The three metal arms of a million-dollar robot twitched restlessly over Judy Verhage's chest, snipping and sewing and fixing a faulty valve in her heart.

No need to crack open her chest. The surgical instruments were inserted through three small incisions. No need even for a surgeon to stand over her holding the instruments. That was the robot's job.

Verhage's heart surgeon, Scott Stuart, was seated several yards away in a corner of the St. Luke's Hospital operating room, his head buried in the viewfinder of a giant console. As he concentrated on a 3-D video image of the interior of Verhage's heart, he directed the robot's movements with two hand controls and a series of pedals.

"There is no doubt this is the next step in surgical technology," Stuart said. "This is literally the cutting edge."

That's what a lot of physicians say after they've been at the controls of a surgical robot.

Robots are popping up in operating rooms nationwide. In the past two years, hospitals have bought about 100 of the robots, known as the da Vinci Surgical System. More than 260 are in use worldwide.

In the Kansas City area, Shawnee Mission Medical Center and St. Luke's are using da Vinci robots. University of Kansas Hospital has a less elaborate one-armed robot called Aesop that moves a video camera as the surgeon gives orders.

Since the first surgeries with a da Vinci robot were performed in 1999, more than 20,000 patients have had robotic operations.

The Food and Drug Administration has approved the da Vinci for a variety of procedures from heart bypasses to heartburn surgery. The robots now perform about one in 10 surgeries to remove cancerous prostate glands, and the numbers are rising rapidly.

New uses are being added as more surgeons adapt the robots to their practices. The robot's manufacturer, Intuitive Surgical Inc. in Sunnyvale, Calif., is working with the FDA to gain approval for robotic hysterectomies.

Many of the robots are being bought by community hospitals now, rather than academic medical centers, said Eric Miller, senior vice president for Intuitive.

"That's a good sign for a medical device company," Miller said. "It's not just for research; community hospitals are seeing it as a must-have tool. There is a competitive advantage to having the robot."

More marketing than medicine?

But skeptics wonder whether there's more marketing than medicine behind the robots, as surgeons and hospitals look for justifications for their investment in the costly technology.

So far, few large studies have evaluated the benefits of robotic surgery. And what evidence there is, the skeptics say, suggests that robotic results aren't significantly better than those of conventional surgery.

"The 'Star Wars' technology has patients starry-eyed. They come in saying, 'I want that,'" said J. Brantley Thrasher, a urologist at University of Kansas Hospital. "But the jury is still out whether this is really going to revolutionize surgery. My guess is not."

The da Vinci robots were developed out of decades of research by NASA and the Defense Department into technology that would permit doctors at a distant hospital to perform surgery on astronauts in space or soldiers on a battlefield.

Long-distance robotic surgery has been used successfully by surgeons in New York to remove the gall bladder of a woman at a hospital in Strasbourg, France. And NASA has tested it by having a surgeon in Canada perform mock surgery on a dummy in an underwater lab off the Florida coast.

'Superman'

For civilian surgeons, the robots have been a natural progression in the development of minimally invasive surgery. Those are operations that use cameras and surgical instruments mounted on long, narrow tubes that allow surgeons to operate inside the body through tiny incisions.

The key difference between conventional minimally invasive surgery and surgery with the da Vinci system is that the robot holds the camera and the tools.

That's a significant advantage, said Stuart, the St. Luke's heart surgeon.

"There is no muscle fatigue, no shaking with the robot," he said. "Your vision is better and the surgeon isn't giving anything away in terms of dexterity."

The robot controls also have a greater range of motion than the tools used in conventional minimally invasive surgery. And the surgeon can adjust the robot's arms so that a 1-inch movement of the hand moves the surgical instrument just a fraction of an inch. With precision like that, even a novice at the robot's controls can pick up a piece of surgical thread and tie it in a knot.

"You can be Superman," said Joseph Petelin, a general surgeon at Shawnee Mission Medical Center. "It extends the ability of a surgeon beyond his physical limits."

Petelin, a pioneer in minimally invasive surgery, uses the robot for operations on the esophagus that demand paper-thin incisions.

"It enhances my abilities," he said. "I'm five times as accurate using the da Vinci."

Patients are seeking out robot-equipped surgeons because they can turn major operations with large incisions into minimally invasive procedures.

As soon as Judy Verhage learned that she had a faulty heart valve, her husband, Paul, went on the Internet looking for alternatives to open-heart surgery.

"He really didn't want me to have my chest opened up," said Verhage of Lawrence, Kan. "He wanted to save me from a long recovery."

When the Verhages discovered that St. Luke's was doing robotic surgery, they ran the idea past her cardiologist.

"Being of the old school, he wasn't aware of all that could be done," Judy Verhage said. "Dr. Stuart persuaded him. He felt I would be a good candidate."

On Thanksgiving Day, just three days after her surgery, she was discharged from St. Luke's. If she had undergone open-heart surgery, she would have stayed at the hospital through the holiday weekend.

Recuperating at home two weeks later, the 57-year-old elementary school worker said she was feeling "pretty good, a little bit sore around the edges."

"Each day I'm getting better," she said. "It's just hard to believe they were able to do something so big the way they did."

Intrigued

Jim DeMoss, 66, of Overland Park, Kansas, chose robotic surgery at Shawnee Mission Medical Center when he was diagnosed with prostate cancer about six months ago.

"I was intrigued by the robot. It seems to be less invasive. And being able to recover faster, that sounded good to me," he said.

DeMoss had the surgery on a Thursday, was home on Friday and returned to work at his food brokerage firm on Monday.

"In a little over a month, I was in Colorado hiking 10 miles a day," he said.

As for incontinence, a common problem after prostate surgery, DeMoss said he was back to normal within a couple weeks.

"It was not an issue," he said. "I've been comparing notes with my friends (who had conventional prostate surgery), and I've been really fortunate. They've had some problems."

DeMoss' surgeon, David Emmott, has done more than 1,000 conventional prostate removals. Now that he's done about 60 of the procedures with the robot, he's decided he will never go back to the old way.

"I've done my last open prostate (surgery)," he said "This is a superior procedure."

Emmott said his patients who've had robotic surgeries have experienced less blood loss, shorter hospital stays, less pain and faster recoveries.

"This is going to take over prostate surgery. There's no question in my mind," Emmott said. "In the next two years it will be the majority of surgeries. This is the wave of the future."

Not so fast, said J. Brantley Thrasher of University of Kansas Hospital.

Thrasher is a national spokesman for the American Urological Association, the professional organization of urologists. He has reviewed the evidence to date for prostate surgery done with conventional open incisions, with minimally invasive techniques and with a robot. He's found no significant differences in their outcomes.

"It comes down to the experience of the surgeon," Thrasher said. "It can be done well any of three ways."

The robot is a tool, Thrasher said. "It's not going to make a bad surgeon good. The clinical expertise is still in the hands of the surgeon."