Miniaturized TV cameras voyaging deep into the body revealing sources of pain. Surgery requiring no stitches. Robot arms, powerful as video game warriors, repairing dying hearts. lnfrared wands targeting a cancerous mass of fast-growing tumors. lnnovations today only beginning to reveal the promise of tomorrow. Next on Operating ln The Future. Even in the hands of the best doctors, the body takes a beating during traditional surgery. But as we turn the corner into the new century, surgeons are revolutionizing the ways they operate. They're making smaller incisions, using computers and cameras to illuminate anatomy's secrets, and practicing surgery via remote stations from across the room or across the world. This prescription mixes raw high tech, healthy measures of knowledge and vision and a large dose of compassion. Because medicine always comes back to helping a person. A person with a problem. A person like Cliff Boag. lt's always there. 95 percent of the time, it's there. Cliff is a 40-year-old father of three. For the last five years, he's lived with a stabbing, stubborn pain in his groin. Mysterious from the beginning, the pain overshadows Cliff's life.

We have three children, you know, we have a life ahead of us. We can't let this, you can't live on pain medication. The pain, caused by simple activities like walking, lifting a child, or sitting too long, is most severe on the lower left side, just below the belt. Desperate for help, Cliff saw an assortment of specialists. Most had no answers. One suggested exploratory surgery for a hernia. But even after doctors opened him up, found a hernia, and fixed it, the pain didn't leave. Finally, Cliff was referred to Doctor James Rosser, otherwise known as Butch, or ''The Big Boss.'' A doctor with a new idea. He put me at ease, you know, more than any other doctor l've ever met. But he said ''Don't worry, you know, this thing can run but it can't hide. We'll get in there and set this thing off and figure it out.'' l heard that he was a wizard.

You know, his hands don't look like they would do the job. They're just too big. People look at me, they wonder, you know, how this guy, especially a big old guy like me with ham hocks for hands, how does this guy do those delicate things? How does he do it? Butch Rosser is totally at home inside the human body and knows its anatomy inside and out. He has another advantage. He's applied his love for radio controlled airplanes to his surgical technique. Flying these airplanes calls for extraordinary two-handed hand-eye coordination, a skill needed by a surgeon with one foot in the future. Butch's vision of the future was inspired by another love, science fiction. lt all started with the television shows of his childhood. The two shows that inspired me the most were Star Trek and The Jetsons.

And l think, just like a lot of people that were touched in interesting ways by that show, we want to accelerate the future. Hermes? Talk to me, goose. Butch doesn't have a Star Trek tricorder yet, or a C-3PO, but he does have a trusty sidekick named Hermes. Hermes is a voice-activated, computer-driven surgical assistant. Awry. Hermes, insufflator. Doctor Rosser takes Hermes for a test flight before Cliff's surgery. Hermes helps control the CO2 doctors will use to inflate or insufflate Cliff's belly, creating room for the camera and instruments. Hermes helps with the camera shots, zooming in for close ups, adjusting light, and rolling tape for the surgical staff. So l bring in the probe, and... Though trained in traditional surgery, Butch was an early proponent of laparoscopic techniques, operating through small tubes while using a tiny camera for viewing inside the body.

So we're going to use our miniaturized instruments to be able to go in while he's awake and let him help me find out what's going on. lt's like Jerry Maguire. Help me help you. Oh, l can't wait. l can't wait for him to be able to come home and say ''You know what? l don't feel this pain. You know, l feel normal again.'' While Kelly looks forward to Cliff's recovery, Butch and the team prepare for surgery, and Cliff waits. l'm nervous. Talked to the anesthesiologist and l got the lowdown. And it's not going to be fun for me. That's because it's going to hurt. lt's all part of pain mapping, a new approach developed by Doctor Rosser and his copilot for the day, Doctor Lloyd Saberski, a neurosurgeon. Saberski had the idea of tracking down pain by viewing nerves inside the patient's body while he or she is awake. The doctors will be making incisions smaller than Cliff's thumbnails, sticking long instruments into his belly, and directly touching the nerve.

