Remote surgery
Encyclopedia
Remote surgery is the ability for a doctor to perform surgery
on a patient even though they are not physically in the same location. It is a form of telepresence
. Remote surgery combines elements of robot
ics, cutting edge communication technology
such as high-speed data connections and elements of management information system
s. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting
for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.
) in New York
performing a cholecystectomy
on a 68-year-old female patient 6,230 km away in Strasbourg
, France
named Operation Lindbergh. That operation, called Project Lindbergh after Charles Lindbergh
’s pioneering transatlantic flight
from New York to Paris, was conducted over a dedicated fiberoptic
link to ensure guaranteed connectivity and minimal lag
.
surgeon in Hamilton
, Canada
, has conducted numerous remote surgeries on patients in North Bay
, a city 400 kilometres from Hamilton. Even though he uses a VPN
over a non-dedicated fiberoptic connection that shares bandwidth
with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.
Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital
in Toronto
, Canada, the surgical room responds to the surgeon’s voice commands
in order to control a variety of equipment at the surgical site, including the lighting
in the operating room, the position of the operating table and the surgical tools
themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.
The possibility of being able to project the knowledge and the physical skill of a surgeon
over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics
can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres
.
Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy’s Hospital in London
, England
compared the success of kidney
surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stone
s .
surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention . This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.
make this easy in a three dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.
Another future possibility could be the use of remote surgery during long space exploration missions.
and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
on a patient even though they are not physically in the same location. It is a form of telepresence
Telepresence
Telepresence refers to a set of technologies which allow a person to feel as if they were present, to give the appearance of being present, or to have an effect, via telerobotics, at a place other than their true location....
. Remote surgery combines elements of robot
Robot
A robot is a mechanical or virtual intelligent agent that can perform tasks automatically or with guidance, typically by remote control. In practice a robot is usually an electro-mechanical machine that is guided by computer and electronic programming. Robots can be autonomous, semi-autonomous or...
ics, cutting edge communication technology
Telecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
such as high-speed data connections and elements of management information system
Management information system
A management information system provides information needed to manage organizations efficiently and effectively. Management information systems involve three primary resources: people, technology, and information. Management information systems are distinct from other information systems in that...
s. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting
Telecommuting
Telecommuting or telework is a work arrangement in which employees enjoy flexibility in working location and hours. In other words, the daily commute to a central place of work is replaced by telecommunication links...
for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.
The Lindbergh Operation
One of the earliest remote surgeries was conducted on 7 September 2001 across the Atlantic Ocean, with a surgeon (Dr. Jacques MarescauxJacques Marescaux
Jacques Marescaux is a French doctor of international renown. He is Chairman of the digestive and endocrine surgery at University Hospital, Strasbourg.- Biography :* 1948: Born in Clermont* 1971: Major in the contest for the Internat...
) in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
performing a cholecystectomy
Cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.-Open surgery:A...
on a 68-year-old female patient 6,230 km away in Strasbourg
Strasbourg
Strasbourg is the capital and principal city of the Alsace region in eastern France and is the official seat of the European Parliament. Located close to the border with Germany, it is the capital of the Bas-Rhin département. The city and the region of Alsace are historically German-speaking,...
, France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
named Operation Lindbergh. That operation, called Project Lindbergh after Charles Lindbergh
Charles Lindbergh
Charles Augustus Lindbergh was an American aviator, author, inventor, explorer, and social activist.Lindbergh, a 25-year-old U.S...
’s pioneering transatlantic flight
Transatlantic flight
Transatlantic flight is the flight of an aircraft across the Atlantic Ocean. A transatlantic flight may proceed east-to-west, originating in Europe or Africa and terminating in North America or South America, or it may go in the reverse direction, west-to-east...
from New York to Paris, was conducted over a dedicated fiberoptic
Optical fiber
An optical fiber is a flexible, transparent fiber made of a pure glass not much wider than a human hair. It functions as a waveguide, or "light pipe", to transmit light between the two ends of the fiber. The field of applied science and engineering concerned with the design and application of...
link to ensure guaranteed connectivity and minimal lag
Lag
Lag is a common word meaning to fail to keep up or to fall behind. In real-time applications, the term is used when the application fails to respond in a timely fashion to inputs...
