Trauma Pod: a semi-automated telerobotic surgical system.

BACKGROUND: The Trauma Pod (TP) vision is to develop a rapidly deployable robotic system to perform critical acute stabilization and/or surgical procedures, autonomously or in a teleoperative mode, on wounded soldiers in the battlefield who might otherwise die before treatment in a combat hospital could be provided. METHODS: In the first phase of a project pursuing this vision, a robotic TP system was developed and its capability demonstrated by performing selected surgical procedures on a patient phantom. RESULTS: The system demonstrates the feasibility of performing acute stabilization procedures with the patient being the only human in the surgical cell. The teleoperated surgical robot is supported by autonomous robotic arms and subsystems that carry out scrub-nurse and circulating-nurse functions. Tool change and supply delivery are performed automatically and at least as fast as performed manually by nurses. Tracking and counting of the supplies is performed automatically. The TP system also includes a tomographic X-ray facility for patient diagnosis and two-dimensional (2D) fluoroscopic data to support interventions. The vast amount of clinical protocols generated in the TP system are recorded automatically. CONCLUSIONS: Automation and teleoperation capabilities form the basis for a more comprehensive acute diagnostic and management platform that will provide life-saving care in environments where surgical personnel are not present.

Towards an intelligent hospital environment: OR of the future.

Patients, providers, payers, and government demand more effective and efficient healthcare services, and the healthcare industry needs innovative ways to re-invent core processes. Business process reengineering (BPR) showed adopting new hospital information systems can leverage this transformation and workflow management technologies can automate process management. Our research indicates workflow technologies in healthcare require real time patient monitoring, detection of adverse events, and adaptive responses to breakdown in normal processes. Adaptive workflow systems are rarely implemented making current workflow implementations inappropriate for healthcare. The advent of evidence based medicine, guideline based practice, and better understanding of cognitive workflow combined with novel technologies including Radio Frequency Identification (RFID), mobile/wireless technologies, internet workflow, intelligent agents, and Service Oriented Architectures (SOA) opens up new and exciting ways of automating business processes. Total situational awareness of events, timing, and location of healthcare activities can generate self-organizing change in behaviors of humans and machines. A test bed of a novel approach towards continuous process management was designed for the new Weinburg Surgery Building at the University of Maryland Medical. Early results based on clinical process mapping and analysis of patient flow bottlenecks demonstrated 100% improvement in delivery of supplies and instruments at surgery start time. This work has been directly applied to the design of the DARPA Trauma Pod research program where robotic surgery will be performed on wounded soldiers on the battlefield.