Their mission is to fire up the pain and identify the nerve causing it. Cliff's mission is to tell them when they've hit the nerve. Then, they'll put him under and freeze the nerve and quiet it. Cliff should remain pain-free for several months. This is a different technique. So we can take the patient on a fantastic voyage and through their abdomen and they can help us. And we're going to try to look at those nerves. Before making the first incision, Butch numbs the area with local anesthesia. But remember, Cliff is fully conscious, just slightly sedated to make him more comfortable and calm. Okay, let's have a little knife. Do you feel this, my friend, at all? l don't feel anything. Oh, you don't feel anything. Okay. Now, the one thing, traditional laparoscopy involves a scope that's about a half-inch.

This is two millimeters. So you only need a little bitty cut here. Just a little one. That's it. That's it. Now, let's see our scope. Because this scope, and l need to check it, look how small this scope is, and it's very fragile. lt's time to engage Hermes. Hermes, Awry. lnsufflator. Hermes starts to work, inflating Cliff's stomach. Down. Down. Hermes, light source. Activate. Activated. Okay, we're on the fantastic voyage. We're going through the tunnel now. All right, we're open and free. All right, this is looking good. Brighter. Hermes. Light source. Light source. Brighter. Brighter. Brighter. Brighter. Okay, hang in there. l have to find a safe place to land. Are you with me, Mister Boag? Okay, look at there. That is the inguinal region. That is our target. We got a great view. Okay, here we go. Here, we're going to go. Tell me when you feel that pain.

The doctors couldn't do this without Cliff. No, down. None of that's hurting you? Well, it hurts, but l'm... But is it the pain? That's what l need. ls it the pain? Am l reproducing your pain? They work against the clock. Several minutes later, with Cliff's help, the surgeons believes they've found the source of Cliff's pain... How are things right now, Phil? lt's a sharp pain. Yeah? You're having a sharp pain? Yes, right there. they can't see without the help of a television monitor. Let's go ahead and put him to sleep, okay? Once Cliff is under, the doctors are ready for the next step in the process, the temporary freezing of the genital branch of the femoral nerve. Rosser works gingerly. Surgeons call this area of the body ''the triangle of doom.'' One wrong move can lead to impotence or paralysis of Cliff's legs. Using another probe, Doctor Saberski will freeze the troublesome nerve with liquid carbon dioxide. The frozen nerve will revive in a few months.

But if pain returns, Doctor Rosser, hoping for a permanent solution, will clip the nerve. Now, look at that. That's that nerve. The pointer is right on the nerve. Right on the nerve. That's our target. l'm convinced that's the genital branch. All right, zoom in, please. Okay, engage. Put him in the center, please. And see this ice ball forming? We're going to freeze that nerve. Now he's withdrawing the probe. She's following him out. The lower probe is out. All right. No bleeding. All right, big guy. lt's time to go home. Even Hermes has something to say. Hermes, controls. Compliment. You are such a great surgeon. You are such a great OR staff. All right, bravo! We're out of here. Smaller is the key to the future. Hey, you did great, big guy. You were great! Okay? l don't remember. You don't remember, that's great. Let's see how he's doing.

How you doing, big guy? Thank you. l feel good. You were, can l give you a little hug? You know, he... We heard you were a hugger. He was great, though. He's only been out like 45 minutes. You can't even see the incisions. And no stitches. Real teeny tiny, no stitches? Yeah, because this is a modern day miracle. Cliff is on his way home. Pain mapping, the procedure doctors Rosser and Saberski use to uncover the source of Cliff Boag's pain, is only possible because of advances in minimally invasive techniques and tools. But even though minimally invasive surgery is becoming more mainstream, not every doctor finds the new tools easy to use. l think the guys and women that grew up with the Nintendo games are much better at this than guys my age. When Joseph Hahn became a surgeon in the 70's, it was a different era.