.
Applications
Since then, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopicLaparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
surgeon in Hamilton
Hamilton, Ontario
Hamilton is a port city in the Canadian province of Ontario. Conceived by George Hamilton when he purchased the Durand farm shortly after the War of 1812, Hamilton has become the centre of a densely populated and industrialized region at the west end of Lake Ontario known as the Golden Horseshoe...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, has conducted numerous remote surgeries on patients in North Bay
North Bay, Ontario
North Bay is a city in Northeastern Ontario, Canada. It is the seat of Nipissing District, and takes its name from its position on the shore of Lake Nipissing.-History:...
, a city 400 kilometres from Hamilton. Even though he uses a VPN
Virtual private network
A virtual private network is a network that uses primarily public telecommunication infrastructure, such as the Internet, to provide remote offices or traveling users access to a central organizational network....
over a non-dedicated fiberoptic connection that shares bandwidth
Bandwidth (computing)
In computer networking and computer science, bandwidth, network bandwidth, data bandwidth, or digital bandwidth is a measure of available or consumed data communication resources expressed in bits/second or multiples of it .Note that in textbooks on wireless communications, modem data transmission,...
with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.
Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital
Mount Sinai Hospital (Toronto)
Mount Sinai Hospital is a hospital in Toronto, Ontario, Canada. Although it is physically linked by bridges and tunnels to two University Health Network hospitals , Mount Sinai is an independently operated facility...
in Toronto
Toronto
Toronto is the provincial capital of Ontario and the largest city in Canada. It is located in Southern Ontario on the northwestern shore of Lake Ontario. A relatively modern city, Toronto's history dates back to the late-18th century, when its land was first purchased by the British monarchy from...
, Canada, the surgical room responds to the surgeon’s voice commands
Speech recognition
Speech recognition converts spoken words to text. The term "voice recognition" is sometimes used to refer to recognition systems that must be trained to a particular speaker—as is the case for most desktop recognition software...
in order to control a variety of equipment at the surgical site, including the lighting
Lighting
Lighting or illumination is the deliberate application of light to achieve some practical or aesthetic effect. Lighting includes the use of both artificial light sources such as lamps and light fixtures, as well as natural illumination by capturing daylight...
in the operating room, the position of the operating table and the surgical tools
Surgical instruments
A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools...
themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.
The possibility of being able to project the knowledge and the physical skill of a surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics
Telerobotics
Telerobotics is the area of robotics concerned with the control of robots from a distance, chiefly using wireless connections , "tethered" connections, or the Internet...
can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres
Field hospital
A field hospital is a large mobile medical unit that temporarily takes care of casualties on-site before they can be safely transported to more permanent hospital facilities...
.
Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy’s Hospital in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
compared the success of kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s .
Unassisted robotic surgery
As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an ItalianItaly
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention . This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.
Force-Feedback and Time Delay
The ability to carry out delicate manipulations relies greatly upon feedback. For example it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or Haptic technology, have been developed to simulate this. However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.Depth Perception
Being able to gauge the depth of an incision is crucial. Humans binocular visionBinocular vision
Binocular vision is vision in which both eyes are used together. The word binocular comes from two Latin roots, bini for double, and oculus for eye. Having two eyes confers at least four advantages over having one. First, it gives a creature a spare eye in case one is damaged. Second, it gives a...
make this easy in a three dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.
Possible Uses
One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.Another future possibility could be the use of remote surgery during long space exploration missions.
Limitations
For now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments. Before its acceptance on a broader scale, many issues will need to be resolved. For example, established clinical protocols, training, and global compatibility of equipment must be developed. Also, there is still the need for an anesthesiologistAnesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....
and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.
External links
- Article and Media Gallery for telesurgery
- PBS article on telesurgery
- Using remote surgery as a teaching tool
- How robotic surgery works
- Article in Pulse of the Planet about remote surgery
- BBC News SCI/TECH -- First transatlantic surgery
- High Performance Network Video in support of Telesurgery / NEEMO7 Mission - Revolutionary Telemedicine Techniques
- Robot Successfully Completes Unassisted Heart Surgery