Remote surgery (also known as telesurgery) 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. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. 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 less relevant. 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.

Telesurgery uses wireless networking and robotic technology to allow surgeons to operate on patients who are distantly located. This technology not only benefits today’s shortage of surgeons, but it also eliminates geographical barriers that prevent timely and high-quality surgical intervention, financial burden, complications, and often risky long-distance travel. The system also provides improved surgical accuracy and ensures the safety of surgeons. In this paper, we describe the current trend of telesurgery’s innovative developments and its future.

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 . The system overcomes today’s shortage of surgeons, geographical inaccessibility of immediate and high-quality surgical care, significant financial burden, potential complications, and long-distance travel . This technology not only benefits the patients but also provides technical accuracy and ensures the safety of surgeons.

Surgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the da Vinci Surgical System, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engeenering at the Technion. Used mainly for “on-site” surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients. The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point and communicate through headsets during the operation.

The first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon (Dr. Jacques Marescaux) in New York City performing a cholecystectomy on a 68-year-old female patient 6,230 km away in Strasbourg, France. It was named Operation Lindbergh. after Charles Lindbergh’s pioneering transatlantic flight from New York to Paris. France Telecom provided the redundant fiberoptic ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed

The success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS QOS-MPLS. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over 20 complex laparoscopic operations between Hamilton and North Bay.

Since Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopic 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.[citation needed]

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 stones.

In 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries, were insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that, telesurgery is something that is possible and generally safe for large areas within the United States.

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 Italian 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.

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. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body. However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.

Conclusions

The use of telesurgery technology is at a halt and has been since the first and only telesurgery was conducted in 2001. However, with further optimization of visual display, latency time, and haptic feedback technology, design and publication of further randomized controlled trials, and minimization of the factors that limit its clinical translation, telesurgery’s widespread implementation in clinical settings will become highly feasible and geographical barriers will be eliminated.

Source: Wikipedia , ncbi