(San Antonio - October 9, 2006) The first time Drs. David Jimenez and Constance Barone performed the pediatric skull surgery that now defines their careers, a medical student videotaped the procedure using a handheld recorder.

On the grainy tape, the image wobbles along with the student, who filmed it while standing on a chair.

Fast-forward about 10 years: Jimenez and Barone, a husband-wife team, stroll into a spacious surgical suite at University Hospital wired with about $225,000 worth of technology - including six cameras, two 56-inch plasma television screens and four high-resolution monitors.

Both surgeons wear wireless microphones so colleagues sitting in a boardroom a building away can hear their every word.

Jimenez and Barone are conducting a high-tech learning conference, known as "telesurgery," for others to learn about the less-invasive technique they pioneered.

"Is this taping? Can you hear us?" Jimenez speaks into his microphone.

From a speaker, the voice of one of the neurosurgeons in the boardroom responds, "Yes, we can."

Long gone are the days of the round, two-story surgical suite, where observers (think Jerry and Kramer in the famous Junior Mint episode of "Seinfeld") and medical students hover above a procedure to see how it's done.

Now, thanks to increasingly high-tech computerized gadgets - and the surgeons skilled to use them - doctors and students are getting astoundingly detailed views into human anatomy and are able to beam those images anywhere in the world.

Operating rooms in San Antonio and across the nation are being redesigned or built from scratch to accommodate the changes. In Jimenez's suite - which he persuaded hospital officials to build for him recently - steel ceiling booms lift lights and computer monitors off previously crowded floor space. Like a mini-television studio, cameras placed at all angles send images into the boardroom at the nearby UT Health Science Center.

Microscopic cameras at the end of scopes Jimenez places in his young patient's head also give the learners glimpses into the procedure they'd never get otherwise.

"When you're up on that second story or at the surgeon's shoulder, it's extremely hard to see anything at all," acknowledged Dr. Adrian Park, a spokesman for the American College of Surgeons and vice chairman of surgery at the University of Maryland.

"You get the scope in and everyone can see the image and you can beam it everywhere," he said. "The educational benefit of that is amazing. Students can see how they can avoid trouble, what the tricks are."

Park, an expert in emerging operating room technologies, said patients also benefit from the advances, especially since less-invasive surgeries that speed up recovery. Hospitals are spending more money up front outfitting surgical suites with new systems, but they're making the expenses up by discharging patients earlier, he said.

Still, he cautioned it's important for physicians to realize and communicate any limitations of technology.

"It's up to us not to be so dazzled by technology that we lost sight of what the true benefits are," he said. "I say to medical students that the only true instrument with nerves going to the tips are your fingers."

Jimenez and Barone, self-confessed gadget geeks, embrace the enhanced help the tiny cameras and enlarged images give them. With a punch of a button, data, such as the results of an X-ray, can be pulled up in the operating room. The lights can be dimmed or even turned to an eerie greenish glow so video images can be seen better.

"In the old days, you'd keep adding up all these pieces of equipment, and it's like piling up an entire room with furniture," Jimenez said. "So we've integrated massive amounts of data and looked at the ergonomics of the room. In the past, the patient would have been spending an extra hour in the emergency room while we fiddled with these things."

The minimally invasive procedure, correcting a defect in babies known as craniosynostosis, turned what's usually a six-hour operation into a 45-minute one. The two doctors worked closely with technology company Karl Storz Endoscopy-America to design the operating room at University Hospital and combine all the surgical hardware and software.

As director of surgical services at St. Luke's Baptist Hospital, Rachel Barrera manages the needs of patients, physicians and nurses. That practice alone can sometimes be as delicate as surgery itself.

The average age of an operating room nurse is 51. Meanwhile, the hospital often deals with physicians fresh from their medical residencies who were raised on video games and are more than comfortable with the latest medical gizmos.

So when Barrera was in discussions with designers of a new integrated surgical system, she was blunt.

"I told them, 'What you have to do for me is have the system high-tech enough for the doctors coming out today, but you have to simplify it enough for my nurses,'" she said. "I don't want them to be upset with a system they can't figure out."

St. Luke's uses a robotic surgical system known as da Vinci for several laparoscopic procedures, allowing for precision through incisions that are about an inch long. A physician sits at a video console and maneuvers handgrips guiding tiny instruments inside the patient. The instruments are attached to two large robotic arms, and another arm has a camera inserted through an incision.

As operating room technology gets smarter, physicians and nurses will need to get smarter, too, Park said. Patients have now come to expect less-invasive procedures, which means image-based advances such as camera scopes are the norm.

"This is an exciting time in surgery," he said. "But I still say it will be a long time until we replace the precious thing that is good clinical judgment with any type of technology."

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