Abstract and Introduction
Background Intubation is one of the most important anaesthetic skills. We developed a robotic intubation system (Kepler intubation system, KIS) for oral tracheal intubation.
Methods In this pilot study, 12 patients were enrolled after approval of the local Ethics board and written informed consent. The KIS consists of four main components: a ThrustMaster T.Flight Hotas X joystick (Guillemot Inc., New York, NY, USA), a JACO robotic arm (Kinova Rehab, Montreal, QC, Canada), a Pentax AWS video laryngoscope (Ambu A/S, Ballerup, Denmark), and a software control system. The joystick allows simulation of the wrist or arm movements of a human operator. The success rate of intubation and intubation times were measured.
Results Eleven men and one woman aged 66 yr were included in this study. Intubation was successful in all but one patient using KIS at a total time of [median (inter-quartile range; range)] 93 (87, 109; 76, 153) s; in one patient, fogging of the video laryngoscope prevented intubation using KIS.
Conclusions We present the first human testing of a robotic intubation system for oral tracheal intubation. The success rate was high at 91%. Future studies are needed to assess the performance and safety of such a system.
Tracheal intubation is one of the most commonly performed procedures in anaesthesia. Whereas tracheal intubation can be easy in the hands of the skilled operator in the perfect conditions of the operating theatre, it can be more difficult in suboptimal conditions, such as the emergency department, or in the hands of the less skilled, occasional operator. In addition, our patient population has a higher incidence of morbidly obese patients who present specific problems during intubation. Different operator-related factors might also play a role, physical differences, such as arm length or height, and arm strength, might have an influence on the individual skill set. Tracheal intubations, commonly performed with high success rates in anaesthesia departments, can be associated with lower success rates in emergency departments, where intubation success rates can be as low as 70% of the time at the first attempt and 89% at the second attempt.
Robots have long found their way into surgery (e.g. DaVinci robotic system), allowing operating robotic arms with little force and possible higher precision, but less so in anaesthesia. A study conducted by Tighe and colleagues demonstrated the use of a surgical robot to assist in airway management in two cases of mannequin intubation; however, the expense of such a system prohibits its widespread adoption for this application. We have developed a specific robotic intubation system (Kepler intubation system, KIS) and successfully tested it in airway mannequins, including semi-automated operation.
This article presents a pilot study of its evaluation in humans.