He was trained to make big incisions, incisions that not only allowed him to see what he was fixing, but to get his hands on it, too. And so, if you were having a liver operation, for example, or a colon operation, you would have in incision that literally would start from your breastbone and go all the way down to your pelvic bone. But Hahn wondered if such large incisions were always necessary. Seeing the trauma people went through, the complications that occur, the sort of massive incisions that were going on, it seemed to make just a lot of sense to me to try and minimize trauma. He wasn't alone. Today, scopes, the basic tool of minimally invasive surgery, are used routinely everywhere in the body. The reproductive system, the abdomen, the joints, the chest, even the ducts inside the breasts. Though they have different names, each is about the same. Hollow rods called canulas are inserted into small incisions. The rods provide pathways for both miniature television cameras used by surgeons to look inside and for instruments used to make repairs. Eyes on, not hands on. Here at the Cleveland Clinic, Hahn is a major advocate for new, improved surgical techniques.

The surgeons who work under him are on the leading edge of the learning curve as they develop new procedures. They're even using scopes to remove major organs of the body. Doctor lnderbir Gill, a colleague of Doctor Hahn's, is a kidney specialist and an expert on minimally invasive technique. Well, you put the laparoscope in there and all of a sudden, those little things that, you know, were just swept out of the way, now are real entities. Doctors perform between nine and 10,000 kidney transplants a year, using live donors for about 4,000 of them. Traditional harvesting requires a large incision and is very invasive for the donor. Doctor Gill is perfecting a significantly less invasive method for harvesting kidneys. Using this innovative approach, Doctor Gill locates the kidney with a laparoscope. Next, he separates the kidney from the body. He makes the final incision, the one he'll use to remove the kidney, as small as possible in this case, it still has to be large enough to fit his hand.

This little incision is truly within the bikini area, and we are not going to be cutting any muscle whatsoever. This creates the potential for the healthy donor to have a quick and easy recovery. Today, this technique is offered at four or five centers in the United States, including the Cleveland Clinic. Tomorrow, as doctors receive the appropriate training, the procedure should become widely available. The reason we are doing this is laparoscopy affords us unmatched visualization. lt's hard for people to understand this, that you can obviously see better with your two eyes than with a little laparoscope. l think the converse is true. The magnification and the visualization that the laparoscope gives us in unparalleled. ln the future, what is now minimal will become miniature. A forerunner of this new generation of even smaller devices is an instrument being tested by a breast surgeon, and another member of Doctor Hahn's team, Doctor Jill Dietz. This is the camera that goes to the ductoscope. 21st Century breakthroughs won't be limited to operating rooms or biomedical laboratories. The scope Dietz is using was born in Hollywood.

A group of movie producers created a miniature camera to look inside very small places. With the help of Doctor Dietz, they're developing an even smaller model called the ductoscope, to diagnose breast disease, particularly breast cancer. lt's a 1 .2-millimeter scope, smaller than, say, uncooked spaghetti noodles. Until now, no one has ever been able to see inside the breast this clearly. While still experimental, this procedure recently received FDA approval, and Doctor Dietz is the first surgeon anywhere to use it. Going to get your vital signs and... Julie Willett, a nurse at the Cleveland Clinic, agreed to be part of the scope's trial. l thought it would help benefit patients down the road and help fight cancer. And another reason, because l thought it would be a less invasive kind of a procedure for me. There'd be less cutting involved, because they have this little scope with a little camera at the end of it, and she could go in and clearly see the mass and take it out. So l saw it as a winning type situation for me. ln 1996, one out of every nine women got breast cancer. And the risk keeps on increasing.

The scope creates the potential to spot cancer early enough to save lives. We've entered the milk duct. And you can see the light that comes from the end of the camera shining through the skin, deep within the breast. A light that illuminates the minute camera, allowing Dietz clear vision, a window into the interior of the breast. Women that are at high risk for breast cancer, currently there is no good screening method that'll catch breast cancer when it's extremely early. lt's not a cure for cancer, but it certainly is going to help diagnose cancer, and also help fight cancer in the early stages. ln my situation, mine was non-cancerous, but she was able to take the mass out, whereas if it had been left in there, who knows what could have happened down the road. Dietz hopes the scope will add to the arsenal of effective screening tools doctors use to fight against breast cancer. She's inspired by the rapid advances of the 21st Century.

