ONE of the fascinations of a television programme such as Chicago Hope or ER is the fact that we find it difficult to believe that somebody can cut a hole in a human body, go inside and then fix something. There is a morbid fascination with this and probably not a little schadenfreude . Cutting holes in the torso may be the technique that will go down in history as 'that barbaric practice of the 20th century'. Today, surgery is moving in a different direction. According to Ron Kikinis, the director of the surgical planning laboratory at the Brigham and Women's hospital in Boston, the way some things are done today is hardly any different from a long time ago. 'Emergency medicine is essentially the same as it was a few hundred years ago. They have some modern tools but conceptually nothing has changed,' he said. Having moved from Israel when he was three years old, Dr Kikinis grew up in Switzerland and speaks with a kind of methodical Swiss precision that reminds one of the utter dependability of a Swiss timepiece. If there is ever a man into whose hands you would be willing to put your life, this is he. This old method of cutting huge holes in the body is going to change and Dr Kikinis is one of a handful of people at the centre of that change. 'What we are working on is going to change at least some of this paradigm,' he said, referring to a technique called 'image-guided surgery' which it uses the latest in computer imaging technology. Dr Kikinis is the man in charge of computer imaging. 'If we look at the way surgery is done today, it is basically hand-to-eye co-ordination. 'There is a feedback loop between the eyes and the tactile sensory feedback,' he said. He then looked at his coffee cup as an example. 'If it had a tumour, we could easily cut it out.' Then he carefully put his cup under the table and said: 'Now, we must cut through the table to get to the cup and the process is far more difficult.' When a surgeon today removes a tumour, for example, the patient feels almost nothing inside his body, but there is great pain because of the gaping hole the doctor had to make to get to the tumour. Dr Kikinis said: 'Think about it. If you have ever hurt your knee or shin, it hurts for a week or two.' One answer is to use an endoscope and very long, thin instruments. In this way, a tiny hole is made in the body and some tubes are put inside that contain both lighting and cutting instruments. Unfortunately, the view is rather narrow. Dr Kikinis said: 'It is like a sailor who can see all the waves around the boat but is hopeless at finding the direction to Hong Kong or San Fransisco.' The answer to these numerous problems is computers. Dr Kikinis and his team decided to use magnetic resonance imaging (MRI) to obtain the images they needed. Unfortunately, an MRI scanner traditionally was designed as a box with a tube in it. The patient was put in the tube and the images were taken. Working with General Electric, the maker of the scanner, they came up with a modified design that now allows the surgeon to have access to the patient as well. At first they used super computers to interpret the data but now they can use a system from Sun Microsystems, one of the world's leading makers of workstations running under UNIX. For about US$25,000 they could buy everything they needed on the computer side; a SPARCstation 20, with dual 60-megahertz processors and two gigabytes of disk space. The machine was running Solaris 2.4 and OpenLook 3.2 on a twenty-inch monitor. The images that appeared on the screen were high resolution images of an entire head, including skin. The image could be moved with the mouse in real time so that any side or angle could become visible at once. Dr Kikinis then set the software to 3-D and handed me a pair of special spectacles. The entire skull then jumped out of the screen and became a three dimensional object. I could see blobs of calcium floating about inside the skull. Anything green would be a tumour. Dr Kikinis then moved the mouse again and all I saw was the brain, moving in three dimensions somewhere between me and the Sun monitor. There may only be a small number of universities and hospitals that can do this today, but it is clear that this is the way surgery is headed.