Meet Penelope.

She works in the operating room (OR), handling surgical instruments, handing them to the surgeon and then returning them to their proper place.

But Penelope isn't your usual scrub nurse. “She“ is the world's first autonomous, vision-guided, intelligent surgical robot under development, according to her manufacturer, Robotic Surgical Tech (RST; New York), with the goal of improving efficiency and patient care in the OR.

The Penelope Surgical Instrument Server made medical history in June when the robot for the first time functioned as an independent assistant to the surgical team at New York-Presbyterian Hospital (New York). Using voice recognition software, a robotic gripper and digital cameras, Penelope successfully completed 37 instrument maneuvers during the excision of a benign tumor on a patient's forearm.

“Everything went very well, and we learned a lot from this first procedure,“ Michael Treat, MD, president and CEO of Robotic Surgical Tech and the designer of the robot, told Medical Device Daily.

When the surgeon asks for an instrument, Penelope identifies it and picks it up from the instrument tray with a special gripper and hands it to the surgeon. When finished, the surgeon simply lays the instrument down. Penelope then uses a vision system to locate where the surgeon has put it and place it back on the instrument tray.

Funded in part from a grant from the National Science Foundation (Arlington, Virginia), Penelope is designed to assist nurses and surgeons, but will have no direct patient contact.

Though other robots have been used in the operating room, Treat said that Penelope is unique. Whereas a robot like the da Vinci from Intuitive Surgical (Sunnyvale, California) — the first operative surgical robotic system cleared by the FDA — functions as an extension of the surgeon's hands and fingers, Penelope is autonomous, performing actions independently, though directed by the surgeon's instruction.

“Penelope is designed to be on her own,“ Treat said. “She is the first robot in the OR that has any degree of artificial intelligence software deliberately put in it. Penelope does her own work in the background. One of the things that she will do is keep her instrument tray updated and rearrange things as necessary to have the right instruments ready.“

Penelope even includes software to predict which instrument the surgeon may need next and provide a detailed count of what instruments were used.

Treat said that Penelope also is the first surgical robot that uses machine vision. Penelope 3.0, the latest version of the robot, does this via two cameras, one over the instrument tray, and the other over the transfer zone where instruments are returned. Having a complete field of view enables Penelope to be fully aware of the situation and instrument positions.

“Having a sense of vision is a very cool thing and a very long-term useful thing,“ Treat said.

Also very cool is Penelope's ability to address the nation's nursing shortage, a situation that Treat, attending surgeon at New York-Presbyterian and assistant professor of clinical surgery at Columbia University (New York), is acutely aware of. His hope is that robots like Penelope can free a hospital's nurses from the more repetitive and qualitative tasks, so they can focus more time on patient care.

“The robot can help a hospital do more cases with the same number of people,“ he said. But Penelope is not intended as a scrub nurse replacement.

“It's not a human being — that's the simplest way to put it,“ Treat said. “It can be a stand-in, or an extender for certain activities, so that [nurses are] doing less of the mechanical things and more of the people things.“

Surgical robots like Penelope are part of the “OR of the future“ — the current surgical buzzword describing the proliferation of advanced technology in the OR to enhance patient safety via improved efficiency. The company said Penelope can help hospitals increase productivity, reduce liability costs and enable more accurate instrument counts and better resource allocation.

“This robot is the start of a new class of surgical robots,“ robots that can function as “independent co-workers,“ Treat said.

RST's goal is for a robotic surgical instrument server to become “something that people will think is pretty much essential, a standard piece of equipment“ in the OR, Treat said. The venture-backed, development-stage company is hoping to get its clinical grade system of Penelope in beta test sites this year as it works toward FDA approval.

“We'd like to essentially find some early partners that want to take the plunge with us into the real OR of the future,“ Treat said. The company is seeking to raise an additional $1.5 to $5 million from venture capital or private investors. “If talks go well, it will be probably sometime in '07 that we would have a fully stickered, street-legal, commercially available version.“

He added, “Even with the relatively early system that we have, the Penelope 3.0, I think a hospital could get more done by simply extending their work force.“

Penelope is not only a new kind of robot, but “represents the beginning of something that is very, very important to healthcare,“ Treat told MDD. “Penelope will have lots of descendants I hope, and I think this robot will be remembered as the very beginning of it all.“

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