AAMC Reporter: October 2005

Here Come the Robots!

By Scott Harris

The whole idea is rather "Jetsons-esque."And it may be coming soon to a hospital near you.

It also may be an idea whose time has finally arrived. Meet the new medical robotic assistants — a special breed of electronic servants that are already supporting doctors, nurses, and patients in various ways in a number of hospitals.

Though still in the early stages of development and use, the robots are already making an impact in virtually every phase of health care, from resident education to emergency room consultations.

"It's part of a whole trend," says Michael Treat, M.D., an attending surgeon at New York-Presbyterian Hospital, associate professor of clinical surgery at Columbia University College of Physicians and Surgeons, and co-developer of a robotic surgical assistant nicknamed "Penelope."

"I think more involvement with robots is inevitable all around us," Treat says. "For today's medical students and all younger people, there will be a day when they can't imagine when robots weren't there. I think we're getting into an age of personal robots and intelligent artificial beings."

Penelope, still a mere prototype, is one of the "beings" at the vanguard of electronic medicine. Tentatively scheduled for production in late 2006, she's 60 pounds of stainless steel, carbon fiber, and plastic that responds to voice commands and — using cameras and artificial intelligence — hands implements to surgeons during procedures, replaces and keeps tabs on the implements, and even anticipates the implements that specific doctors will want next. A product of the New York firm Robotic Surgical Tech, Inc., which Treat founded, Penelope assisted in a surgery for the first time on June 16 — the removal of a benign tumor from a patient's forearm.

"The machine can do the manual jobs and the busywork, like keeping track of the instruments," Treat notes. "This makes it smoother and safer, because you don't lose things. It's going to help entire operating staffs."

A Virtual Doctor

With help from an RP-6 mobile robot, a patient interacts with Dr. Neil Martin, professor and chief of the Division of Neurosurgery at UCLA Medical Center

Also on the front lines of medicine is the Remote Presence robot (or RP-6 for short), a five-foot, 227-pound mobile unit built by InTouch Health, Inc., of Santa Barbara, Calif. Unlike Penelope, which currently has no copies, several dozen RP-6 units are already on the market.

But the two electronic servants have completely different purposes: Penelope is a robotic surgical assistant, while RP-6 is essentially a virtual doctor. Physicians use the joystick-operated, microphone- and camera-equipped RP-6 to speak with and visually examine patients at remote locations. A patient sees the doctor's face on a video screen atop the unit, and in turn a visual feed beams back to the doctor's home, office, or any other pre-designated location. Doctors in several hospitals nationwide are using the RP-6 to make virtual patient rounds, consult remotely with other doctors, and provide many other services.

"Everybody uses these robots for different things," says Michael Klein, M.D., surgeon-in-chief at Detroit Medical Center's Children's Hospital of Michigan, where doctors currently use RP-6 in the emergency room and burn unit.

"We can provide expert advice from a distance," the surgeon says. "We see over 80,000 patients each year in our E.R., so it's very busy.With the robot, we can see more patients, make quicker decisions, and speed care along. Every time you describe this to doctors, they think of a different way it could help them."

The robots also make valuable educational resources.

"These robots are very good for teaching," says Paul Vespa, M.D., head of critical care in the neurosurgical intensive-care unit at the UCLA Medical Center and associate professor at UCLA's David Geffen School of Medicine. "You can supervise the on-call residents much more easily. You can go over records and images with them in real time — and have an interaction and offer instruction right then. Education can often be disjointed if you discuss these things with a resident after the fact, so it can really be advantageous to do this in the heat of battle, so to speak."

Of course, robots cannot provide every service a person can, doctors note. Things requiring a delicate touch — literally or figuratively — remain "human domain." Another issue for RP-6 is that it can make attending physicians, who often find themselves overextended as it is, on call virtually all the time to examine patients. Furthermore, an RP-6 can travel only through areas that have been equipped with a wireless network, so some hospitals probably would have to be retrofitted — a potentially time-consuming and costly operation. Also, the robots themselves are expensive investments — $120,000 each.

In addition, says Vespa, "there is sometimes a sense of unease for the patient in terms of the doctor being remote. It works best when you already know the patient and they know you, or if there is not a language barrier."

But overall, the robots are getting rave reviews. Recent tests at The Johns Hopkins Hospital have shown that, by and large, patients do not mind the robots.Many patients adapt to them almost immediately and some actually seem to prefer robotic consultations to traditional ones largely because of the robots' novelty.

At the Detroit Medical Center, whose leaders have leased a record high of 10 RP-6 robots, the sky's the limit.

"We have absolutely no horror stories," says David Ellis, corporate director of planning and future studies at Detroit. "We have very happy patients and relatives. People feel they are seeing more of the doctors because of these robots. They have immediate practicality right out of the box."

Richard Santucci, M.D., chief of urology at Detroit Medical Center's Detroit Receiving Hospital and associate professor at Wayne State University School of Medicine, is helping to formulate protocols for how the center will use the robots in the future. He says the potential has only begun to emerge.

"These robots are like a telephone — you have to learn when to use it and when not to use it," Santucci explains. "We feel this can improve outcomes with patients, and can really decrease the length of stay. We hope this will improve the degree and quality of residential supervision. We could apply this technology to high-risk pregnancies, so we can monitor pregnant women outside the hospital. And we could use it to see and update family, and pass along information when the news is bigger than a phone call but smaller than something that warrants a drive to the hospital.

"For us, the robots are here to stay."

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