Performing Surgery from Miles Away

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If you’ve seen the classic 1976 film “Logan’s Run” then you are familiar with the scene of a robot transplanting someone’s face. The protagonist walks into a shop and purchases a new face like a new pair of shoes, and the robot gets started—sans doctor.

Is that what our future is looking like? It’s possible!

In 2001, a successful laparoscopic cholecystectomy, which is a procedure that removes the gallbladder by using smaller incisions, was conducted on a 68-year-old woman with the assistance of a robot. The surgeons were stationed in New York City, while the patient was located in Strasbourg, France. The transatlantic surgery carried out with no difficulties, only took 54 minutes, and the patient witnessed a full recovery within two weeks.

The technology used for this procedure is called “Asynchronous Transfer Mode” or ATM. It included a system called “ZEUS” that consisted of two physically separate subsystems; one was called “surgeon-side” and the other “patient-side.”

The surgeons in NYC had a console that took the surgeon’s input, such as their incisions and other medical procedures, and transported it to the patient’s subsystem that was based in Strasbourg. Two robotic arms translated the input into actual instrument manipulation, and an additional robotic arm controlled the endoscopic camera. The high-speed communication channel–the ATM which linked the two subsystems–connected their two computers from NYC to Strasbourg.

Though the process had about a 155 milliseconds of lag-time, the doctors declared it safe and feasible. The future is for surgeons to be able to conduct procedures from different locations; experts are calling it “telesurgery.”

In 2014, doctors in the Florida Hospital Nicholson Center pushed the limits to test lag-time response when using this machinery and computer programming to see just how far away the doctors could be from the patient. Don’t worry, they weren’t testing it on real patients, but rather using a program called a “mimic simulator.” This allowed surgeons to conduct lifelike procedures from a distance and report back on how accurate and lifelike it really was.

“What we’re researching is when can we take the next step–when can a surgeon go from being 20 or 30 feet away from a patient to being connected by the Internet and be 20 or 30 miles away, or 12,000 or 13,000 miles away?,” Roger Smith, CTO of The Florida Hospital Center, told Computer World.

Really, it came down to connection quality; if the Internet or whatever system they were using was strong and efficient, the surgery would go smoothly.

Recently, doctors have been toying with the idea of using iPads to help conduct medical procedures from miles away. A software program called “Proximie” can be used on an iPad and it makes it possible for surgeons to be present during in-progress surgeries.

Dr. Ghassan Abu-Sitta, head of plastic surgery at the American University of Beirut Medical Center, uses the software to assist with surgeries being conducted in Gaza. He told CNN that he is able to watch a surgery in real time while drawing the proper incisions that needed to be made next on his screen.

He has already used it on two different occasions from hundreds of miles away. He was able to show colleagues in Gaza how to negotiate a blast injury and operate on a congenital anomaly that was affecting the hand while he was in Beirut. He told CNN it felt like he was actually in the room managing the surgery.

That being said, how safe can these systems and robotic assistants be in conducting surgeries?

Dr. Ashutosh Tewari, chairman of urology at Icahn School of Medicine at Mt. Sinai Hospital in New York City, and board-certified neurologist, oncologist, and principal investigator, has high hopes for these types of medical advancements in technology.

“My take on this is that it [Proximie] is very promising technology,” he tells BTRtoday.

However, he does state that there are technological challenges we must first overcome before placing full confidence in this type of equipment.

“When a surgeon is making a decision about a particular action, they are also relying on their experience and the virtual cues that the feed is providing [through the Proximie program],” Dr. Tewari explains. “If that visual feed can be augmented based on imaging or some electrical finding, that the bone is just behind this area or that blood vessels are hiding behind a flab, if that can be superimposed onto the physical feed it will enhance the surgical decision making.”

If anything, Dr. Tewari believes it is an outstanding source of education. “I think it’s not just watching someone doing something; surgery is a combination of decision making, tissue handling, learning the exact steps, and then putting those exact steps just right together,” he says. “The technology will be a bridge between the mind of a trained surgeon and another trained surgeon at a different site.”

Proximie is a surgical assistant tool that connects an expert to a surgeon to help them conduct a delicate procedure, and for that the software has been very successful. However, how about surgical-assisting robots? Are those a safe medical advancement?

A popular robotic surgery system used in the U.S. right now is called da Vinci system. It doesn’t conduct the actual surgery itself, but it does assist the surgeon. These robots help surgeons to make smaller incisions than a human hand could do on its own, which helps quicken the healing process. According to PBS, a study reported that between 2007 and 2011 the number of da Vinci systems installed increased by 75 percent in the United States: from 800 to 1,400.

PBS reported that a study found 245 incidents of death or injuries within 12 years caused by the da Vinci Robotic Surgical System—71 deaths and 174 nonfatal injuries as a result of this equipment were reported to the FDA, with 80 of the reports falling short and five in which no FDA report was even filed.

In 2013, The Seattle Times reported on a man who experienced serious injuries during his robotic assisted prostate surgery. The patient, a 67-year-old retiree, went through a 13-hour procedure where he lost around seven pints of blood and concluded with a torn rectum, permanent incontinence, and eventually suffered from kidney failure and a stroke before passing away not long after.

The doctor who conducted this surgery using the da Vinci robot claimed the company never told him he was going to need an extensive training process, and led him to believe the equipment was simple and easy to use. The company who designs and distributes the da Vinci surgical robots, Intuitive Surgical, Inc., declined an interview with BTRtoday.

So far, these technological advancements in the medical world have helped surgeons and medical professionals to gain knowledge on procedures that they otherwise might have never known about. However, it looks like with the technology that is currently out there, you’ll always need an expert somewhere in the world controlling it.

Looks like we’re not leaving it all up to the robots just yet!