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 Anesthesia & Analgesia, 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.
Surgical Robots Could Be Used for 'Teleanesthesia'
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. (A video clip illustrating the procedure can be viewed online at http://links.lww.com/AA/A159.)
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."
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," 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."
Electrical stimulation of vagus nerve could combat inflammatory bowel disease