A medical breakthrough brings 'Star Wars' technology to remote hospitals

HAMILTON, Ontario -- Mehran Anvari first discovered his love for surgery in high school while dissecting frogs and other small animals.

"I was pretty good in dissection class, and I felt this was something I really enjoyed," said the 43-year-old Canadian physician. "I remember we did dogfish, we did frogs, we did rats."

Dr. Anvari has come a long way from carving up specimens preserved in formaldehyde. The founder and director of the Center for Minimal Access Surgery (CMAS) at McMaster University here, he is among the world's leading practitioners of laparoscopic surgery.

"The layman's term is 'keyhole' surgery," said Dr. Anvari, describing a process where the surgeon operates through a small incision via a long slender tube (usually equipped with miniature video camera) that allows him to see and work inside the body.

The technique is important because such "minimally invasive" surgery causes less trauma to the patient, allowing faster healing and lowering the probability of post-operative infection.

Recently, Dr. Anvari broke new ground when he used a specially configured laparoscopic robot, which measured and then precisely transmitted the movements of his hands and fingers, to operate on a patient some 400 kilometers away, in North Bay, Ontario.

Performed on 28 February 2003, it was the world's first hospital-to-hospital operation of this kind.

"It is a tremendously exciting thing he has done," said Dr. William Orovan, chair of the department of surgery at McMaster. "It has huge applications in a country like Canada, which has a small population scattered over a wide area. It brings first-rate surgical care to remote communities."

A science fiction dream, the development of such "telerobotic" surgery has been long talked about for use in outer space and at remote research outposts. And Dr. Anvari and others believe it has great potential not only in Canada but also in the developing world.

Dr. Anvari, however, views his work as much more than simply developing a high technology platform for doing delicate operations at a distance.

In related endeavors to develop and promote "telementoring" -- in which he "looks over the shoulder" of another surgeon via video relay and guides him or her by voice -- Dr. Anvari has demonstrated a strong desire to serve the whole of humankind -- an impulse that stems from his practice of the Bahá'í Faith.

Though founded just four years ago, CMAS has become a hub for training in minimally invasive surgical techniques. More than 500 doctors have received training at CMAS -- and at least 50 have been from outside Canada, coming from countries as far away as India, China, and Russia.

"The Bahá'í ideals have given me very much clarity about the fact that we live in a world that is very connected, and I believe it is important to look not only at what you can do to help yourself, but at what you can do to help others," said Dr. Anvari.

Dr. Anvari spends considerable time -- often without the prospect of remuneration -- showing other surgeons how to do minimally invasive surgery, sometimes in person and sometimes via telementoring.

"It is the global outlook, given to me by the Faith, that has stirred me to do this kind of work," he said.

His activities as a Bahá'í are also responsible, at least in part, for his interest in telerobotics. Until last year, he served on a Bahá'í committee in Canada that was charged with spreading the Bahá'í teachings to all parts of the country, something that often took him as far as the Arctic Circle.

"Because of my Bahá'í activities, I had a chance to travel to many parts of Canada -- and around the world -- and I saw the need across the country, and globally, for improved surgery and health care," said Dr. Anvari.

"Ideas don't develop in isolation," Dr. Anvari added. "I suppose if I was not made aware of those needs, if I did not aim to help people, I may not have pursued the whole idea of looking at telerobotics."

Born in Iran, Dr. Anvari was raised in a family where both parents were involved in the medical profession. "My mother is a pharmacist and my father is a specialist in laboratory medicine," he said, adding that he had always been interested in medicine and patient care. "But I found I enjoyed working with my hands, and so I specialized in surgery."

Both parents are also Bahá'ís, and in the mid-1970s they saw that Bahá'ís in Iran were increasingly becoming the targets of religious persecution. They sent Dr. Anvari and his brother to England for secondary school and, then, just before the Iranian revolution in 1979, left Iran themselves.

Dr. Anvari went on to medical school in England, did his surgical residency in Canada at McMaster, obtained a PhD in Australia, and then returned to McMaster, where he is now a Professor of Surgery.

His work in telerobotics is not so much a matter of inventing new equipment, but rather of creating an integrated system from current medical technologies.

For some time, for example, surgeons have used tiny video cameras to guide their instruments in the body. Specialized robots, also, have been devised to give added precision and stability to such work.

Dr. Anvari's breakthrough came about by combining advances in information technology with laparoscopic robotics, enabling him to do delicate surgery at a distance.

"The new thing is the way we have configured the robots to use day-to-day telecommunications, in a system where this can be done as a regular clinical service," said Dr. Anvari. "All I did was to think about a way to put things together, things that exist in other health care settings."

Specifically, Dr. Anvari used a "surgical system" called ZEUS, developed by a company in California, Computer Motion. The ZEUS robot was connected and supported by Bell Canada's Virtual Private Network Service to the robotic 'arms' in North Bay General Hospital's operating room.

Dr. Anvari's hand, wrist, and finger movements were translated from the ZEUS console, with a delay of no longer than 150 milliseconds, to control the endoscopic camera and the surgical instruments in the abdomen of the patient in North Bay.

At the patient's side in North Bay, a local surgeon, Craig McKinley, positioned the robotically controlled instruments and assisted in the surgery.

"With the challenge of attracting specialized surgeons to Canada's northern communities, this technology allows us to provide necessary services close to home and family," said Dr. McKinley.

The operation was widely reported. Articles about it were carried in the Toronto Star, the National Post, the Globe and Mail, and the Toronto Sun. As well, TIME Canada, CBC Radio and TV, CTV, and Global have reported on Dr. Anvari's research efforts.

A map of Canada explains the significance of the story. With a land area of nearly 10 million square kilometers, Canada is the second largest country in the world. Some 85 percent of the population lives within 300 kilometers of the southern border, but about one-third of the population lives in rural areas.

The rural population is often widely scattered, making it difficult to attract and support medical specialists, especially those with experience in complex surgical techniques.

"The number of specialists is very low in rural Canada," said Lee Teperman, administrator of the Society of Rural Physicians of Canada. "In many cases, it means you must transport patients a long distance."

Dr. Anvari said that while the machines used in telerobotics currently cost up to US$1 million, the price is likely to come down to about US$250,000 soon -- making it quite affordable for rural medical centers in Canada.

He believes further decreases in price and improvements in telecommunications will make telerobotics and telementoring important in the developing world.

"The robotic surgery attracts a lot of attention because it is new and very 'Star Wars'-ish," said Dr. Anvari. "But a very important and critical aspect of our work is focused on establishing new centers in other countries, in training other surgeons, and in providing mentoring and telementoring."

Dr. Anvari said CMAS is currently exploring setting up collaborative programs with medical centers in Haiti, Yemen, and Uganda. "We have learned a number of things here that can help improve the quality of health in many countries."