Are high-tech alternatives to surgery better?

Robert Bazell Chief science and health correspondent • Profile • E-mail

As part of the NBC News weeklong series on the "Future of Medicine," NBC chief science correspondent Robert Bazell explores how technological advances in computers and three-dimensional imaging are providing new alternatives to surgery. Training on robotic simulators promises to make doctors better at what they do while fiber optics help some patients benefit from less invasive operations. Deep brain stimulation is allowing some patients with Parkinson’s or other paralyzing diseases live normal lives.

Yet no matter technological progress doesn’t always mean people are healthier, as scientists in the 21st century scramble to stay a step ahead of drug-resistant, flesh-eating bacteria.

Q. Medical simulators, or realistic robotic dummies, are increasingly being used at medical schools to train students. What are they and how do they make a doctor better?  

A. Simulator technology has really advanced in the last few years to the point where its become very much a part of training in many places for medical students. Traditional medical training has been done on a live patient, but there’s always that frightening moment when you do something for the first time.

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Robotic dummies look like department store mannequins. Their jaws can move; their tongues can swell; their breathing feels more rapid and you can feel their pulse. You can bring them back to life with electric paddles. You realize that it’s a dummy, but they can respond in ways far beyond being a dummy.

They have a heart beat and they respond to drugs and medications. People speaking into microphones can have them complain of pains or moan or all sorts of other things. You could have different scenarios where the robot's breathing tube gets blocked.

How many times do you get to see a gunshot wound unless you work in a very busy emergency room in a high crime area? With a simulator you can learn to practice and encounter it.

All those things can be programmed into the computer so you can train for every situation.

It’s not just for physicians and nurses, a lot of training is being done for paramedics and other people who have medical skills that are needed in an emergency. They cost about a quarter of million dollars to a million dollars each depending on how many bells and whistles there are.

Simulators have become a teaching tool for the teamwork needed in the operating room to help avoid medical errors.

It’s a way to practice, practice, practice.

Q. Should they be used to retrain older doctors?

A. The big question is whether these will be used for older doctors who have been out of medical school for a while to test their competency in the way that airline pilots are tested in flight simulators. The concept of medical re-certification is going to become more controversial, but it’s going to happen. It’s very frightening for older doctors to have someone watch them do what they’re doing. But it is the wave of the future.

Q. How are brain science and medical technology coming together to treat disorders once considered untreatable?

A. There’s a technology called deep brain stimulation where electrodes are implanted in the brain to stimulate areas that are affected by movement.

There’s a case of a woman with a movement disorder called dystonia, which gives an extreme stiff neck, almost paralysis. We originally followed her through a treatment of Botox, which can relax muscles. But it wore off. We then followed her through deep brain stimulation. And, for now, she’s doing much better. She couldn’t even eat before and now she goes to the pizza parlor and back to a normal life.

It’s been dramatically successful for some people with Parkinson’s disease. The electrodes have to be precisely positioned and the patient is awake during the surgery. And there’s a long period of adjustment to getting used to the battery pack that’s implanted just under the skin. It doesn’t work for everyone.

Q. What other disorders could be treated with brain implants?

A. There is a lot of thought about using it for other things, including depression. It’s not clear how much it’s going to work or what the potential is. It goes back to lobotomies and electroshock. There have been a lot of crude attempts to implant things in the brain. This electrode implantation has the specificity that you can stimulate very precise areas of the brain. The more you know precisely what each part of the brain does, the more you can possibly stimulate it in this manner.

Q. What are the dangers?

A. Anytime you’re going into the human brain you have potential to do damage. If you’re off by a millimeter you can destroy something precious in the brain, so you have to put the electrodes in exactly the right way.

We’re understanding more about brain science and with this ability to position things in the brain, there’s a way of creating a three-dimensional space that’s almost like a GPS system. The imaging is so good that doctors know within a millimeter where everything is all the time.

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