The future of robotics can be ours

The nursing profession is dynamic and evolving. As automation and computerization continue to develop and advance in industry, it is only a matter of time before the health care profession--specifically perioperative nursing--is affected. Robotics is the newest change and challenge. This article will explore the use of robotics and touch briefly on its definition, development, current practice, advantages, disadvantages, and future relating to OR practice.

HISTORY OF ROBOTICS

The term robotics was added to the Cumulative Index to Nursing and Allied Health Literature in 1991. The term originated from the Czech word robota, which means "compulsory labor." It first was used in a 1921 play, Rossum's Universal Robots, by Karel Capek to describe mechanical devices that looked human but lacked human sensibilities and performed only automatic, mechanical operations.(1)

The Robot Institute of America defines robots as reprogrammable

multifunctional manipulators

designed to move material,

parts, tools, or specialized

devices through variable

programmed motions for the

performance of a variety of

tasks.(2)

The most significant development in the robotics field that is not included in this definition is the new use of sensors, which have allowed robots to work in various environments.

Conceptually, robots date back to ancient times, and myths speak about mechanical creatures being brought to life; however, in truth, robotics did not become possible until the invention of the computer in 1941.(3) As computer components have developed and become smaller, the ability to create working robots has become more of a reality.

The first experimental robot was a model called Shakey, developed by the Stanford Research Institute, San Francisco, in the late 1960s. Shakey was able to stack blocks using a television as a visual sensor and then process the information using a small computer. Since this time, the research in robotics has developed quickly.

Today, computers are equipped with microprocessors that can interpret data feedback from a variety of sensors. Using feedback, robots, to some degree, can change their operations in response to changes in their environments. Robotics' sophistication has created robots' ability to pick up eggs by way of tactile array sensors in the gripping mechanisms that send information to main computers regarding the pressure the robotic hands exert.(4) With this information, the main computers instruct the hands to loosen, tighten, or maintain the current gripping force.

The first documentation of robotics used in heath care occurred in 1991 in a Connecticut hospital. Five robots were used as porters to transport items from one area of the hospital to another.(5) Nursing staff members were skeptical of the robots' use; however, they ultimately grew affectionate toward them and eventually named them Roscoe, Reggie, Rover, Rosa, and Rhonda. In the long run, the nurses discovered that a robotic family could be complementary to their work because the robots were able to do the time-consuming work and allow staff members to concentrate on patient care.

PROBLEMS OF A NONAUTOMATED WORLD

Currently, in many ORs, nursing staff members are assigned to hold laparoscopic lenses in place while surgeons operate. There are many inherent problems in using this system, including differences in language.(6) When other people are assigned to control laparoscopes, a new "language" must be developed so that the individuals holding the laparoscopes understand what the surgeons desire.(7) Often the individuals must second-guess what the surgeons want to see--adding time to the procedures and to the patients' exposure to anesthetic agents.(8) Another problem is that during critical moments, the slightest tremor of the individuals holding the laparoscopes can lead to significant patient complications.

A final obstacle is the ever-present financial one. With the increase in financial constraints, the use of extra assistants can add a significant expense. Additionally, if the assistants are less skilled, their lack of understanding of the importance of following instruments in and out of the abdomen through the accessory cannulae can increase the potential for patient injuries.(9) By using robotics, the need for extra assistants is eliminated.

ROBOTIC AIDES

The first surgical systems were passive robotic aides. These were systems in which surgeons provided the physical energy to drive the surgical tools. Today, most robotic aides that have a degree of autonomy have active mechanisms. These aides have been found to be intrinsically safe and currently are in use in stereotactic neurosurgery and laparoscopy.(10) Figures 1 and 2 illustrate a robotic aide used for laparoscopic procedures.

[Figures 1 and 2 ILLUSTRATION OMITTED]

Studies on the accuracy of robotic surgical arms versus experienced human assistants have shown that cameras held by robotic aides are more effectively manipulated and controlled than their human counterparts.(11) Clinical research currently is occurring in orthopedics, urology, and otology.(12) Additionally, a robotic microdexterity platform is being developed for use in brain, eye, ear, nose, throat, face, and hand surgery, in which a telemanipulator can position the tip of a slave arm to an accuracy of 25 [micro]m.(13)