Is sci-fi surgery so outrageous?

Suspended animation. Mind control. Operations performed over the internet. Dr Richard Satava, pioneer of ‘outrageous surgery’, believes all this – and much more – will soon be possible

Dr. Satava 

Dr. Satava's Lab

You have 2.5 billion heart beats in a lifetime. Imagine if you could choose how to spend them. Imagine being able to control an artificial limb or even an external machine – a car, perhaps – with your brainImagine a battlefield where a solider, mortally wounded, is given an injection to put him into suspended animation, flown to a hospital thousands of miles away, operated on, and then brought back to life.

Or imagine that same soldier still lying on the battlefield but being operated on by a robot, controlled by a surgeon in another country.

Dr Richard Satava would like to be that surgeon. And if that scenario plays out 20 or 30 years from now, he’d like to take a pill that extends his life so he can still be there. Satava wants to be, as he puts it, a “pioneer of putting all this into practice”. “Outrageous medicine” is the term the 69-year-old professor of surgery at the University of Washington in Seattle has coined to describe all these technologies. But far from being the exclusive domain of science fiction, these scenarios, Satava says, will someday soon become a reality – and some have already arrived.

Satava spent his childhood devouring sci-fi novels by authors such as H G Wells and Edgar Rice Burroughs. In adulthood, he’s set about making the larger-than-life hypotheses within them happen. As a hospital commander during Operation Desert Storm, he wondered how technology could improve care for soldiers on the battlefield. Later, while working at the American government’s Defense Advanced Research Projects Agency (DARPA), which is responsible for developing new technology for use by the military, he helped design the Trauma Pod – an unmanned, mobile operating room which surgeons can control remotely. Satava says the idea for that came from sci-fi writer Robert Heinlein’s 1955 book Starship Troopers, in which “a pod was sent down from the starship to put the wounded soldier in, and the surgeon back at the starship would go ahead and cure him”.

While he was at the agency, he even held a conference every couple of years to ask science fiction writers what they thought health care was going to look like in the future.

You may think all this makes Satava sound a little crazy. In fact, he is taken very seriously. Twice awarded the Smithsonian Laureate in health care, he helped develop the world’s first surgical robot, and served on the White House Office of Science and Technology Policy panel. Today, in addition to his role at the University of Washington, Satava works as an adviser at the American Army Medical Research Command, which earmarks millions of dollars a year to cutting-edge medical technologies.

Satava and his colleagues at the university are working on technologies designed to make us stronger, survive previously unsurvivable illnesses and live longer. In one lab, a biologist has attached electrodes to moths in order to understand how their brains control movement – which they hope will soon help amputees move prosthetic limbs with their brain.

In another, a professor is working on “quantum dots” – microscopic, photosensitive flecks of silicone that could one day be used to “inject” new information into the brain and provide non-invasive treatment for Alzheimer’s, epilepsy and blindness. And it doesn’t end there. As Dr Satava tells me, “We’re only limited by our imagination.”

Our first stop is the office of Mark Roth at the Fred Hutchinson Cancer Research Center. Roth, 50, is probably not your average research scientist. He sports a pair of jeans and new Converse trainers (an old, worn, blue pair lie discarded under his desk), and works in “metabolic flexibility” – the ability of animals to, in effect, turn themselves off like a hibernating bear – and suspended animation.

Two years ago, Roth appeared onstage at TED, the popular Technology, Entertainment and Design conference, to talk about how he and his team had managed to put mice into a state of suspended animation using hydrogen sulphide. Roth proved that H2S, used as a chemical warfare agent during the First World War, regulates the rate at which the cells in the body consume oxygen. By lowering that rate he could put an animal into a kind of forced hibernation. A mouse that had been fully suspended has no heartbeat, but the cells have also stopped dying. After six hours, Roth was able to bring it “back to life”. He says that putting a human into suspended animation could have huge implications for trauma surgery. On the battlefield, for example, a mortally wounded solider could be suspended, flown back to a hospital without suffering any blood loss, operated on, and then brought back from his suspended state.

Trying to get the medical community on board would be challenging, though, Roth admits. He thinks inducing a partially suspended state (“dimming the lights rather than turning them out completely”) would be more acceptable. Roth’s company, Ikaria, has successfully conducted tests on volunteers. Beyond that, he acknowledges that it’s a few years off being licensed for medical use.

Could hydrogen sulphide be used to prolong life? If we were to take it at night, to suspend instead of sleep for example, would we live twice as long? Roth swivels in his chair to face me and grins. “We know that if you take non-human animals and totally suspend them – and by that I mean we stop them from moving at all; no cell divisions, no DNA synthesis, nothing – and we ask ‘did that day spent in suspension count against their life clock?’, the answer is: it does not.”

