:
…the researchers have created a new Anklebot, and on July 1, MIT and the Baltimore Veterans Administration Medical Center will establish a Center of Excellence on Task-Oriented Exercise and Robotics in Neurological Diseases to further such work on lower extremity movement.
“This heralds a transition of therapeutic robotics from research to practice, similar to when computers went from being specialized number-crunchers for engineering and science to the ubiquitous consumer appliances for word-processing and presentation that we use today,” said MIT Professor Neville Hogan, a principal investigator in the work who holds appointments in mechanical engineering and brain and cognitive sciences.
The researchers will be discussing several aspects of their work at the International Conference on Rehabilitation Robotics (ICORR) being held this week in Chicago.
Hermano Igo Krebs, co-principal investigator and a principal research scientist in mechanical engineering, said, “It appears that we are at the cusp of a revolution in the way rehabilitation medicine is practiced, and therapeutic robotics is at center stage.
“The focus of the new center is to accelerate the pace of this revolution using a multisystems approach for the recovery of stroke patients’ gait, investigating models of neurological plasticity [the brain's ability to adapt], cardiovascular fitness, therapeutic robotics and behavioral modifications…”
In the MIT-Manus therapy, a person sitting at a table puts a lower arm and wrist into a brace attached to the arm of the robot. A video screen prompts the person to perform an arm exercise such as connecting the dots or drawing the hands of a clock. If movement does not occur, MIT-Manus moves the person’s arm. If the person starts to move on his own, the robot provides adjustable levels of guidance and assistance to facilitate the person’s arm movement.
In the first clinical trial, the researchers found that stroke patients who used the machine four to five hours a week improved further and faster, as measured by increased function of the impaired limb, than a second group of patients that did not receive robot-assisted therapy. “In fact, patients in the robot-assisted group improved twice as much as the control group,” Krebs said. At the same time, the trial showed that the robot is well tolerated by patients and causes no pain.
The new center at the Baltimore VA aims to “implement for the lower extremities what we did for the upper extremities,” Krebs said.
The MIT-Manus work also answered a longstanding question among therapists: manual manipulation of a stroke victim’s disabled limb does indeed aid recovery of the use of that limb. “There had been a great deal of intuitive belief that this works, but our research provided conclusive objective evidence,” said Hogan, who is director of MIT’s Newman Laboratory for Biomechanics and Human Rehabilitation.
More…
The Globes [online] is reporting that an Israeli company OphthoCare yesterday obtained FDA approval to market in the US its electronic eyeglasses, for treating lazy eye syndrome (amblyopia) in children. NIH acknowledges that amblyopia is the most common cause of visual impairment during childhood (see here).
The technology:
The LCG (Liquid Crystal Glasses) comprise of electronic shutter that is incorporated into the optical refractive lens. It is controlled by preprogrammed microchip and is activated over the sound eye in short intervals. These CLOSE – OPEN sessions exercise the weak eye and enforce its use.
Exercising of the weak eye is performed all day long while glasses are worn. It strengthens the amblyopic eye, improves the visual acuity and enhance binocular vision as well.
The fact that the sound eye is occluded for short periods only makes it very convenient to the child and easily adopted by him.
Exercise modality is adjustable via software and actual exercise time is recorded automatically in the microchip providing feedback to a “compliance unit” and presenting it to child and parents. This information is also valuable to the ophthalmologist and is important part for further treatment prescription.
More at the OphthoCare website…
Japan Corporate News Network is reporting that Japanese manufacturer Omron Healthcare has announced on July 5th that it will bring to market the KaradaScan Check HBF-357, a consumer version of its KaradaScan body composition monitor.
Some details from the press release:
The HBF-357 can display body weight, the levels of skeletal muscle, body fat and visceral fat, basal metabolism, BMI (body mass index), visceral fat rate, and body age.
The company will also release the HBF-356, a lower-price version, on the same day. The HBF-356 can display body weight, the levels of body fat and visceral fat, basal metabolism, and BMI.
The products are likely to retail for 10,000 yen ($90) and 8,000 yen ($72), respectively.
Omron Healthcare website…
The Zeno Zit-Zapper continues with strong sales, even after prom season. We first covered its release last month, and now MSNBC has posted a closer look at Zeno’s development team:
Taking a product from proof of concept to sales status in a period of just 12 months does constitute a speed “virtually unheard of” in the medical device market, Klemp says.
…Although Zeno has been approved for over-the-counter sale, the product initially will be marketed only through medical offices and spas.
Down the road, Klemp envisions a product more readily available to consumers. But for now, the company works to establish credibility and “get the medical and scientific community behind us.”
Maybe that’s wise. The medical community is usually a lot less fickle than teenagers.
A trial run with the device, and a cautionary note from a dermatologist, are up at the Washington Post.
More at Crutchfield Dermatology…
Engadget writer Ross Rubin has some thoughts on his experience with the first defibrillator available to consumers, the Philips HeartStart:
In the walkthrough with the plastic mat, the HeartStart determined that the model needed one shock and no more. Its almost completely voice-driven interface also recognized when I made the mistake of failing to remove the backing from one of the gel pads, instructed me to do so, and proceeded after I fixed the error. In general, the voice’s authoritative tone and quick pace were effective. For example, as it is about to deliver its electric pulse, it cautions bystanders, “No one should be touching the body.” Even after a successful defibrillation, the HeartStart provides instructions on C.P.R. and even keeps a beat to assist with pumping the heart — kind of a Donkey Konga for the E.M.T. set.
Flashback: Philips HeartStart Home Automated External Defibrillator (AED)
More at Philips…
The notion that women tolerate pain better than men just doesn’t withstand the test of science:
Scientists investigating gender differences in pain have found that not only do women report more pain throughout the course of their lifetime, they also experience it in more bodily areas, more often and for longer duration when compared to men.
There also seem to be differences in how men and women think and feel about their pain. For example, anxiety may affect men and women in different ways, and the strategies used to cope with pain may actually make their experience worse.
These conclusions are based on several studies into the pain response of volunteers exposed to a pain stimulus, such as a cold water bath, as well as field studies in clinics and hospitals.
“Until fairly recently it was controversial to suggest that there were any differences between males and females in the perception and experience of pain, but that is no longer the case,” said Dr Ed Keogh a psychologist from the Pain Management Unit at the University of Bath.
“Research is telling us that women experience a greater number of pain episodes across their lifespan than men, in more bodily areas and with greater frequency…”
“Women who concentrate on the emotional aspects of their pain may actually experience more pain as a result, possibly because the emotions associated with pain are negative.”
To carry out this research, scientists asked volunteers to place their non-dominant arm in a warm water bath (37 degrees centigrade) for two minutes before transferring the hand into an ice water bath maintained at a temperature of 1 – 2 degrees centigrade.
The cold pressor tank allows researchers to monitor the pain threshold (the point at which volunteers first notice the pain) and pain tolerance (the point at which volunteers can no longer stand the pain). An upper time limit of two minutes is used in these kinds of studies.
Other research by the Pain Management Unit has looked at the relationship between gender differences in anxiety sensitivity and pain. Anxiety sensitivity is the tendency to be fearful of anxiety-related sensations (e.g., rapidly beating heat), and seems to be important in the experience of pain sensations. In a study of 150 patients referred to a hospital clinic with chest pain, researchers discovered that the factors that predicted pain in men and women were different.
Researchers believe that it is the fear of anxiety-related sensations and an increased tendency to negatively interpret such sensations, both of which are more predominant in women than men that influences women’s experiences of pain.
On the other hand, men are reported to be in denial.
The press release: Women feel pain more than men, research shows.
More at the BBC…
