Robot may be new wave in cosmetic procedures

Using a robot to conduct remote tele-rounds can halve the average hospital stay of laparoscopic gastric bypass patients, according to a new study. Already, the unit also has proven useful for teaching surgical procedures, while the system also could serve patients undergoing post-bariatric revisions and other procedures or consultations, experts add.

In the study, doctors used a six-foot-tall remote presence robot (RP-7; InTouch Health) to conduct night and other rounds and compared how bariatric patients in this group fared versus those who exclusively received in-person rounds. They found through retrospective chart review that mean length of stay (LOS) totaled 2.33 days in the group that received in-person visits (284 patients) versus 1.26 days in 92 patients who received robotic visits.

Impetus for the study came from reading about the robot’s use in a urology setting, says Alex Gandsas, M.D., chief of bariatric surgery, Sinai Hospital, Baltimore, associate professor of surgery, Johns Hopkins School of Medicine, and the bariatric study’s lead author. While the urology study focused on patient satisfaction, says Dr. Gandsas, “I thought one probably could use a similar approach not only to make patients happy, but also to decrease LOS by rounding these patients more frequently and helping them reach discharge criteria sooner.” The study design excluded patients who suffered post-operative complications, as robotic visits wouldn’t help in these cases, he says. More importantly, physicians visited patients in the bedside-rounds group (Group A) post-operatively, then the next morning and late afternoon, followed by a morning bedside visit on day two. Patients receiving robotic rounds (Group B) got bedside visits at the same intervals in addition to tele-rounds on their first post-operative night, plus at noon, 2 p.m. and 7 p.m. the following day.

The robot features an LCD display that projects the surgeon’s image to the patient, plus two built-in cameras and a microphone that enable the surgeon to conduct a two-way videoconference, says Dr. Gandsas. “It also has rollers so one can drive the robot using a joystick” connected over an 802.11-G wireless network (with data encryption) to a standard Windows PC, he adds. “With the cameras and monitoring display,” says Dr. Gandsas, “the patient can see and hear you. At the same time, you can hear and see the patient, as well as zoom in and move around” as needed. Using the robot, he states, “We were able to identify and quickly correct situations that would have delayed discharge, for example, insufficient hydration, poor breathing (checked through a standard spirometer) or pain that wasn’t being sufficiently managed.”

Earlier discharges achieved with the $200,000 robot contributed a projected $380,000 to the hospital’s bottom line, says Dr. Gandsas. Meanwhile, he says patients welcomed the system with “open arms. It’s somewhat like talking on the phone ? patients quickly focus on the conversation, not the technology.” Additionally, he notes that earlier studies have shown patients prefer electronic visits with their treating physicians over in-person visits by strangers.