Robots prove mettle as surgical aides

Humans freed up for harder tasks

New York --- Gliding into the operating room for the first time to assist a surgeon, Penelope wasn't nervous.

Unlike other novice medical assistants, "she" felt nothing. That's because Penelope is a robot, a machine that recently made medical history as the first to act as an independent surgical aide during an operation.

During a procedure in June at New York-Presbyterian Hospital to remove a benign tumor from a patient's forearm, Penelope responded to voice commands from a surgeon, handing over clamps, forceps and other instruments with its magnetized mechanical arm. Watching with digital cameras, the robot retrieved the instruments when the surgeon put them down.

Inside its computer brain, artificial intelligence software kept track of the instruments to ensure none was misplaced and predicted what tool the surgeon would ask for next.

"Penelope is just the first step," said Dr. Michael Treat, a surgeon, physicist and lifelong robotics fan who founded the company that developed Penelope.

"When you're in the operating room and you're trying to fight your way through a difficult trauma case, there could be a machine that's helping you mind the instruments and not lose things and keep track of stuff, kind of watching your tail for you," Treat said. "That's a glorious vision."

It is a vision closing in on reality. Robots are playing an increasing role in surgery and health care across the country.

Many hospitals use mobile robots to fill prescriptions, deliver meals and ferry blood samples to labs.

More than a dozen institutions use mobile robots that let doctors make virtual rounds, checking on patients from their offices and homes. That robot, made by InTouch Health Inc. of Santa Barbara, Calif., is topped by a video screen that shows a live image of the doctor's face. The physician, who controls the robot with a joystick and a special console, can see and hear the patient through a video camera and microphone.

In March the UCLA Medical Center began testing the robot in its neurosurgery intensive care unit, and the Detroit Medical Center deployed 10 of them in six hospitals.

Great at sponge counting

Surgical robots typically fall into two categories.

Machines actively controlled by a surgeon function as tools to enhance human vision or movements for delicate procedures. Such robots have been used on patients with knee injuries, heart problems and throat cancer.

Then there are robots like Penelope that work on their own, performing some of the duties of medical professionals.

Will Penelope put nurses out of a job?

"She's not going to replace, she's going to enhance the job," said Doreen Taliaferro, an operating room nurse for 20 years who served as Penelope's backup during its first surgery.

While Penelope performed smoothly, Taliaferro was there to take over if anything went wrong and to handle items such as medications and sponges, which are beyond the robot's current abilities.

"This is going to give me more time with my patient and my surgical team," Taliaferro said.

Treat said that is the goal of Penelope: to take over repetitive tasks and free up people for work that requires a human touch, such as interacting with patients and families. The robot also is a reliable counter of surgical equipment and eventually could help prevent items like sponges from accidentally being left inside patients.

"It's like 'Star Wars,' " Treat said. "R2D2 is not replacing Luke Skywalker. R2D2 is kind of a sidekick."

Treat, who spoke from a hospital bed while recovering from a broken leg suffered in a car accident, said he would have no problem with robots aiding his own recovery.

"I'm getting superb care, but the staff is really overstressed. It would really be wonderful if there was a little personal robot to get me a glass of water."

Treat, known as an inventor, came up with the idea for Penelope after a medical resident suggested he create a robot scrub nurse. Treat and a graduate student built a cardboard model in 2001 and had a working prototype the next year.

Eventually Treat founded Robotic Surgical Tech Inc. in New York, and the team expanded to half a dozen people.

"It was a very Wright brothers approach," Treat said. "We had a lot of bright people who just said: 'I can do this.' "

Plans for future robots

About $500,000 has gone into developing Penelope, also called the Surgical Instrument Server, Treat said.

The initial money came out of Treat's pocket, but the project has gotten funding from the Army, National Science Foundation and Defense Advanced Research Projects Agency, which is interested in building surgical battlefield robots.

The robot, named for the resourceful wife of Odysseus in Homer's epic poems, weighs 60 pounds and has a lightweight arm of carbon fiber mounted on a stainless steel frame.

Treat has plans for robots that would act as surgical "first assistants," performing duties such as applying suction, exposing tissue with a retractor, and stitching up patients.

Beyond that, he envisions machines with artificial intelligence that may perform operations mostly on their own. Such machines could be used on the battlefield or during manned missions to other planets.

Penelope has five more operations coming up in a trial program. The next, set for the fall, is a more complicated hernia procedure, Taliaferro said.

In June, Penelope assisted Dr. Spencer Amory, director of surgery at the Allen Pavilion of New York-Presbyterian Hospital.

Amory spoke into a headset to request instruments, prompting Penelope to hand items over while repeating their names, as in a normal operation.

Penelope handled instruments such as clamps and forceps. Human assistants dealt with sponges and sharp items like scalpels and needles.

Iris Lopez, the patient in Penelope's first operation, said she had no worries about the unusual member of the team.

"The robot was just like a human for me," she said.