Home E-Weekly September 7, 2010

Can Robots Place Regional Blocks?

Published: September 3, 2010

In addition to its laparoscopic applications, the da Vinci surgical robot might be able to perform complex regional anesthesia from remote locations, according to researchers at the University of Florida College of Medicine in Gainesville.

The researchers first attempted an ultrasound-guided, single-injection nerve block on a "phantom" patient, a model that provided a realistic view of what physicians would see if they were performing an actual block. After the ultrasound probe was manually placed on the phantom and secured with one of the robot's arms, anesthesiologists turned their backs to the phantom and used the da Vinci's controls to identify nerve structures, pick up the needle, position it near a target nerve and inject the drug.

Next, researchers used the da Vinci to place a more complex perineural catheter (captured on video) for a continuous nerve block. While many of the technique's steps could be accomplished with the robot, manual assistance was still required to complete aspects of the block, including the placement of the ultrasound transducer and the opening of medication ampoules.

The researchers note that automated anesthesia is still limited by the need for physician presence to provide patient care and manage potential complications, the da Vinci's multi-million dollar price tag and the fact that some steps of the block's placement had to be performed manually. They also admit their research, which appears in the September issue of the journal Anesthesia & Analgesia, is purely experimental. "Even if optimized for anesthetic practice, robotic-assisted anesthetic procedures are not likely to become a part of routine anesthetic practice," they write.

Still, the study demonstrates that remote regional anesthesia is possible. Stephen L. Shafer, MD, professor of anesthesiology at Columbia University and Anesthesia & Analgesia's editor-in-chief, believes "a highly trained anesthesiologist could provide dozens of specialized nerve blocks to patients around the world in a single day if future studies show that [the technology] is practical."

Daniel Cook

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