Again, it's just taking us to giving people the best treatment they have with a less amount of surgery, a less amount of complications, a less amount, you know, less pain, less recovery time. So it's an exciting time right now. Using smaller scopes and operating in tighter spaces inside the body requires steady hands, hands as steady as a robot's. Again, the sort of concept of the OR of the future is there would be some robotic devices. And we're also looking at doing this for heart bypass surgery, where you'd sew the coronary arteries to the heart arteries using the robotic arm. The operating room of the future, where robotic arms are used to repair damaged hearts, is becoming a reality. This futuristic OR is manned by a 34-year-old, soccer-playing surgeon, Volkmar Falk, and his visionary mentor, professor Friedrich Mohr.

They live in Leipzig, Germany, where soccer, not heart surgery, is the usual focus. And they work at this ultramodern medical center, the Leipzig Herzzentrum, dedicated exclusively to taking care of the heart. This state-of-the-art operating suite is where many of their ground-breaking minimally invasive heart surgeries take place. Surgeons around the world repair almost a million diseased hearts a year. Until now, open heart surgery usually required cracking open the sternum and prying open the chest. But in Leipzig, doctors are able to operate through three small incisions, each about the size of a dime. The whole heart center is very high tech. Nevertheless, we felt our limits, especially in endoscopic surgery. We felt that there is a limitation, we can't do very precise coronary work endoscopically, and so we thought, about two years ago, how can we overcome that? Professor Mohr made medical history last year, by overcoming those limits and performing the world's first totally videoscopic mitral valve repair.

He used this American-made robot-like system. Actually, it's not a robot, though it looks like it was made for the bridge of the Starship Enterprise. lt's really a tele-manipulation system. As the surgeon sits at a console, he guides robot-like arms attached to tiny, computer-enhanced mechanical wrists. The wrists reach deep inside the patient. There's one small catch. The console and the surgeon are not in the operating room. Psychology, it's something completely new, because you're no longer at the table, and so as a surgeon, you used to be sterile and to be able for immediate action. Now, you're at the remote location, so you're six meters away from patient, and that changes a lot, in terms of your attitude. The procedure is still being perfected, but it's a risk patients like Dieter Schaller are willing to take.

The former race car driver knows that his surgeon, Volkmar Falk, has logged more surgeries using this system than anyone in the world. He also understands how traumatic traditional open heart surgery can be. So he says that he thought about it quite a bit and then he came to the decision that a smaller hole in the body, basically, would mean that the healing process goes faster, and that made up his final decision to choose the less traumatic approach. Mister Schaller realizes the minimally invasive surgery has additional risks. Doctors must stop his heart and place him on a heart-lung machine for hours. All he has to say is that he hopes tomorrow is a great day, for both him and the team and that his health is well after surgery. His surgery will take approximately four hours, more than double the time of a traditional approach. lt will require some of the most sophisticated operating tools ever created, tools still classified as experimental. We're going to see a bypass procedure today, a total endoscopic bypass procedure.

And we will take down the left internal mammary artery, and that's the artery that runs along the sternum, and that will be used as a graft. And we will graft the left interior descending artery, which is the main coronary artery, to the left heart. Mister Schaller is a candidate for this surgery because he has only one blocked artery. For now, if more vessels needed repair, his doctors couldn't use this system. Though Volkmar operates from another room, there is still a full surgical team in the OR, including another skillful surgeon. But unlike open chest heart surgery, only Volkmar can hold and move the instruments inside Mister Schaller's body. Dependent on the robotic arms, he's still one hand short. A lot of steps you usually wouldn't think about in surgery require that an assistant hold something. lt's like a mountain climber.

