Remote anaesthesia using surgical robot

3 Sept 2010

A surgical robot could be used to perform complex regional anaesthesia procedures remotely — teleanaesthesia, according to researchers who carried out a simulation at the University of Florida College of Medicine.

 The researchers performed a series of simulations to evaluate the feasibility of performing robot-assisted regional anaesthesia procedures. The simulations used a da Vinci surgical robot system consisting of four robotic arms with a high-definition stereoscopic camera.

 The procedures were performed using an ultrasound "phantom" that simulated what the anaesthesiologist would see when performing ultrasound-guided procedures. The anaesthesiologist was in the operating room but facing away from the robotic arms and simulated patient, as the procedure was carried out using the da Vinci system's operator console.

After initial placement of the ultrasound probe, the anaesthesiologist 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 anaesthesia 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 cost of the da Vinci system is another practical obstacle, if not already present in the hospital.

Although robot-assisted regional anaesthesia 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.

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 procedures remotely — teleanesthesia. "There are too few skilled regional anesthesiologists to meet the demand," comments Dr Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. "This technology is in its infancy. 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."

Read the full study in Anesthesia & Analgesia at:
www.anesthesia-analgesia.org/content/111/3/813