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Sighinolfi MC, Moschovas MC, Qun Z, Yuntao M, Hui C, Dan X, Shuo W, Xiao L, Jun W, Rocco B, Patel V. Current perspectives of telesurgery applications among different specialties: first multicentric and multispecialty retrospective study. J Robot Surg 2025; 19:247. [PMID: 40434479 DOI: 10.1007/s11701-025-02393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Accepted: 05/07/2025] [Indexed: 05/29/2025]
Abstract
Telesurgery has recently emerged as a transformative technology with the potential to revolutionize surgical care with humanitarian and training opportunities. The advent of new robotic systems with telesurgical capabilities promoted the interest toward telesurgery; the Toumai (Microport, China) is among these new platforms and the only approved in Europe so far. The Toumai is a multiport robotic system with an immersive console and a single patient cart. The aim of the study is to report the largest series of telesurgical robotic procedures reported so far to prove the feasibility and safety of the technology. This is a multicenter cohort study on a series of patients who underwent robotic telesurgical procedures across China with the Toumai robotic system. The primary endpoint is to evaluate the safety of telesurgery measured as the need for conversion to local surgery or to different approaches. Furthermore, we reported the type of procedures performed and summarized the characteristics of connectivities. Overall, 66 overall surgeries-consisting of ten urological, 55 general, and one gynecological case-were performed with the Toumai across China, with an average distance of was 800, 220, and 300 km, respectively. No conversions to local surgery were recorded. The average delay time was 65, 34, and 61 ms for urological, general, and gynecological surgery, respectively. Apart from colecistectomies, gastric surgery (total gastrectomy, gastrowedge resection) and radical prostatectomies were the mostly performed interventions. Despite some issues needs to be addressed from a regulatory standpoint, technological and telecommunication advancements are willing to support the successful implementation of telesurgery; further series are expected to address the reproducibility of these outcomes in European countries.
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Affiliation(s)
| | | | - Zhao Qun
- The Fourth Hospital of Heibei Medical University Heibei Tumor Hospital, Shijiazhuang, China
| | - Ma Yuntao
- Gangsu Provincial Hospital, Lanzhou, China
| | - Cai Hui
- Gangsu Provincial Hospital, Lanzhou, China
| | - Xia Dan
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wang Shuo
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Xiao
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Wang Jun
- The Second Hospital of Dalian Medical University, Dalian, China
| | | | - Vipul Patel
- Global Robotic Institute, Adventhealth, Orlando, USA
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Chu G, Guan B, Ji X, Yu X, Yang R, Besli S, Zhao J, Gao Y, Wang J, Wang S, Li J, Niu H. Global trends and insights of telesurgery research: a bibliometric analysis of publications since the 21st century. Surg Endosc 2025; 39:3259-3284. [PMID: 40229598 DOI: 10.1007/s00464-025-11697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 03/30/2025] [Indexed: 04/16/2025]
Abstract
BACKGROUND In recent years, telesurgery has shown a rapid development trend as an innovative surgical technique, and been applied to the clinical treatment of various tumor diseases. However, the current research on telesurgery is still relatively fragmented, lacking a systematic summary of its development and future directions. Addressing these limitations is crucial for advancing the application of this novel surgical technology. METHODS This bibliometric study of publications related to telesurgery that were indexed in the Web of Science Core Collection from 2000 to 2024. VOSviewer, CiteSpace, and Bibliometrix were used to analyze and visually represent the gathered data, and the relevant content was presented according to the BIBLIO guidelines. RESULTS We researched 565 publications across 269 journals authored by 2422 individuals affiliated with 917 institutions spanning 62 countries. Notably, the United States leads in the number of publications, with China also making noteworthy contributions. Kyushu University and the University of Washington emerge as prominent institutions in terms of research output within this domain. Analysis of document co-occurrence and co-citation reveals that Jacques Marescaux from France holds the top position globally among authors and wields significant influence in this field. Keyword analysis indicates that key future research directions in this area include mitigating latency issues in telesurgery, integrating advanced network communication technologies, and enhancing the performance of telesurgical robots. Furthermore, ethical and legal issues associated with telesurgery may emerge as critical challenges to be addressed for its further expansion and application. CONCLUSION This research provides an overview of telesurgery research findings, encompassing the evolution of research priorities in telesurgery. The study anticipates that the secure implementation and broader adoption of telesurgery will bring more benefits to patients on a global scale.