You need three points of fixation, usually, to not fall down. And the same is true in surgery. lf you hold soft tissue with three fixation points, then you can do an easy stitch. Here, we have only two hands, so l basically have one hand to hold something, one hand to do the stitch. And you will see later that this is more difficult, so you have to find ways to circumvent this problem. The surgeon inside the OR, Doctor Anno Diegeler, makes the incisions, or ports, and inserts the canulas, or hollow tubes, to hold the specialized instruments, including a tiny 3-D camera. Volkmar's view through the goggles is magnified ten times. Unlike two-dimensional endoscopes, it provides dazzling high resolution three-dimensional pictures. lt's a cross between working in virtual reality and operating under a microscope. You can see that the artery is covered by fat tissue and also by muscle bundles that go across, which makes takedown a little difficult because you can't see it really and you have to first dig it out.

When you sit at the console, you're almost totally immersed. l mean, you're inside that cavity, basically. You don't have the feeling that there is any distance between you and what you're seeing. lt's actually right there. lnside the console, his hands guide the instrument handles. As he works, his motions are translated to the robotic arms and tiny instruments inside Mr. Schaller's body. Precision is critical in such a potentially dangerous operation. Making the slightest slip is not an option. So even if Volkmar has an extra cup of coffee, the system makes adjustments. As you can see, the system is not shaking. Even if l would be shaky, the system wouldn't transmit those fast motions. And actually, that's a very helpful tool, because if you watch conventional endoscopy, you have a one-to-one transmission of all motions, including tremor. And if you have a long shaft on the instrument, this will even amplify the tremor. Volkmar can also move the camera with handles. Pressing a foot pedal, he engages the camera while the instrument tips stay in place. Like a race car driver, he must coordinate hand and foot movements to maneuver a demanding course.

Okay. So l can look around, and basically, it's driven like the wheel of a car, which is very intuitive, by the way. Much more convenient than voice control. Don't be fooled by this magnified view. Volkmar must control his surgical tools in a very small space. He needs all the help the system can provide. The robot-like arms are incredibly responsive and precise and function as mechanical extensions of Volkmar's own arms. Attached to the mechanical arms are long, pencil-thin instruments. And this part here couples to the electronic part, which is the motors, basically. And the different motors actually drive those wheels. And then, there's a lot of cabling inside the shaft. And then, at the end, there's this articulating wrist, and this is called the endo-wrist. And by moving those wheels, l can move the tip. So it's a combination of very sophisticated electronics, but also it's a masterpiece of mechanics. After freeing the artery for the graft, he must open the protective covering around the heart and look for the blocked artery. lf the doctors can't find the blocked artery, they must remove the robot-like arms and open Mister Schaller's chest. Now l make a clip here, just to mark the area.

So this is the target vessel here. And you can see, this is the right ventricle. lt beats differently from the left. And here's the clip, here's the target vessel, and this is the graft. And it should be enough, lengthwise. So our next step would be to decide whether we try to do the procedure closed chest now. Anno will put the patient on pump by dissecting the groin, and then put in a catheter that then can arrest the heart. Anno. Here l am. Closed chest. Okay. With the target artery clearly in sight, the two surgeons decide to continue endoscopically. But before they connect the open artery and bypass Mister Schaller's clogged one, they have to stop the heart. They hope one day this won't be necessary. One big aim of modern cardiac surgery is to get rid of the pump in as many cases as possible, which we know has some detrimental effects on the human body. Which is a generalized inflammatory response. Also, it affects the clotting system and a number of different things.

Also, there's a small risk of stroke associated with the use of the pump. But right now, the endoscopic approach forces us to apply cardiopulmonary bypass in order to be able to really work endoscopically on the heart. We have not found yet a way to do that efficiently, endoscopically beating heart procedures. But this is really experimental stage, and it will require a couple more months, maybe years, to really develop an endoscopic beating heart procedure. Dieter Schaller's heart is not beating. With the heart stilled, Volkmar sews the healthy artery in place. He works under the watchful eyes of his mentor. Professor Mohr understands the great potential the system offers for advancing surgical education. One day soon, he hopes to link two consoles side by side. One for the master and one for the student. So if you have a trainee who starts his first case, he is sitting on the master and is doing the case, but his super master is sitting aside to him. So if he does something wrong, he just takes over digitally and the guy sees the right step and feels the right step as his own hands, because it's transferred to the instruments.

