PO-631-01 TELEROBOTIC CARDIAC CATHETER ABLATION IN A RURAL HOSPITAL: A PROOF-OF-CONCEPT SIMULATION STUDY

Abstract

Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the US and worldwide. Advancements in telecommunication, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. The purpose of this study was to pilot test a system and methods to explore remote surgery in a rural community hospital setting using a novel telerobotic catheter ablation platform. Telerobotic System: We assembled a portable pre-clinical telerobotic catheter ablation system from commercial-grade components using 3rd party vendors. A Plexiglas case housed a 3-dimensionally printed cardiac model and simulated vasculature to represent the patient. Finally, we used a proprietary telerobotic cloud service and an off-the-shelf VR headset to allow a remote operator to perform the simulated telerobotic operations. Simulations: We carried out eight simulations with an experienced operator in Chicago, IL, and the Operating room (OR) team at Ocean Beach Hospital, a rural community hospital in Ilwaco, WA. OR team members were assigned to one of two simulation scenarios: loss of network connection or cardiac perforation with subsequent life-threatening tamponade physiology. Ethnographic Study: Two ethnographers observed and recorded each simulation via two stationary cameras in the rural hospital OR. The ethnographers also conducted semi-structured and focus group interviews. Interviews and observations suggested that rural OR teams could readily adapt to the telesurgery context. However, team perceptions of communication and emergency management were significantly impacted during simulated network failure with loss of contact with the remote operator. Most participants believed the team would have been more responsive to the challenges had they received formal training or had prior experience with the procedure. We demonstrate feasibility of a system and methods for the study of specialty telerobotic surgery in a rural hospital OR setting.