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    ² An existing surgical robot could be used to perform
complex regional anesthesia procedures -- in theory, allowing expert anesthesiologists
to perform robot-assisted procedures from remote locations, according to a study in the
September issue of

 

, official journal of the International
Anesthesia Research Society (IARS).
Although robot-assisted regional anesthesia is "strictly experimental" for now,
"This study demonstrated that a multipurpose surgical robot could be adapted for
simulated nerve block placement," according to the report by Dr. Patrick J. Tighe and
colleagues of University of Florida College of Medicine, Gainesville.
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The researchers performed a series of simulations to evaluate the feasibility of
performing robot-assisted regional anesthesia procedures. The simulations used an
existing surgical robot, called the da Vinci system. Consisting of four robotic arms with a
high-definition stereoscopic camera, the da Vinci system is used to perform various
types of robot-assisted surgical procedures.
The procedures were not performed in actual patients, but rather using an
ultrasound "phantom" that simulated what the anesthesiologist would see when
performing ultrasound-guided procedures. The anesthesiologist was in the operating
room but facing away from the robotic arms and simulated "patient," as he or she
performed the procedure using the da Vinci system's operator console.
After initial placement of the ultrasound probe, the anesthesiologist was able to
successfully carry out a simulated nerve block procedure, including identifying nerve
structures, picking up the needle and positioning it at targeted nerve, and performing the
injection.
The robotic system was then used to attempt a more technically advanced
regional anesthesia procedure: placing a perineural catheter for continuous nerve block.
Although some steps had to be performed manually, most of steps of this complex
catheter placement procedure were successfully performed by the da Vinci operator.
There were some important limitations in performing the simulated procedures,
including the fact that some steps had to be performed manually. The "multimillion dollar
price tag" cost of the da Vinci system is another practical obstacle.
Nevertheless, "The simulation proved that robotic-assisted regional anesthesia is
feasible using existing clinical equipment," Dr. Tighe and colleagues write. Further
research will be needed to advance this concept, including studies to "optimize robotic
interfaces with other nerve block equipment."
http://www.sciencedaily.com/releases/2010/08/100826205340.htm?



Robotic technology can change the way healthcare is delivered, offering

treatment from faraway cities, or countries, for soldiers in Afghanistan and intensive
care patients in U.S. towns not big enough to attract specialists. They point to a day
when micro-sized robotic organisms may be used to fight blood clots and thinking
machines keep watch on frail seniors, alerting medics and doctors if they topple down
the stairs.

³Time is brain. Time is heart,´ said Rogove, president of C3O, a small group of
doctors who pilot robots in emergency rooms and intensive care units. He predicts the
technology will grow explosively because many hospitals struggle to find specialists.

The robotic system was then used to attempt a more technically advanced regional
anesthesia procedure: placing a perineural catheter for continuous nerve block.
Although some steps had to be performed manually, most of steps of this complex
catheter placement procedure were successfully performed by the da Vinci operator.
Obvious questions concerning cost, efficiency, and feasibility abound. Indeed, the
multimillion dollar price tag of the DVS system presents a significant barrier to
widespread deployment. Two engineers, an anesthesiologist, and a urologist were
required to engineer this simulated exercise, underscoring the human support
necessary to complete these tasks. Continual patient monitoring, a critical feature
during any nerve block placement, was not addressed during this demonstration.
Clearly, physician presence would be required for such robotically assisted anesthetic
procedures to provide ongoing patient care and manage potential complications. Even if
optimized for anesthetic practice, robotic-assisted anesthetic procedures are not likely
to become a part of routine anesthetic practice.XX
Instead of a procedure-specific device, this simulation used the multipurpose da
Vinci Surgical System Type S (DVS) (Intuitive Surgical, Sunnyvale, CA). This system
incorporates 4 separate robotic arms, with 1 that is mated to a high-definition
stereoscopic camera. The workstation allows the person performing the procedure to
view the robot's camera output, control the limbs, and receive simultaneous video input
from third-party sources.
Nevertheless, "The simulation proved that robotic-assisted regional anesthesia is
feasible using existing clinical equipment," Dr. Tighe and colleagues write. Further
research will be needed to advance this concept, including studies to "optimize robotic
interfaces with other nerve block equipment.
In the future, robot technology might be used to perform long-distance,
"teleanesthesia" procedures. There are too few skilled regional anesthesiologists to
meet the demand.If future studies show that it is practical, one highly trained
anesthesiologist could provide dozens of specialized nerve blocks to patients around
the world in a single day. There would still be a requirement for a local anesthesiologist
to look after the patient, handle any complications, and provide backup anesthesia in
case the block fails."

Salazar, Ann Margareth D.

BSNIII-15