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Telemedicine Carves a Path for Remote Surgery

AAMI

By Gabrielle Hirneise, AAMI contributing writer

Telemedicine has revolutionized the way we view health care, and there is more to come.

Telemedicine became a necessity during the COVID-19 pandemic to limit disease transmission. As the technology grows in popularity, telesurgery – surgeries that can be performed on patients from a remote location via robots and telecommunications platforms – may be on the horizon.

From Robots to Telesurgery

While telesurgery hasn’t yet seen mainstream implementation, it is not a new concept. But much like the revolution that occurred with the introduction of flexible endoscopy and laparoscopic surgery, robotic surgery has become a mainstay in health care. Robot-assisted telesurgery may not be far behind.

Although laparoscopic surgery brought about less invasive procedures and quicker recovery times for patients, the struggle to maintain precision with the small scale of the incisions and the instruments led to the development of surgical robots. In the 1990s, Richard M. Satava was at the forefront of these efforts.

“Robotic surgery is actually an assisting of a surgery – it enhances our performance – I can make motions to 10 microns with a robot, but no human (including myself) is able to do better than 100 microns accuracy,” said Satava, now professor emeritus of surgery at the University of Washington.

But Satava had no interest in stopping there. Having been an academic surgeon, a flight surgeon, an astronaut candidate and an avid science fiction fanatic, he had a vision. The surgeon general at the time saw promise in this vision, especially for military applications, so Satava was sent to DARPA, where he proceeded to fund projects to further robotic surgery and telesurgery.

“On the battlefield, when a soldier is seriously wounded, it will take anywhere from 45 minutes to six hours to get to the closest battlefield hospital,” Satava said. “The death rate between the time they are wounded and the time they arrive at a hospital that has a surgeon was 17%.”

Proposals to improve survivability included an armored vehicle that would double as a roving operating room, where medics could transfer injured soldiers. Inside the vehicle would be a telesurgeon-controlled robot to help keep the patient alive from a remote location. The ambitious project never got off the ground.

Telesurgery Today

In 2001, Jacques Marescaux and a group of surgeons performed the first transatlantic surgery as part of Operation Lindbergh. Based out of New York, the group of surgeons successfully removed the gall bladder of a 68-year-old patient in France. This brought to light a major shortcoming of the technology however, as the telecommunication cost alone was two million dollars.

Technical issues are also a factor. In particular, latency, or the delay between the movements of the surgeon operating the control station and the movements of the robot. Even latency periods of 50 to 150 ms can affect the efficacy of surgical procedures.

Today, advancements such as 5G wireless technology and the recent implementation of telemedicine in light of the COVID-19 pandemic have rekindled interest in remote surgery.

In December 2020, physicians performed vocal cord surgery on a cadaver using a wireless 5G network from 10 miles away. The 5G network allowed for lower latency, and the physicians communicated that the experience was much like being physically present with a patient in the operating room.

In July 2020, a patient who tested positive for COVID-19 needed a collection drained in their forearm. Because only a few physicians could be present to surgically drain the collection, consulting physicians utilized the augmented reality Proximie platform to draw proposed incisions on a screen and speak to the operating physicians in real-time.

As a means for better health care delivery over large distances, or bridging the gap during a public health emergency, telesurgery may just be part of our future. But getting there will take a collective effort from surgeons, engineers and the public alike.

“In medicine and science, when a revolution occurs it only occurs when you have multiple disparate disciplines coming together and making a very complex project become successful,” Satava said.

For more information about telemedicine, check out the AAMI News issue, Focus on Healthcare at Home.

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