DARPA is promoting its vision of the operating room of the future primarily through its Trauma Pod program. It’s an ambitious initiative managed by Richard M. Satava, a professor of surgery at the University of Washington. Satava, a hospital commander in the first Gulf War, was prompted by his experiences there to think about how technology could improve battlefield medical care.

Satava’s main objective with Trauma Pod is to use robotics to project the skills of surgeons to precisely where they’re needed on the battlefield. How to do that? Using an unmanned, mobile operating room that expert surgeons can control at a distance. The concept is in line with the current trend of reducing personnel and logistics on the battlefield through the use of autonomous and teleoperated systems. The U.S. Department of Defense expects to reduce deployed personnel by up to 30 percent by 2025.

Behind this vision is a multiphased program led by SRI that includes contributions from the University of Washington, the University of Texas at Austin, the University of Maryland, and Oak Ridge National Laboratory, as well as from companies like General Dynamics, Intuitive Surgical, General Electric, Robotic Surgical Tech, and Integrated Medical Systems.

In the first phase of the program, to be completed next spring, the goal is to demonstrate a prototype of a trauma pod. The prototype will be built with commercially available technologies wherever possible. Intuitive Surgical’s da Vinci robot will be the main surgical robot, and Integrated Medical Systems’s Life Support for Trauma and Transport (LSTAT) stretcher system will work as a high-tech surgical bed. LSTAT, now used on helicopters and ships as well as by MASH units in the field, carries a defibrillator, ventilator, oxygen supply, and other equipment.

Other systems, however, will have to be custom made. That includes machines to perform the functions of operating room nurses. Our primary role in the Trauma Pod project is in developing the tool changer—an automated machine that performs some of the functions of the nurse who hands surgical tools to the surgeon. Our current prototype consists of a rotating device that holds up to 15 tools. It can retrieve a surgical tool and present a new one in about 0.7 second.

DARPA is planning a series of proof-of-concept demonstrations. If the tests are successful, in the second phase the agency will fund research aimed at miniaturizing and integrating all the systems, so that they form a portable operating-room-on-a-stretcher platform that could eventually be carried by Humvees, helicopters, or other vehicles.

Here’s DARPA’s vision of how it would work: say an explosion sends shrapnel into the leg of a soldier in an urban war zone circa 2025. The soldier is put into a trauma pod that is accompanying the squadron. The trauma pod scans the soldier’s body with a CT system and detects the leg injury. It then administers antibiotics and anesthesia to the wound. Next a surgical robot, remotely controlled by a doctor, removes the metal fragment, stabilizes the bleeding, and closes the wound. The soldier is then evacuated by aircraft to a base nearby for further treatment.

The concept of surgical robots has gone from crude prototypes to FDA-approved commercial technology in just the past 15 years. The surgical robots of the future promise even more spectacular advances. They will use imaging technologies such as ultrasound, MRI, and CT scans as their “eyes,” and they will break free from centuries of surgical convention, entering the body through existing openings and moving inside the patient as they make their way to the surgery area. Your descendants might even swallow one of these some day.

As the technology matures, surgical robots promise to improve a wide range of procedures in terms of patient recovery time, cost, and safety. Medicine, however, is, as it should be, a conservative field, following Hippocrates’ mantra: “I will keep [patients] from harm and injustice.” In the next several decades, surgical robots, like many technologies introduced in medicine, will prove their value and become mainstream tools—tools always guided by a physician’s judgment and dedication to the delivery of the best health care.

Acknowledgments

The authors wish to thank graduate students Mitch Lum, Denny Trimble, and Dianna Warden; our colleagues at the University of Washington Jesse Dosher, Mika Sinanan, and Rick Satava; Timothy Broderick and Lynn Huffman of the University of Cincinnati; and many others for their contributions to our surgical robotics work and helpful comments on this article.