Telesurgery
Artificial Intelligence Emerging Technology Medicine

Twenty Years of Telesurgery; Improving Healthcare Delivery to Underserved Locations

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January 23, 2021
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The Past, Present, and Future of an Incredible Technology

Reading Time: 5 minutes

Introduction 

“Telesurgery is an emerging surgical system that utilizes wireless networking and robotic technology to connect surgeons and patients who are distantly located from one another.” 

Raison et al. (2015)

It has been twenty years since the first successful telesurgery was conducted in New York, and the robotic and health-tech industry’s tremendous technological advancements are undeniable. That initial procedure, a two-hour-long laparoscopic cholecystectomy (or gallbladder removal), was completed by a team using the ZEUS robotic system. 

The subject was a 68-year-old female with a history of abdominal pain and cholelithiasis. While the patient was in a hospital in Strasbourg, France, her surgeons were working diligently in New York, a whopping 8,700 miles (14,000 km) away. They were connected via high-speed terrestrial networks (Asynchronous Transfer Mode or ATM), which facilitated a data transfer of 10Mb/s. 

The operation lasted one hour and 54 minutes, with an additional 16 minutes to set up the surgical apparatus and for trocar placement. No difficulties or complications were encountered. Despite the extraordinary distance, the average lag time for transmission was estimated at 155 milliseconds (0.155 seconds). 

The patient had an uneventful recovery and returned to normal activities two weeks after the surgery. Though this was not the first robot-assisted surgery ever, it was a huge milestone for the telesurgery industry. 

Source: BBC

The first robotic-assisted surgery you ask? 

Well, it was conducted in 1985 with the help of Puma 560. The robotic arm participated in a stereotaxic operation to insert a needle into the brain for biopsy, a procedure that was previously linked to several physician errors due to hand tremors. 

The surgery sparked more interest in telesurgery, and several subsequent studies sought to improve on lag time and connection. These studies basically aimed to bring actual science and what had previously been science-fiction together. 

Another fortunate benefit of telesurgery is that it can help address the shortage of surgeons, an age-long challenge in medicine. A 2019 report forecasts that physician demand will continue to outpace supply and that by 2032, there will be a discrepancy of between 46,900 to 121,900. As far as surgeons go, according to the report, the US is predicted to lack as many as 23,000 surgeons. 

Technology can step in and with telesurgery, physicians can overcome the barrier of geographical location, thus improving patients’ level of care. 

A Trip Down Memory Lane: The Evolution of Telesurgery

Since 2001, researchers have sought to improve telesurgeries’ success rate with faster networks and improved robots that can deliver great results without complications. Latency time became a monumental challenge. Although the first telesurgery did not run into complications even with a latency time of 155 milliseconds, it has been reported that for optimal results, the target should be less than 100 milliseconds. 

In fact, latency time greater than 300 milliseconds will lead to major inaccuracies in instrument handling. 

Latency time is the time delay in transferring auditory, visual, and even tactile feedback between the two distant locations

Raison et al. (2015)

Between 2003-2005, the use of telesurgery increased, and surgeons conducting an estimated 21 robot-assisted surgeries from a distance. These included 13 fundoplications (a procedure that treats certain gastroesophageal conditions), three sigmoid resections (removal of the sigmoid affected by cancer), two right hemicolectomies (removal of the ascending colon, the part attached to the end of your small intestine), two inguinal hernia repairs, and one anterior resection. The procedures, which took place between St. Joseph’s Hospital in Hamilton, Ontario and North Bay General Hospital in North Bay, Ontario (245 miles apart) were carried out over an IP-VPN system that boasted a speed of 15Mbps of bandwidth. 

In 2007, researchers at the University of Washington deployed a surgical robot in Simi Valley’s desert for telesurgery experiments on an inanimate model. The procedure was powered by wireless communications via Unmanned Aerial Vehicle (UAV). It was performed telerobotically with a maximum latency time of 20 milliseconds between the surgeon’s console (master) and the robot (slave), and 200 milliseconds for the video stream. 

Obviously, the longer the distance, the more the latency time. This is why fast, stable networks are so crucial; thankfully, they are improving quickly, hence 4G and 5G. 

The Rise of 4G and 5G Networks

In December 2018, utilizing a Corindus CorPath System, a doctor in India performed percutaneous coronary interventions on patients about 20 miles (32km) away. Five patients who underwent their elective and experimental PCI at India’s Apex Heart Institute. Those were the first percutaneous coronary interventions conducted from a remote location outside a catheterization lab. 

In December 2019, a Fujian doctor, a province in Southeastern China, performed the first telesurgery over the 5G network. The procedure involved the removal of the liver from a test animal, which was about 30 miles (48km) away. A lag time of 0.1 seconds was maintained, which is fast enough to reduce the risk of potentially deadly medical mistakes in human subjects. 

Source: YouTube

In March 2020, physicians at First Medical Center at PLA General Hospital collaborated with Huawei and China Mobile to guide a stimulation device’s placement in a patient suffering from Parkinson’s disease. It was the first-ever 5G-powered remote surgery conducted on the human brain. The 5G networks made the operation go incredibly smoothly. Although it was conducted on a patient 1864 miles (3000km) away, the surgeon reported that he could barely feel the distance. While speaking about the latency time in this video, he explained how 5G networks are a vast improvement over 4G networks. 

In April 2020, 5G networks assisted Dr. Antonio de Lacy in instructing his remote colleagues who were 3 miles away. He drew on a screen, and although the distance was minimal, the 5G-powered tele-monitored surgery experienced a lag time of only 0.01 seconds (10 milliseconds). 

In June 2020, orthopedic surgeons conducted two remote surgeries with the support of China Telecom and Huawei. There are also reports about how China Mobile assisted in a gallbladder removal over the distance of 124 miles (200km). 

Why is Telesurgery important?

Improving access to crucial procedures

Telesurgery will provide high-quality surgical services to underserved locations like rural areas, spacecraft, battlefields, and more. Patients will no longer have to travel long hours to a surgeon that can attend to them. With improved 5G coverage and advanced robotic surgical arms, the inaccessibility and shortage of surgical experts will hopefully become a thing of the past. By eliminating the necessity for long-distance travel and the financial burdens associated, people can now gain access to quality healthcare much more easily. 

Reducing physician-based errors

Hand tremors are the nightmare of every surgeon. Anxiety and stress trigger difficulties with fine motor tasks. This can impact outcomes, end careers, and even result in untimely death. Since surgeons will be performing procedures in more relaxed circumstances, obstacles like hand tremors can be easily addressed. Telesurgery will improve accuracy and reduce unnecessary damage to healthy tissues. 

Improved collaboration among surgeons

Since telesurgeries are performed via the internet, two or more surgeons can collaborate to oversee procedures.  

Conclusion  

The implementation of telesurgery in the US has been relatively slow. This is due to the FDA’s safety concerns. Most regions of the world also may have legal issues that will stop them from using such technologies. Other challenges associated with telesurgery include the difficulty of acquiring equipment, the need for a fast network, lack of fully developed training programs, and funding. 

As telesurgery continues to gain ground, the big question remains: would you be comfortable going under a knife controlled by robotic arms while your surgeon is several miles away? Let us know in the comment box below and please don’t forget to share this post with anyone who might be interested!

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SOHAIL MERCHANT
Youngstown, Ohio

Medical Doctor (M.D.); Research Fellow at Lumen Foundation Artificial Intelligence Division

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