Though examinations of the potential impact of telesurgery tend towards the especially dramatic, the possibilities of the technology are both more wide-ranging and comparatively mundane. As robotic-assisted surgery continues to gain in prominence, actual physical proximity of surgeon to patient might become a luxury rather than a necessity.
To learn more about where telesurgery is headed, Surgical Products interviewed Roger Smith, PhD, the chief technology officer for Florida Hospital’s Nicholson Center for Surgical Advancement.
Can you talk about some of the fundamentals of telesurgery? For those physicians who are unfamiliar, how does it work?
Telesurgery, or remote robotic surgery, is a procedure using surgical robots, with the surgeon operating at a location different from their patient. Typically, surgeons conduct robotic surgery through a console, with the patient just a few feet away. With telesurgery, the surgeon could be operating on a patient anywhere, from one room over to thousands of miles away. This is possible through high-speed communication networks and current internet capabilities.
What are some of the successful efforts in telesurgery already undertaken by the Florida Hospital Nicholson Center?
At the Nicholson Center, our primary focus has been testing the feasibility of telesurgery across metropolitan hospital systems. To determine this, we explored the issue of latency in tandem with limited bandwidths, specifically how much latency a surgeon could tolerate before it was no longer safe to operate. Lag times, or video delays, are an incredibly important aspect of telesurgery. Consider a gamer experiencing visual delays due to connectivity issues. They may miss an obstacle or jump too soon to compensate, resulting in a run-in with a wall and costing the gamer the advancement to the next level. For surgical procedures, the logic still runs true. Video delays can result in a severed artery or pierced organ if not handled correctly.
Our studies determined that surgeons cannot even perceive delays below 200 milliseconds, and they can adapt to delays from 200 to 500 milliseconds, while anything above that threshold could put the patient’s safety at risk. We found that current internet capabilities in technology-rich areas make it very possible to conduct telesurgery safely within these latency thresholds, without compromising patient safety.
(Image credit: Florida Hospital Nicholson Center)
How do you envision telesurgery changing access to medical care?
Telesurgery has the potential to greatly improve access to medical care. The concept of remote surgery was originally engineered by the military, with the thought of extending access to emergency surgery on the battlefield. This use case still has potential today. If a soldier was injured on a battlefield and required immediate, specialized surgery, an expert surgeon could operate from a safe area, miles away.
Or, more realistically, many patients in rural areas have limited access to specialized surgeons, specifically for urgent procedures. There may also be patients who are unable to travel due to their condition. Telesurgery could give these patients access to the best surgeons, no matter where they are.
How will telesurgery transform the work of doctors and other healthcare professionals?
Telesurgery will open many doors for doctors and healthcare professionals, but it will also change medical training and education as well. Even though robotic surgery has become a staple for many procedures, such as prostatectomies, there is not yet a universal training system in place for all surgeons. Naturally, training for remote surgery would be much more extensive, incorporating best practices for communication within the operating room and what to do in the case of connectivity issues.
Surgeons trained in telesurgery could one day have the opportunity to expand their skills geographically, no longer needing to be limited to one area.
What changes need to happen with our digital infrastructure to allow telesurgery to become commonplace?
Our current digital infrastructure is actually more than capable of hosting telesurgery. It’s social acceptance and legal hurdles that serve as the primary barriers to making it commonplace.
Performing procedures from a great distance might make some doctors and patients a little nervous. What safeguards are in place to make certain there’s no adverse effects that arise from the basic nature of telesurgery?
There is still a long journey ahead for telesurgery for this very reason. When robotic surgery first started making its way into mainstream medicine, people had the same concerns, and some still do. As with any innovation, remote robotic surgery will take time to be commonly accepted. Research, like the tests conducted at the Nicholson Center, are taking place to ensure doctors are properly prepared for the delays that come along with surgery across the internet. Once medical device companies start developing robots equipped with the ability to communicate across networks, more training and safety measures will be put in place. For now, telesurgery requires additional funding to develop proper technology, as well as addressing matters such as insurance coverage, licensing and legal barriers.
