A U.S. surgeon doesn’t have the everyday opportunity, or responsibility, to oversee a bariatric surgical procedure from his desk at home — especially if that surgery is taking place 5,400 miles away in Argentina.
But perhaps one day, it could be more of a norm, via Remote Presence.
InTouch Health (Santa Barbara, California) last week reported the use of its RP-7 Remote Presence Robot by a Baltimore surgeon who taught his techniques to a surgeons in Argentina, mentoring them not just by telemonitoring but by “telementoring.”
Alex Gandsas, MD, is associate professor of surgery at The Johns Hopkins University School of Medicine and division head of bariatric and minimally-invasive surgery at Sinai Hospital (both Baltimore).
The Argentine surgeons “beamed into the robot that they have at those two hospitals, so they [had] a computer control station in front of them and through the wireless Internet they can beam into that robot, which is about 5 foot, 5 inches tall,” an InTouch spokeswoman told Medical Device Daily, “and they can manipulate it and move it around the OR.”
The bariatric surgery followed a three-month training program, during which Gandsas taught Sergio Cantarelli, MD, and Gabriel Egidi, MD, entirely with the robot, while they were in Bahia Blanca, Argentina.
“I’ve never had the opportunity to shake the hand of either of these surgeons, but with the power of the Internet and the RP-7 robot, I was able to teach and coach these doctors through a very difficult surgery that will positively change a patient’s life forever,” Gandsas said in a statement.
Cantarelli and Egidi first watched Gandsas perform these surgeries in Baltimore through a two-way screen and video offered by the RP-7 robot, and then when it came time for the surgeons in Argentina to perform their surgery, Gandsas watched them from a computer control screen via Cantarelli and Egidi’s robot.
“They had a robot present in their OR, and Dr. Gandsas was able to present through the robot and give them pointers on the surgery to make sure they were doing the safest things and everything necessary to have the surgery be complete,” the spokeswoman said.
The robot displays the doctor’s face on a 15-inch screen and is guided by a joystick from the computerized ControlStation.
InTouch says that Remote Presence telementoring can be used by experts in the field to cost-effectively train physicians and medical teams on any clinical procedure and best practices. The robot is based on InTouch Health’s so-called “Virtually There” technology.
“The RP-7 robot instantly brings specialists to hospitals across the globe in need of training and expertise on surgical procedures that they might not otherwise have access to,” InTouch CEO/chairman Dr. Yulun Wang said in a statement.
The spokeswoman said that this was the “first surgical telementoring from start to finish that we have done.”
However, she said the company expects that this particular application of telemonitoring using the RP-7 is “going to take off.” For example, Gandsas already has two such additional trainings scheduled, and has interest from another surgeon.
Currently, the company has 120 robots in the field, 100 in the U.S. and the remainder outside the country.
“Some hospitals have one, and some hospitals have multiple units,” the spokeswoman said.
Each hospital pays $5,000 per month to rent the robot, and they must purchase each control unit at $2,500 per unit. Typically, the spokeswoman said, one hospital has multiple robots with multiple physicians using it. Robots are often on different floors or on different wings of a hospital, she said, such as the emergency department and the intensive care unit.
The spokeswoman said that many of the users of the RP-7 robot are smaller hospitals, who may not have under its roof the expertise that a larger hospital may have.
In an era when efforts to control costs have all players in the U.S. healthcare system seeking solutions such as pay-for-performance in addition to various quality control measures, one answer to helping physicians and smaller hospitals might just be be contained in a robot.
For example, Gandsas was one of the researchers involved in a study of 376 patients who underwent laparoscopic gastric bypass surgery and was published in the Journal of the American College of Surgeons in July.
In that study, Gandsas and other researchers concluded that “robotic telerounding substantially reduces length of stay of patients undergoing noncomplicated laparoscopic gastric bypass operations.”
“Telepresence technology applied in these settings had a substantial financial impact by reducing variable cost and creating capacity for growth and income,” the study concluded.