Hydrogen sulphide smells like rotten eggs, and Roth points out, the first examples of people being overcome by it were in the sewers of London (it’s emitted after organic matter breaks down). But mankind has known about its potentially life-extending properties for a while too. “Why is it that throughout the thousands of years since Hippocrates we have had an affinity to go to the sulphur springs and experience these healthful waters?” Roth asks. “And water from sulphur springs has been bottled and sold for decades.” If, Roth says, we have a certain number of heartbeats in a lifetime, we could in theory use them whenever we choose. “Just have them when the red carpet is there for the Oscars and then wait for the next movie deal, and your career will last for many, many decades.”

That afternoon I have lunch with Richard Satava at the Faculty Club on campus. Sitting at a table next to a wall of glass that overlooks Lake Washington, Satava conjures up future scenarios. Like this one: he’s sitting in an office in Washington operating a surgical robot which is poised to operate on a solider wounded in Afghanistan 6,700 miles away. That soldier has life-threatening injuries and to prevent blood loss or damage to his organs, he is injected with a solution that puts him into a temporary state of suspended animation. He needs an organ transplant, so Satava instructs the computer built into the surgical robot to print one using the soldier’s stem cells. It sounds like one of his sci-fi books. But the surgical robot already exists – Satava wants to show me the latest model – and last year a surgeon at Wake Forest School of Medicine in North Carolina demonstrated the latest advances in “bioprinting” – literally using human cells instead of ink – which in the future they hope will be able to print tissues and organs; no more waiting for a donor.

Satava is interested in how we can artificially extend life, too. One way, he says, is with Resveratrol, a drug scientists are experimenting with that has been shown to increase the lifespan of small animals by one-and-a-half to two times. A study by the National Institute on Ageing found obese mice that received the drug lived 44 per cent longer than obese mice that did not – it is now undergoing human trials.

Another way, he says, is finding a switch to turn off apoptosis or cell death. “If we block the enzyme from working, the telomere (molecules at the end of a chromosome) stays whole, continues to reproduce and lives longer,” he says.

Forgetting the practical implications of us all living to 150, Satava posits another question: imagine the leaps we can make as a species if we did. In the early 1900s, for example, life expectancy was 30, so inventors, artists, scientists and engineers reached their peak in their twenties. Today, those same people are at their prime in their forties and fifties. But imagine, Satava says, if they were able to carry on inventing and discovering for another 30 or 40 years.

It echoes something Mark Roth told me earlier: the Renaissance, he said, may have been a direct result of the development of reading glasses, which enabled “older people to participate in a way that they couldn’t before because their eyes were not working properly”.

At the biorobotics lab, professor Howard Chizeck and PhD student Fredrik Ryden are about to demonstrate Raven, the latest surgical robot which they hope will one day facilitate remote operations like the ones Satava had talked about. Currently, hospitals across America are using a robot called DaVinci for some prostate surgery and sometimes to repair heart valves and for gynaecological procedures. But DaVinci robots are usually controlled by a surgeon sitting at a console in the same operating theatre.

Satava sits at the console on the other side of the room and, wearing 3D glasses, demonstrates how he can control Raven’s robot arms to pick up and put down small objects. Ryden is working on a project known as “haptic feedback and touch” so that when surgeons operate remotely, they’ll be able to feel like they are pressing down on an organ with a scalpel, when in fact they’re pressing down on thin air with a joystick.

Ryden lets me take the controls and I move the “scalpel” over a real image of a pig’s heart. I can feel it beating as I push down on the control – it’s unnerving. Chizeck says they’re also working on creating “no fly zones” around certain anatomical structures that a surgeon doesn’t want to touch. “Or we can make surfaces to guide the surgeon’s tools – a pathway that’s easy to follow.

“And,” Chizeck says, “why does the surgeon need to be in the same room as the patient? If you’re five hours by aircraft from somebody, the patient could be stabilised by paramedics and the surgeon could dial in and do the tricky parts of the operation remotely over a high-speed internet connection.” They even tested this theory out last year in California’s Mojave desert. A surgeon in Washington manipulated some little pegs on a mannequin, and because there was no internet connection in the middle of the desert, they used a transponder on an unmanned aerial vehicle hovering overhead. It could, Chizeck points out, be really useful in the aftermath of an earthquake or tsunami where it’s impossible for surgeons to get on the ground. “And we could be doing those operations around the clock if we wanted, without having to worry about time zones and without even having to scrub up between patients.”

What makes this even more incredible is how relatively close to operational it all is. Satava says this has huge implications for soldiers on the battlefield – soldiers who in future may no longer die from their wounds in the theatres of war. Perhaps, then, it’s not so outrageous after all.