His goal is to improve the learning curve while providing the patient with the best possible care. l think it's an okay graft. So l think we have the right treatment, hopefully. The grafted artery is tested. Fortunately, the blood flows smoothly through it and into the heart. The surgery is a success. But it has taken five hours, because the surgeons are inventing a new way to operate. You have to redefine the operation completely, because there's multiple steps you don't even think about usually. There are just motions you make that are beyond your conscience, which now become a real problem again. And then there's no textbook written on this surgery yet, so you have to figure out all the problems yourself. The doctors expect Mister Schaller to do very well.

They were able to complete the operation without splitting open his chest. And thanks to the small incisions, they expect him to heal quickly. Each time Volkmar and Professor Mohr operate using the system, they are one step closer towards realizing their goal, making this novel heart surgery the standard. Stepping through the doors of time, we've seen how surgeons searching for pain view nerves inside the body. We've discovered how 21st Century surgical technology is bringing hope to doctors working to defeat cancer, and how heart surgeons are saving lives without making gaping incisions. What groundbreaking methods will doctors use when they operate on the final frontier, our vital master control center, the brain? Daddy. Mama. John Duncan hopes surgeons can save his life. Their 21st Century tools aren't small scopes. They are an infrared wand and a chemotherapy wafer. 31 is right down this hall. When you get inside the room, you'll hand this to the person at the desk, okay?

The 34-year-old father of two suffers from a particularly vicious form of brain cancer. This is a tumor that started someplace else and went... Today, doctors will open John Duncan's skull for the second time. The first surgery diagnosed the cancer. Now, despite weeks of intensive radiation therapy, the tumor has grown. lt has already affected the strength of his right arm and leg. This is really a terrible type of tumor to have. Gene Barnett is John Duncan's surgeon. lf we don't get this under control, this tumor will progressively disable him and eventually take his life, probably in the order of months to a year or two. l went after my radiation thinking they was, after my checkup and everything, thinking they was going to tell me everything was okay, and it's like he hit me in the face with a ton of bricks when he told me that. That just, you almost lose hope, you know? lt's just mental, really mental. While there's no possibility today's operation will cure the cancer, John and his doctors need to buy time.

They hope the malignant tumor can be reigned in until new advances can be made. l think a lot of cancer patients lose it, you know, mentally. They can't, l mean, because it's stressful. A lot of people can't handle it mentally, you know, and that's hard to take. You know, you be thinking, it's almost like when somebody gives you cancer, they give you a death sentence, you know? You're wondering how long. You know, how long l have, you know. You just don't know. lf this area... John's counting on new computerized equipment to give him back his life. This equipment, the Stereotactic Navigational System, will create a detailed road map for doctors when they enter his brain. This device over here contains four infrared light-emitting diodes, which produce, to us, invisible beams of light that are then detected by a tracking camera. lt can determine to within a fraction of a millimeter where any of these LEDs are in space. Markers pasted on Mister Duncan's smooth scalp are signposts for infrared light. While doctors operate, the markers give the navigational system the precise location of John's head in space. Scissors.

The 3-D MRls on the computer monitor help answer questions. How does the outside, his skull, relate to what's inside, his brain? How deep should the scalpels go? Where does cancerous tissue end and healthy tissue begin? Doctor Barnett and his team open John's brain with a previously-created flap. Our plan then is to go in and, as much as possible, remove this orange and red area that we're seeing on the display, which represents the most aggressive form of the tumor, and then close him back up and then hopefully he'll be no worse for having undergone this. Doctor Barnett has reached the surgical site. decidedly abnormal. Yeah, that's the tumor that we're looking at. Doctor's remove the core of Mister Duncan's tumor. Over and over, they check their position with the navigational system's wand. the edge of the tumor. And so far, that is indeed the case. And so far, l'm pretty pleased with what l see. After the life-threatening malignant tissue is removed, doctors prepare for the next step.

