Look Mallampati, No Hands!
In a feat that could have important implications for the performance of airway management in remote locations and public spaces—not to mention the operating room—Canadian researchers have developed the first intubating robot.In data presented at the 2012 annual meeting of the Society for Technology in Anesthesia, Thomas Hemmerling, MD, and colleagues at McGill University in Montreal, Quebec, reported early success with their Kepler Intubation System.
The Kepler system consists of a joystick that manipulates a robotic arm, which in turn holds a video laryngoscope (Pentax AWS). An operator sitting in an “intubation cockpit” uses computer software to control the apparatus, which also can be programmed to perform automatically—the ultimate aim of the program, Dr. Hemmerling said.
“One could imagine—obviously not in the near future—that these devices are placed similar to automated defibrillators in the public areas,” Dr. Hemmerling told Anesthesiology News. “Another part of development focuses on evaluating whether the Kepler system can be used with higher precision than manual, human intubation devices—similar to the advantages of the da Vinci surgical robot [Intuitive Surgical] in comparison with endoscopic surgery devices.”
Dr. Hemmerling is the inventor of the McSleepy closed-loop anesthesia system.
To demonstrate the feasibility of the device, Dr. Hemmerling’s group first tested it in mannequins. For 30 intubations, the operator in the cockpit was allowed to directly observe the procedure. For another 30 intubations, the procedure was performed blindly.In both cases, the technology delivered 100% first-pass success, according to the researchers, with similar mean intubation times of 46 and 51 seconds, respectively.
The McGill team then had the robot perform 30 more intubations by following the movements of a pre-recorded procedure. Again, the rate of first-pass success was 100%, yet the mean intubation time was faster, at 41 seconds, the researchers said. For all mannequin procedures, the speed of intubation improved over time, the investigators noted.
Finally, Dr. Hemmerling’s group tested their robot in 12 patients. The device achieved successful intubation in 11 (91%) patients, with one attempt foiled by fogging of the video laryngoscope lens.
“The 91% success rate in human trial is influenced by the small number of patients in this pilot study,” he said. “Don’t forget that the failure in one patient resulted from fogging of the video laryngoscope and had nothing to do with the robot. Fogging is a common problem with video laryngoscopes whether they are attached to a robot or used manually.”