Will robot Penelope replace a scrub nurse?

Robot hears surgeon’s request, gives instruments

A portable robot may be available later this year that can stand in for a scrub nurse. Penelope (Manufacturer: Robotic Surgical Tech in New York City) can hand instruments to surgeons during basic general surgeries such as hernias. The robot is awaiting approval from the Food and Drug Administration (FDA).

Penelope, which was developed with a grant from the Arlington, VA-based National Science Foundation, is a cart on wheels that holds a platform including a back tray, front Mayo stand, and side instrument tray.

The robotic arm automatically unpacks a sterile general instrument case from a back tray, arranges the 12 instruments most likely to be used on the Mayo stand, puts the remainder of the instruments on a side tray, and delivers instruments to the surgeon upon request.

The surgeon puts used instruments in a sterile transfer zone, and the robot returns them to the Mayo stand.

Penelope’s control software includes routines for speech recognition to listen to the surgeon, machine vision to see the surgical instruments, motion control to move the arm, and speech generation to give the robot a voice.

Counting will be a shared responsibility of the circulator and the robot, says Michael Treat, MD, the developer.

"The circulator will communicate with the robot by a handheld PDA [personal digital assistant] that will have the update with the count, so the robot is aware, he says. "The circulator can request and update the count at any time, including at the closing time."

The robot also will be able to provide a photographic or electronic documentation of the items that it has handled, Treat notes.

Penelope also has a memory that allows it to learn what a particular surgeon normally uses. If the surgeon asks for another instrument when he or she normally asks for a Crile clamp, for example, the robot will ask the surgeon if he or she meant to ask for a Crile clamp.

"It learns based on your experiences what you’re doing to use in these cases and remembers that, just like a human," Treat says. The information can be transferred from one robot to another one at another facility, he says.

The robot will cost approximately $7 per hour over its lifetime of five years, based on the estimated price of $100,000, Treat says.

He estimates that this price compares with a $30-and-up hourly rate for a scrub nurse, with the hourly rate for surgical technicians not far behind. The software will require maintenance and upgrades, but the company hasn’t developed a price for those services, Treat adds.

While some nurses are likely to feel threatened by the robot, others see Penelope as a positive technological advancement that can free nurses from mundane tasks to use their more advanced skills in caring for patients.

"If you’ve ever scrubbed a hernia repair or some minor procedures such as breast procedures, if you do that all day every day, what challenge is there to that?" asks Nancy E. Fox, RN, BSN, CNOR, nursing educator and consultant with Fox & Associates, a Cincinnati-based consulting firm specializing in perioperative services. "Why not give that up to a robot and use your cognitive skills in a more difficult procedure, such as a cholecystectomy?"

Many nurses are becoming burned out because they aren’t showcasing their skill set, she says. "They don’t keep refocusing and trying." The robot also could free surgical techs to use more advanced skills in more difficult procedures, Fox says. "I don’t think the robot could completely eliminate someone’s job," she adds.

To prevent nurses from feeling threatened by this technology, managers should convey their vision for the department and the team and explain this technology allows staff to use their talents in more difficult procedures.

"A nurse has such a broad range of skills: social sciences, psychology, pharmacology, in-depth anatomy, and physiology," Fox says. "They can more actively advocate for the patient, letting family know more information, completing intraoperative records."

For example, every dilation and curettage isn’t identical, she says. Different cases have different patients, lab values, etc., she says. "A keen eye and knowledge base helps you understand and advocate for that patient more fully," Fox explains. "If you’re fully task-oriented, you miss many significant details."

Nurses are being pulled forward, she adds. "If you go kicking and screaming, it’s much harder to deal with the future. If you understand the future and how technology can help you benefit, it can make life easier, allow you to adapt, and allow you to become more of an advocate and shine with a more advanced skill set."


For more information, contact:

  • Nancy E. Fox, RN, BSN, CNOR, Nursing Educator and Consultant, Fox & Associates, 7010 Hiawatha Ave., Cincinnati, OH 45227-3802. Phone: (513) 272-3365.