A group of researchers from University of Florida (UF) recently demonstrated the feasibility of using Intuitive's da Vinci robot for performing a complex nerve block placement procedure from a remote location. The investigational trial, results for which have been published in Anesthesia & Analgesia's September issue, was performed with a phantom ultrasound.
Although the reality of using the da Vinci for anesthesia procedures is still years away, the implications of such an application could be significant. The excitement mainly surrounds the prospect of using the robot to perform complex anesthesia procedures from a remote location. Teleanesthesia--as it's referred to--may help solve the problem of the shortage of anesthesiologists across the country. An anesthesiologist at a large urban hospital, for example, can administer anesthesia to a patient at a small rural hospital miles away without having to be at the patient's bedside.
There are several issues with this idea, however. As with other types of teleconsultations (a term generally used to refer to remotely-delivered patient care), securing reimbursement can be a problem: who should get paid, and for what? In the UF trial, two physicians--a urologist and an anesthesiologist--had to provide support to make sure that the procedure didn't go awry. But in the clinical realm, would both of these physicians be reimbursed? If so, would it even be financially practical to have both providers at the helm? Another piece of the puzzle to consider here is the cost of the equipment--in this case, the multimillion dollar da Vinci robot.
Besides cost and reimbursement issues, there is also the question of clinical efficacy and physician acceptance. The robot has been pushing into surgical specialties for which it really hasn't established robust clinical data, or for which physicians have been more skeptical for one reason or another. On the other hand, we have the oft-told success story of da Vinci in urology, a service line where, despite plentiful data suggesting that da Vinci's clinical outcomes are not necessarily superior to laparoscopy, robotic adoption skyrocketed over the span of a few years.
The point of recounting these da Vinci story lines here is to demonstrate that robotic adoption for new procedures --in this case, anesthesia-related procedures--heavily depends on surgeon buy-in and clinical evidence. Coupled with the reimbursement dilemmas teleanesthesia would provoke, it is safe to say that robotic anesthesia procedures are an intriguing but likely far off application.