Technical communication: robot-assisted regional anesthesia: a simulated demonstration

Abstract

Recent advances in robotically assisted telesurgery offer expert surgical care for the geographically remote patient. Similar advances in teleanesthesia will be necessary to bring comparable perioperative care to the geographically remote patient. Although many preliminary investigations into teleanesthesia are underway, none involve remote performance of anesthesia-related procedures. Herein, we describe the placement of ultrasound-guided nerve blocks into an ultrasound phantom using the da Vinci multipurpose surgical robotic system (Intuitive Surgical, Sunnyvale, CA). Both single-injection and perineural catheter techniques were successfully performed by an operator who was not physically present at the bedside.

Figure 1

The da Vinci system permitted simultaneous visualization of both ultrasound imagery and needle manipulation external to the phantom surface, and this video output was portable to additional external displays as seen here.

Figure 2

The simulated robotically assisted nerve block required 2 robotic arms. One arm was used for needle manipulation, and the second supported and provided minute adjustments of the ultrasound probe. A third arm was available to assist with manipulation with other equipment used during nerve block placement. The robotic camera angle permitted simultaneous visualization of the ultrasound probe–phantom interface, and needle position.

Figure 3

Photographs depicting the external positioning of the robotic arms and ultrasound probe when viewed externally, as well as the operator view combining live ultrasound and camera video into a single viewport. The needle tip (T) can be visualized in close approximation to the simulated nerve (N).