ER 2.0 : Robots surgery by Jessica Griggs

IF a soldier is severely wounded, they have a markedly better chance of survival if they are seen by a doctor within the hour. But what if the closest field hospital is more than an hour away, or the nearby unit doesn't have the necessary medical expertise?

Help could come in the form of a mobile operating theatre, according to a consortium led by non-profit lab SRI International, based in Menlo Park, California. The device, called Trauma Pod, is still in the early stages, but its developers claim it will ultimately be able to retrieve someone from the battlefield, diagnose them, and perform lifesaving procedures while transferring them to hospital.

Inside the prototype theatre are a team of robots, led by a robotic surgeon remotely controlled by an actual surgeon. The lead robot has three arms under the surgeon's control: one holds an endoscope to allow the surgeon to see inside the patient while the other two grip the surgical tools.

Ultimately, the robot surgeon will be able to perform "temporary fix" procedures to buy the patient a few more hours until they reach a hospital, says lead developer Pablo Garcia at SRI International. "The system will focus on damage control surgery, the minimum necessary to stabilise someone," he says. "It could provide airway control, relieve immediate life-threatening injuries such as a collapsed lung, or stop bleeding temporarily."

The robot will focus on damage control, to buy someone a few more hours until they reach a hospital

Garcia says the robot could also be instructed to independently perform some relatively simple tasks, such as placing stitches or tying knots, to allow the surgeon to concentrate on more complex procedures.

The surgical robot is assisted by 12 other robotic systems, so far also at the prototype stage. The bed itself, developed by Integrated Medical Systems in Signal Hill, California, monitors the patient's vital signs, can administer fluids and oxygen, and will eventually act as an anaesthesiologist, using a robotic arm to place an IV line to deliver drugs. The "scrub nurse", a voice-activated robot arm, passes fresh tools and supplies to the "surgeon" and disposes of used equipment, while the role of circulating nurse is performed by a tool-dispensing robot. Each machine communicates with the others and is closely monitored by software programmed with the correct series of steps for a range of emergency procedures, to ensure everything happens in the right order and prevent collisions. The human surgeon can control each robot and speak to the patient to provide reassurance.

The pod is also equipped with a three-dimensional X-ray scanner, and later versions should include an ultrasound device too.

The system can't operate completely independently of people on the ground, Garcia admits. Fellow soldiers may still be needed to pick up a severely injured or traumatised comrade and place them on the bed, for example.

The Trauma Pod is being developed with $12 million in funding from the Pentagon's Defense Advanced Research Projects Agency. It recently completed the first phase of a feasibility trial, in which the robots inserted a plastic tube, or shunt, into a damaged blood vessel in a mannequin's leg and performed an operation to close a perforated bowel - two common injuries following a bullet wound (The International Journal of Medical Robotics and Computer Assisted Surgery, DOI: 10.1002/rcs.238).

For the trials, the team used the da Vinci surgical robot, which has been performing keyhole surgical procedures in hospitals since its introduction in 2001. Garcia says this robot will eventually be replaced by one specifically designed for damage-control surgery, which the team hopes to develop next.

Other significant challenges remain, including improving the pod's life support systems and demonstrating its ability to stabilise a patient's airway without being controlled by a human surgeon. Eventually the team hopes to shrink Trauma Pod and all its robots to a bunk-bed sized object suitable for carrying on the back of a vehicle, and encase it in a shell able to withstand the rigours of the battlefield.

If development continues as planned, Garcia believes Trauma Pod could be sent to battle zones or other dangerous areas, such as those struck by natural disasters, within 10 years. Also some of the individual systems, such as the life support modules, could find their way into hospital operating theatres much sooner, he says.

Equipping the military with a fleet of robotic battle surgeons will not come cheap, however. The da Vinci robot costs about $1.5 million, plus $150,000 a year in maintenance. This price should come down, Garcia says. "Robotics is really exploding in all different fields. There is no reason why a lot of the technologies won't get cheaper over the next few years."

Ara Darzi of the Hamlyn Centre for Robotic Surgery at Imperial College London says the project has the right vision, but will be challenging. "It will be interesting to see how the system fares in a more hostile environment than the sterile test pod the initial trials were conducted in," he says.

But Brendan Visser, a surgeon at Stanford University in California who helped develop the Trauma Pod, is impressed with how far the project has come. "Three separate robots dance over the top of the patient with their powerful arms moving very quickly, yet they don't crash and they're able to deliver very small items from one arm to another," he says. "It's like those drunk-driving tests where they make you close your eyes and touch your nose, but at very high speed with arms that would break your nose if they smashed into it."

Source : http://www.newscientist.com