The remote robotic surgery technical guidelines appear in the World Journal of Surgery.
Major medtech and healthcare organizations have collaborated on technical guidelines to support the development of remote robotic surgery.
Announced this week and published in the World Journal of Surgery, the guidelines also serve as a sort of manifesto or mission statement.
The paper’s co-authors — representing Intuitive, Medtronic, Virtual Incision, Johnson & Johnson MedTech, Sovato, Medcrypt, and City of Hope — state a problem: “Access to surgical care remains one of the most pressing yet unsolved public health challenges. Surgical deserts—regions lacking adequate access to surgical care—are a well-documented global issue that affects both developed and developing countries.”
And they say remote robotic surgery could be a solution: “By mitigating geographic barriers, addressing surgical deserts, and reducing travel burdens for surgeons, patients, and their families, remote robotic-assisted surgery and procedures can substantially expand access to high-quality healthcare. … These technical guidelines define the fundamental technical requirements to support the design, implementation, and scaling of safe, effective, and interoperable remote robotic-assisted surgical and procedural programs.”
CMR Surgical, Nanoflex Robotics, LN Robotics, and Microport are among the additional companies and organizations acknowledged in the paper.
Remote robotic surgery’s roots go back to 2001 and the “Lindbergh operation” — in which French surgeons located in New York remotely controlled a surgical robot across the Atlantic Ocean to perform a robot‐assisted laparoscopic cholecystectomy on a 68‐year‐old woman in Strasbourg.
However, it has only been in recent years that advancements in robotic-assisted technology, telemedicine, and telecommunications have enabled the telesurgery concept to take off. A key factor has been the rise of high-speed, lower-cost networks that reduce network latency challenges in the procedures. The technical guidelines paper also highlights the rise of telemedicine and its evolution into a standard component of healthcare delivery, serving as a model for remote surgeries and procedures.
“These technical guidelines represent a step forward towards the future of remote surgery,” said Brian Miller, chief digital officer of Intuitive and one of the paper’s co-authors. “Having helped develop the technology that supported Operation Lindbergh nearly 25 years ago, it’s exciting to see these guidelines come together, and we look forward to what’s to come.”
The co-authors wrote the technical guidelines to serve a wide variety of remote robotic surgery stakeholders, including medical device manufacturers and robotic companies; telecommunications and infrastructure providers; technology and cybersecurity professionals; healthcare organizations, hospital administrators, IT, and other professionals; healthcare providers and clinical teams; research and academic institutions; and healthcare regulators.
Some key recommendations in the technical guidelines paper include:
- The characteristics of a surgical-grade network needed to ensure reliability and maximize uptime, including low network latency, minimal jitter, minimal to no packet loss, low error rates, and guaranteed bandwidth;
- Cybersecurity requirements that comply with existing regulations, guidance, and frameworks while addressing unique cybersecurity risks such as exposure to third-party and/or public networks;
- An outlining of the critical interfaces between the remote-enabled robotic system and the surgical-grade network;
- An emphasis on the need for high-quality real-time network communications consisting of two-way video and audio between the remote physician site and the patient site procedure room — requirements that are essential for maintaining situational awareness;
- Requirements for the remote physician site and patient site facilities.
As the field evolves, the coalition behind the technical guidelines plans to update them to reflect technological advancements, specifications, and emerging best practices. There are plans to publish complementary clinical and operational practice guidelines later this year.
