Soon, when a Columbia surgeon asks for a scalpel in the operating room, it may not be a person who responds. Instead, a robot being developed by a CUMC team will hand the instrument to the surgeon, pick it up when he or she is done, and then anticipate which instrument is needed next.
Unlike some of the other surgical robots already in use, this robot, which is still under development, is more than simply an extension of a surgeon's hands. Inventor Dr. Michael R. Treat, associate professor of clinical surgery, created the robot to be interactive. It can respond to requests and make predictions based on a surgeon's preferences, which are entered into its database.
Dr. Treat developed the robot officially known as the Penelope Robotic Scrub Technician System in response to real-world issues he faced as a surgeon, such as the nursing shortage and the difficulty of keeping accurate instrument counts. He believed that automating instrument handling during surgery would enable those who currently do that job to shift to patient care. The robot is named for the resourceful and faithful Penelope in Greek mythology.
"Penelope will save money for hospitals because it's cheap to operate, reduces medical errors, frees up operating room staff for patient care, and will increase the number of operations done in a day," Dr. Treat says of the robot, which may be ready for clinical use by the end of 2004. NewYork-Presbyterian Hospital is already committed to use the first clinical grade robot although it is too soon to say how and where it will be rolled out in the hospital.
With assistance from Columbia's Center for Advanced Information Management, Dr. Treat formed a spin-off company, Robotic Surgical Tech Inc., in 2002. The company licensed the idea of building a robotic device to perform the functions of a scrub technician from Columbia. Dr. Treat began his enterprise with a cardboard mockup; eventually, his team which has now expanded to three engineers developed a working robot prototype. Dr. Treat, who is based in the Allen Pavilion, is a general surgeon with experience in surgical device development and has a master's degree in physics. The team demonstrated the robot to the U.S. Army's Telemedicine and Advanced Technology Research Center, and it purchased a prototype.
At first glance, Penelope's jointed arm appears to have more in common with an adjustable desk lamp than something from "Star Wars." The arm has a magnet at the tip for retrieving instruments, a digital camera eye for "sight," and is directed by a laptop computer. But a demonstration shows the robot's cutting edge capabilities: Computer vision to "see" the tools, voice recognition to understand a surgeon's requests, and artificial intelligence to predict what will be needed next. The researchers are optimizing the software to make the robot work faster; the goal is to make it at least as fast as a human surgical assistant, without compromising its ability to operate safely. To minimize the chance that the robot itself might cause an injury, its arm is made from lightweight components and can only exert a small amount of force.
Dr. Treat says the robot should help reduce a certain type of medical error when a surgical instrument or sponge is left inside a patient after surgery. Foreign bodies are retained in an estimated 1 out of every 1,000 to 1,500 intra-abdominal operations, according to a study in the Jan. 16, 2003 issue of the New England Journal of Medicine.
Penelope keeps count of the instruments in three ways: Instruments are identified by the computer vision system, a sophisticated system that combines a camera with software that can recognize the dimensions of each instrument. In addition, Penelope's developers have placed 2-centimeter-wide tags on the instruments that act like bar codes for tracking. As a final check, instruments are logged and sorted by weight.
To make sure the robot conforms to operating room needs and addresses staff concerns, Dr. Treat and a research assistant, Jennifer Peralta, are conducting a survey of nurses and surgical technicians at Allen.
Kathleen Coleman, assistant head nurse in Post Anesthesia Care Unit (PACU) at Allen, says the robot's ability to quickly and accurately perform instrument counts can save the hospital money faster counts mean operations can end sooner with the added benefit of fewer instruments being lost. Ms. Coleman and Patricia Zimmer, staff nurse in PACU at Allen, say that counting instruments is an arduous task, in part, because technicians are sometimes interrupted during their counts, necessitating recounts.
Elveda McKenzie, a nurse who is clinical manager at Allen, where she oversees the operating room staff, thinks the robot will help the hospital better compete in the recruitment and retention of staff, especially in today's tight labor market. "Introducing such advanced technology in the OR will make us more attractive to nurses and physicians, too," she says. "They want to use the latest technology in order to have the most up-to-date skills."
J. David Liss, vice president of government relations and strategic initiatives at NewYork-Presbyterian Hospital, agrees. "We desperately need more nurses," Mr. Liss says. "If the robot can free nurses from the tedious parts of the job and let these professionals work with patients, we may be able to attract more nurses to NewYork-Presbyterian. The idea is to design a machine that does what machines are good for routine monitoring and tracking while letting people do what they do best taking care of patients."