A pharmacy technician at Via Christi St. Joseph puts powdered drugs and IV bags into a machine. Inside, a robotic arm picks up the drug, shakes it, then injects just the right amount into the bag of fluids.
“When the robot makes something, it’s exactly right,” said Jim Garrelts, director of pharmacies at Via Christi. “It actually weighs that bag so it knows based on the specific gravity of the drug how much of that drug is supposed to be in there by weight. It checks everything, it does it in a perfectly sterile manner, and that means humans aren’t having to do that.”
Hospitals across the country have been adding robots to make tasks more efficient and more accurate, although experts say that robots aren’t for every procedure.
Other hospitals have robots that can deliver linens and meals. Some have robotic programs that can make diagnoses. In Japan, Toyota has started making what Forbes calls “robotic nurses” that can rehabilitate stroke patients, draw curtains or converse with patients.
Robotic tasks are diverse, from aiding in surgery to zapping germs.
Looks like R2-D2
Some people mistake the squat robot at Wesley Medical Center for an ice cream machine, since it’s covered with stickers of Mutant Ninja Turtles
Its name is Johnny Five, but Randy Marler says “it looks more like R2-D2.”
Marler operates the Xenex, a technology marketed as the “germ-zapping robot.” Wesley purchased it in 2013.
On Friday, Marler wheels the Xenex from room to room in the pediatric ER. He sets up the machine, then exits the room. For a few minutes, bright pulses of light are visible through curtains or shutters.
The Xenex sends out UV light.
“Germs do not live through every flash,” Marler said. “We’ve got some great housekeepers, but I don’t care how good you are, you’re going to miss something. The machine, wherever the light hits it’s going to disinfect whatever’s there.”
The robot doesn’t take the place of someone cleaning the room, said Rich McDonald, director of environmental services at Wesley. Rather, it brings disinfection to a higher level.
Earlier this month, Brett Grizzell, a cardiothoracic surgeon with Wichita Surgical Specialists, sat about 10 feet away from a patient at Via Christi St. Francis.
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Using the da Vinci Surgical System, Grizzell faced away from the patient, looking at 3-D images from cameras inside the patient’s chest. Instead of a large incision in the chest, the da Vinci robot allows for three, small incisions. A small 3-D camera and small surgical instruments are placed inside the patient through those incisions.
The cameras are better than Grizzell’s naked eyes. Unlike human hands, the robot has no tremors.
Patients will have less discomfort and spend about 30 percent less time in the hospital after a da Vinci lung surgery, Grizzell said.
Approved by the Federal Drug Administration in 2000, the da Vinci robot is common in many hospitals, although its $3 million to $4 million price tag keeps it out of some smaller facilities.
It can be used for “just about everything,” Grizzell said, from heart surgeries to colon resection surgeries.
The No. 1 question Christopher Schabowsky gets about the da Vinci is whether the robot is better than open surgery or traditional laparoscopic (minimally invasive) surgery. The answer isn’t so simple, he said.
Schabowsky is a program manager in ECRI Institute’s Applied Solutions Group. ECRI is a nonprofit that researches medical products, and Schabowsky consults with hospitals to help them determine if a surgical robot is worth the cost.
A better question to ask is what procedures is the da Vinci robot best suited for, Schabowsky said.
If the robot allows a surgeon to do a minimally invasive surgery rather than an open surgery, then there will be improved outcomes, Schabowsky said. If not, a robot may not be worth the cost.
“Patients need to be aware that just because a surgical robot is involved in the procedure does not mean they’re going to have better patient outcomes,” Schabowsky said. Outcomes depend on the team, the skill of the surgeon and what procedure is being conducted.
Grizzell agrees that a good surgeon is needed even with robotic surgery.
“This kind of robotic platform is no different than me having a different instrument in my hand,” Grizzell said. “It’s just one of many things that are adapting and evolving. I don’t think it’s replacing any surgery or replacing any surgeons. It’s just part of the evolution of surgery.”
At Wesley, which also has a da Vinci robot, the O-arm Mobile Surgical Imaging System also allows the doctor to see a 3D image.
Logan Sorensen, spine program navigator, said the O-arm acts as a mobile CT scan, helping doctors know exactly where to place screws in a spine surgery.
"You can see a projected screw size, you know where you're placing these screws with almost 100 percent certainty,” Sorensen said.
A downside to the O-arm is that it emits a higher radiation dose than standard fluoroscopy (the dose is similar to a CT scan). The hospital is considering getting a new one with lower radiation for pediatrics. One article published in the Journal of Neurosurgery said that the O-arm, despite the radiation, “allows greater accuracy, lower rate of screw misplacement, and reduced surgical time.”
Adding staff, reducing costs
While hospitals hope that some of these robots will help save money, it isn’t always from cutting staff.
Back at St. Joseph, pharmacy technician Michelle Drew spent time working with the new robots to compound vancomycin into IV bags and syringes.
You still need a person to load and remove drugs from the robot, and the hospital will need an additional employee once it begins compounding drugs it would previously have purchased from elsewhere.
The hospital says the robots are the first of their kind in the area.
“I think it’s very cool to be on the ground floor of something,” Drew said.
The O-arm and da Vinci systems also require additional people to operate them.
As for the new compounding systems at Via Christi, Garrelts said they hope to cover the cost of the two machines (a total of $1 million) in less than three years.
Drugs compounded by the machine have a longer expiration date and not buying from a third party will also result in cost savings, Garrelts said.
“After that we’ll be saving money which, as we all know, reducing healthcare costs is a big deal,” Garrelts said.