They attempt to stop the growth of more cancerous tissue by implanting biodegradable chemotherapy wafers. Doctor Barnett precisely arranges the wafers where the cancer cells are beginning to invade the rest of the brain. l think we may only be able to get five of these in here. The hope is that the wafers, releasing their chemotherapy, will slowly eat away diseased tissue while sparing healthy tissue. The wafers and the cellulose mesh that hold them in place will dissolve within the next several months, leaving behind a full dose of toxins in the tumor bed. Now, doctors put Mister Duncan's skull back together, using a biological glue not unlike household epoxy. Two agents applied together create a seal that will secure the bone in place. Surgery's all done. You're just waking up.

Doctor Barnett won't know if the surgery is successful until John wakes up. lf too much brain tissue was removed, John could be paralyzed on his right side. He waits anxiously in the recovery room. Wiggle your toe, John. Good, good. Wiggle your right foot, John. Can you wiggle your right foot, John? Wiggle both feet. Wiggle both real good. Can you try squeezing your right hand for me? All right. Push away. All right, good. And once again, John, wiggle your feet for me. Real big, both sides. Right side, too. There you go. Excellent. Okay, good. Before surgery, the tumor made it difficult for John to move his right hand. Even if the surgery is successful, he won't regain its use immediately. But he is able to move his right foot right now, which l think is very good. Clearly, it's weaker than the left. Doctor Barnett will continue to follow John Duncan's progress. He hopes to find that the cancer has retreated, or at least that the core of the tumor has not grown back. John, how you doing? Okay. Can you wiggle your feet for me? Oh, great. Look at those toes go. Excellent. All right, try and push me away here, with your arm. Good, good. Not bad. Not bad.

Excellent. Relax here for a second, if you can. ln 1999, we still don't know how to cure this type of tumor. We have treatments that we're hoping that, in the next few years, will translate into some effective treatment for these tumors and to help bridge these people using today's techniques to tomorrow's techniques. l want you to know that we're all done. He's doing fine. John will have to wait about six weeks before he knows if his surgery has worked. Doctor Barnett hopes the new navigational system and the road map it created have preserved John's speech and motion. He and John keep their fingers crossed that the surgery and chemotherapy will hold the tumor back. lf the surgery and chemotherapy don't work, John and Doctor Barnett have other options. One of them, the gamma knife, sounds like science fiction. But it's been around since the 60's. There are new technologies that are under development that will probably one day supersede what we're able to do with the gamma knife, but for now, it remains a very accurate way of providing the ultimate in non-invasive neurosurgery. Many people think of the gamma knife as being an X-ray laser.

Actually, it operates more like a magnifying glass for X-rays, in the sense that you have 201 beams of gamma rays that are precisely channeled so that they all converge at a single point. And what this allows us to do is to truly, in a non-invasive fashion, destroy tissue deep inside the head. Doctors and technicians can set the machine to pinpoint abnormalities and spare healthy tissue. But there is still a slight risk, depending on the site of the tumor, that significant brain damage may result. A newer tool, the CyberKnife, the next generation of radiosurgery machines, also destroys the growth of unhealthy tissue with X-rays. The CyberKnife isn't a Jedi weapon out of Star Wars. lt's based on something out of GM. This is an industrial robot that's used for putting cars together, welding doors on your Saturn, if you will. This is one of only six in the world. A small X-ray generating device is attached to the robot. lt can precisely point beams of X-rays through selected targets in the patient's head.

