Tenaculum and Human Ingenuity
The human hand is versatile and nuanced for some jobs, while being clunky and all but useless for other jobs. Fortunately the human brain makes up for these short comings and allowed us to create tools. On such tool is the tenaculum. The tenaculum is a surgical tool that resembles a pair of scissors, but functions more as a pair of forceps. but functions more as a pair of forceps. It consists of two small thin hooks and handles which are used to hold small parts of the body, like arteries, in place. Though consistent in those regards, Tenaculum actually come in many different shapes and sizes to handle a wide variety of jobs. As tenaculum are not single use and can be sterilized for multiple patients, the price point can vary somewhat based on size, material, design or even color. When purchasing tenaculum; as seen at CIA Medical be prepared to spend anywhere from $20 to $2,500 apiece with the smaller, more specialized versions reaching the higher prices. As expensive as that may seem, tenacula are a vital part of the surgical inventory.
A New Age Of Tenaculum
Tenaculum are just one in a long line of tools created to do jobs the human hand is too clumsy to accomplish. In relatively recent years, instruments have become so small and precise that they are too small even for the hand and other tools must be created to hold them. It has gotten to the point that for some surgeries the physician doesn’t even need to be in the room. Commonly called remote surgery, telesurgery works through the use of robotics and state of the art communication technology. In a situation where losing a signal can mean life or death, the connection must be as close to perfect as possible. In 2001 a surgery was completed remotely from an ocean away with the surgeon, Dr. Jacques Marescaux in New York and the patient in France over 6 thousand miles away.
This operation was performed using the ZEUS surgical system. The ZEUS system was created in and first demonstrated in 1995. In 1998 it was tested on animals and by 2001 it had gained FDA approval. The system is controlled much like a highly advanced video game or simulator with an immersive screen to both provide the best possible visuals, as well as block out unwanted distractions. The system is smart enough to disregard tremors in the hand of the surgeon in order to insure only deliberate motions are carried out on the patient. Because the surgeon is able to sit down, as the level of the station is somewhat irrelevant, the actual fatigue of hours of surgery is considerably curtailed. ZEUS was priced at around $975,000.
The ZEUS system was succeeded by the Da Vinci system of a similar design. Priced at $1,000,000, the Da Vinci eventually made the ZEUS obsolete as it could handle surgeries that the ZEUS couldn’t. While the ZEUS was revolutionary for minimally invasive operations, the Da Vinci can handle radical procedures including prostatectomy and endoscopic arterial septal defect closures.
Robots
It isn’t all sunshine and rainbows for robot assisted surgery however. At pretty much every turn it is far more expensive than traditional operations. From the system itself, to the disposable instruments the estimated additional cost is around $2,000 per patient. Additionally, as the systems are products first and foremost, their designs and settings are proprietary, meaning they cannot be adjusted to fit a particular surgeon’s style or preferences. Before even getting to that point, additional training is required to operate the machines. In a pinch only a doctor previously trained to use the system can actually preform a surgery. This training is not brief either. The average learning curve is about 15 minimally invasive procedures. These learning phase procedures often take double the time they would traditionally, increasing the time of anesthetization. Many patients report being dissatisfied with the results.
It’s not all bad though. After the learning curve many patients end up with shorter stays and quicker recovery times. Another benefit of the console is that surgeons can rotate in and out relatively seamlessly in order to negate fatigue entirely.
The Cutting Edge
The next step being researched now is to miniaturize the robotics themselves. Both the Da Vinci and the ZEUS before it are large, somewhat terrifying robots (depending on perspective). The University of Nebraska Medical Center is one of the institutions leading the way in researching the miniaturization process. It is hoped that it will improve accuracy while making the procedures more reasonably priced, though the latter is unlikely to occur.
Beyond the Cutting Edge
In science fiction the next step would be the repair of the body through nanomachines. Tiny autonomous robots programmed to work in concert to not only mend wounds but even replace tissue. Modern science is still a long ways away from this kind of technology, and the practical application of it is questionable at best even if it wasn’t. That doesn’t mean intrepid scientists aren’t still researching to get us closer to the day that it isn’t quite so farfetched. Should nanomachines become a reality in the world of medicine the possibilities are nearly endless. It is theorized that nanomachines could lead to incision-less surgeries. (http://www.nanowerk.com/nanotechnology-news/newsid=40854.php) Beyond that, nanobots could conceivably be programmed to attack cancer cells, making radiation therapy no longer necessary. However, we are light-years away from even the most realistic projections. It must also be considered, what would happen to the medical field should these technological marvels actually be achieved. Surgeons would essentially become obsolete and that’s not even getting into the moral and societal ramifications
How Far We've Come
The ability to innovate and create things beyond ourselves is why the human race has flourished the way it has. We’ve gone from spears and wheels to tenacula and robots. It will be thrilling to see what the future holds. As is often the case, medical science will likely lead the way. Who knows, the next time you go under the knife, it might not be a human holding it.
