A remote controlled robotic intubation system? I don’t know if that is a good or bad idea, or if it´s even important. I do know it’s cool though. Because anything robotic is, almost by definition, cool. Anyway, it’s called the Kepler Intubation System (KIS) and was developed using low-cost commercially available components. It uses a client-server model that communicate over the internet.

The creators present a study in an upcoming issue of Anesthesia and Analgesia. They suggest it could bring anesthetist airway skills to remote, rural areas where intubations are rare, and consequently have unacceptably low success rates.

The study
In this small study they present mannequin data from 90 intubations. The operator had no previous experience with the system.

30 intubations were made with the operator sitting in the same room as the mannequin, in direct view of the mannequin. This was the direct view group.

In another 30 intubation the operator was sitting remotely without direct view of the KIS or mannequin. He then had to rely on the KIS camera feeds. This was the indirect view group.

For the final 30 intubations the KIS performed a prerecorded trace of the operator’s controls. Intubation was semi-automated up to the point where the vocal cords where localized after which the operator inserted the tube. The semi-automated group.

All 90 intubation were successful with mean intubations times of 46s, 51s and 42s respectively for the direct, indirect and semiautomated groups.

Intubation times for all consecutive trials are in the graph below. Blue for the direct view group, green for the indirect view and red for the semiautomated intubations. It would have been nice to see all this compared to old school human manual laryngoscopy and intubation. I also wonder how the robot would cope with different patients, emergency situations, difficult airways and so on, where the positioning of the patient and manual larygeal manipulation can be just as important as the actual laryngoscopy.

So, even though robots are cool, I am not sure what all this means. It probably means a robot can intubate a standard grade 1 airway mannequin almost as fast as a human. I don’t know if this is ever going to be a feasible alternative to human manual intubations, or if it is even acceptable.

But that´s probably what those sorry losers said about robot surgery back in the seventies too.




Anesth Analg. 2011 Dec 20. [Epub ahead of print] ´The Kepler Intubation System.´ Hemmerling TM, Wehbe M, Zaouter C, Taddei R, Morse J.

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  1. Minh Le Cong says:

    its a cool concept to prove. I think they have actually tested it on real patients by now.
    Practically though its hard to see how this is going to work in real life clinical cases.

    but then again..in Star wars series…they have robot doctors treating Jedi..even Anakin with his legs cut off after his duel with Obi Wan on the lava planet…my son forces me to watch the complete Star wars anthology

    • Thomas D says:

      I agree, it is a sci-fi concept, but always interesting to see when someone’s trying to push the envelope. Is there a published paper on the live patients, or just anecdotal tests? Anyway, I think my anaesthetist day job is safe a few more years.

  2. Pingback: UPDATE – KEPLER GOES LIVE | ScanCrit.com

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