The cardiac surgeon wipes his brow, squirts a couple of eye drops, turns off his computer and throws the switch on his robot — another bypass surgery is complete. Within four hours the patient will be visiting with friends and relatives in the waiting room.

Robotic assisted surgery is a “here and now” leading-edge technology that should realize widespread deployment in the foreseeable future. The U.S. Food and Drug Administration recently approved computer-controlled robotic surgery for gall bladder, abdominal, prostate, colorectal and esophageal procedures representing 3.5 million surgical incidents per year. The MIT Technology Review and Scientific American magazines in recent months featured stories on robotic surgery.

Cardiac surgery is not without risks. The likelihood of death after surgery increases from a 1.1 percent chance between the ages of 20-50 to 7.2 percent between ages 81-90. One-third of all heart surgery patients experience some complication. Of the patients beyond age 65, 4 percent died in the hospital, 4 percent were discharged to a nursing home, and 10 percent spent more than two weeks recovering in the hospital. Memory loss, physical weakness and depression often delay recovery for months.

Robotic surgery offers significant benefits to patients and surgeons. Robotic bypass surgery patients are returning home the day following surgery. That can represent a significant cost savings when you consider the standard hospital stay for a heart patient is at least a week at $1,400 per day. Since the procedure is minimally invasive, a greater number of high-risk patients can be treated with reduced trauma. In the case of cardiac patients, it means the surgeon will not “crack open” the patient’s chest cavity nor place the patient on a heart-lung machine, which offers its own set of risks. In 1994, fewer than one in 100 heart operations was performed without heart-lung machines. This year the number is expected to be 15 percent with a 50 percent rate projected by 2005.

Physicians are pleased with the technology. They report the robotic systems are more accurate due to the “virtual steadiness” of the robotic hands, and since it requires no standing over the patient for hours, robotic surgery is less stressful and fatiguing for attending surgeons. As a result, the surgery team is better prepared to successfully deal with emergency medical situations.

Two California companies, Intuitive Surgical and Computer Motion, have robotic systems on FDA fast-track approval for cardiac procedures. They expect commercial approval this year. Operating room economics will ultimately determine how widely the technology will be deployed. The $750,000 robots must demonstrate not only superior or equal physical outcomes but also increased profit margins. Hospitals have about the same profit margin as grocery stores — 2.5 percent — and heart surgeries represent their biggest moneymaker, with more than 400,000 procedures per year at $25,000 to $40,000 each.

The robotic systems consist of a computer-mediated surgical workstation with a high-quality video display and hand-input devices, a wired network to communicate the surgeon’s gestures, and a cart bearing the robotic arms. In addition to a 3-D operating environment, the system offers some force feedback to give the surgeon a sense or feel of working with tissue and sutures.

Currently, the surgeon and robotic device are in the same room, but in theory they could be time zones apart.

However, significant distance makes a difference due to a disorienting lag time between the surgeon’s hand movement and the actions of the robot. Thirty miles of wireless transmission and 200 miles of cable connection appear to be the operating limits. Increased broadband will eventually accelerate telesurgery and stimulate structural changes in the medical industry as patients access world-class surgical specialists around the world. The next enhancement of robotic surgery could be voice recognition software that allows the physician to verbally instruct the robot through some of the basic movements.