However, this device only works for certain patients with certain conditions. For those people, it can be used rather than traditional surgery and allow them the benefits of an operation, without going under the knife. As we make our way into the 21st Century, doctors predict they'll soon understand cancer better and defeat the disease more frequently outside rather than inside the operating room. The knowledge and technology are almost there. Today we're going to go out and see Steve Gallagher, because he has a history of those intermittent wound infections. Remember when doctors made house calls? Well, they're starting to again. Nurse Lynda Gardner and Doctor Michiuori Murayama are about to bring Doctor Butch Rosser, their boss, face to face with his patient, Steve Gallagher. Hi, Lynda. Hey, Steve. How you doing? Oh, not too bad today. Yourself? Good. But Steve will never leave his home, and Doctor Rosser will never leave his office. This house call's in cyberspace.

The two cameras and the computer that Lynda and Michi are carrying bridge distance and dissolve borders. With Rosser at the lead, the two are part of a revolution that could dramatically change home health care. With the electronic medium, we can have that ease of interaction successfully accomplished, so that we get more information about the patient and therefore, we can serve them better. Electronic house calls provide important links between patients and their doctors. The technique works especially well for specialists like Rosser, who are in high demand, and for patients who can't get to doctors' offices. The calls are especially useful for those like Steve Gallagher, patients with postoperative problems that won't go away. Okay, under your tongue. lt's taken Steve four years to recuperate after mysterious symptoms almost took his life. We'll keep that one. Butch Rosser saved him. Doctor Rosser took it upon himself, he was going to do exploratory surgery and find out what was going on.

Because if not, they were going to lose me within 24 hours. And you say you've been running around 250? Rosser found a football-sized cyst growing on Steve's pancreas, slowly strangling his large intestines. The doctor removed the cyst and damaged bowels, then rebuilt Steve's intestinal track in a series of five other complicated and debilitating operations. During the time since his first surgery, Steve was too weak or too ill to get out of his bed for critical post-surgical checkups. Every couple of months, he ends up having this little abscess, that was gathering in this little area right here. To provide Steve with the constant post-surgical care he needed, Doctor Rosser began making electronic house calls. wound itself. And we should be able to transmit this to Doctor Rosser. lt's as if this world-class surgeon were here in the room. Hi, Mister Gallagher. How you doing? The pictures and audio are a little fuzzy, because this part of the technology is still developing. But they provide the personal link Rosser believes is so essential.

That is perfect, Steve. You look marvelous. Over. You look marvelous, too, darling. Over. Can you see me all right? Over. Your reception is fine, doctor. Over. After greeting his patient, Butch reviews the high resolution pictures sent by Lynda and Michi. That wound looks better than it has ever looked before. What do you think about that? Oh, absolutely, doctor. l like to get things answered. l think anybody who has been through any major surgery doesn't want to get something second hand and go home guessing ''Well, l still don't know much more and l still have to wait for my doctor to come back.'' Okay, we're all set. l think people like to see the, quote unquote, ''Big Boss'' because my number one goal, l'm going to take care of you like you're family. Even though they're separated by miles, Steve feels the intensity of Butch's concern and attention.

l bought four more years on this planet than l should have had. lt's the constant care. What else might the future bring? What might it bring to Cliff Boag, the young father suffering from mysterious intense pain in his groin. l knew right away, you know, as soon as, basically when l went home, l could feel a big difference. The nerve Doctors Saberski and Rosser froze temporarily is no longer causing problems. A few weeks after surgery, Cliff is looking forward to taking his family to the beach, a 400-mile trip, and then water skiing when he gets there. Up to a few weeks ago, these activities would have been impossible. And what about the future of John Duncan, the other young father, waging a life and death war against brain cancer? l feel stronger than l did.

After Doctor Barnett removed the core of the tumor and planted chemotherapy wafers in his brain, John has had few side effects. Now, his right hand, weakened by the advance of the tumor before surgery, has regained some of his strength. Several weeks after surgery, he feels healthy and optimistic. l think l'm living with it and l'm beating it. ln several more weeks, his surgeon, Doctor Barnett, will take an MRl and determine if the cancer is growing or retreating. All the surgeons we've met, and many of their colleagues around the world, people engaged in life and death battles every day, have the hope, the vision, and the courage to go beyond what others think is possible. Their breakthroughs and compassionate care will carry us into the next century.

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