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Affiliation(s)
- Guangdi Chu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bo Guan
- Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China
| | - Xiaoyu Ji
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xue Yu
- Qingdao Sixth People's Hospital, Qingdao, China
| | - Ruonan Yang
- Department of General, Visceral and Transplant Surgery, University of Munich, Munich, Germany
| | - Sevval Besli
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Jianchang Zhao
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yuan Gao
- Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China
| | - Jianning Wang
- Department of Urology, Shandong Medicine and Health Key Laboratory of Organ Transplantation and Nephrosis, The First Affliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology, Jinan, China
| | - Shuxin Wang
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.
- Chongqing University, Chongqing, China.
| | - Jianmin Li
- Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China.
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
- Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China.
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Patel V, Collins JW, Marescaux J, Dohler M, Saikali S, Dasgupta P, Reddy S, Gamal A, Patel E, Rogers T, Siddiqui A, Breda A, Mottrie A, Hassan A, Hung A, Secord A, Rocco B, Pugh C, Sundaram C, Sighinolfi MC, Ellison EC, Davila EP, Wilson E, Balkhy H, Kaouk J, Liang C, Kavoussi LR, Roche M, Martino M, Anvari M, Sylla P, Coelho RF, Thomas R, Clayman R, Leveillee R, Estape R, Goldberg R, Madder R, Horgan S, Magnuson JS, Nathan S, Ross S, Costello A, Xu Z, Chauhan S, Redan J, Satava R, Miles B, Sachdeva AK, Moschovas MC. International multispecialty consensus statement and expert opinion of best practices in telesurgery. J Robot Surg 2025; 19:135. [PMID: 40167848 DOI: 10.1007/s11701-025-02298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 03/18/2025] [Indexed: 04/02/2025]
Affiliation(s)
- Vipul Patel
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Justin W Collins
- Division of Surgery and Interventional Science, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Mischa Dohler
- Advanced Technology Group, Ericsson Inc., Santa Clara, CA, USA
| | - Shady Saikali
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
| | - Prokar Dasgupta
- King's College London, King's Health Partners, Responsible, AI, UK
| | - Sumeet Reddy
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
| | - Ahmed Gamal
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
| | - Ela Patel
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebrations, FL, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, SUNY University at Buffalo, Buffalo, NY, USA
| | - Alberto Breda
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | | | - Ameer Hassan
- Department of Neuroscience Valley Baptist Medical Center, Harlingen, TX, USA
| | - Andrew Hung
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Bernardo Rocco
- ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | | | | | | | - Eduardo Parra Davila
- Hernia and Abdominal Wall Reconstruction, Good Samaritan Medical Center-TENET Health, West Palm Beach, FL, USA
| | - Erik Wilson
- University of Texas Health Science Center, Houston, TX, USA
| | - Husam Balkhy
- University of Chicago Medicine, Chicago, IL, USA
| | - Jihad Kaouk
- Center for Robotic and Image Guided Surgery, Zegarac-Pollock Endowed Chair in Robotic Surgery, Vice Chair of Enterprise Surgical Operations, Cleveland Clinic, Cleveland, OH, USA
| | - Cui Liang
- Department of Urology, Civil Aviation General Hospital, Chaoyang District, Beijing, China
| | | | | | | | | | - Patrice Sylla
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Ralph Clayman
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Raymond Leveillee
- Bethesda Hospital, Baptist Health South Florida, Coral Gables, FL, USA
| | - Ricardo Estape
- HCA Florida Institute for Gynecologic Oncology, Miami, FL, USA
| | - Ross Goldberg
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Madder
- Frederik Meijer Heart & Vascular Institute, Corewell Health West, Grand Rapids, MI, USA
| | | | | | | | | | | | - Zhang Xu
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, China
| | | | - Jay Redan
- University of Central Florida (UCF), Orlando, FL, USA
- AdventHealth, Orlando, FL, USA
| | | | - Brian Miles
- Houston Methodist Hospital, Houston, TX, USA
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, IL, USA
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Celebrations, FL, USA.
- University of Central Florida (UCF), Orlando, FL, USA.
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Pavone M, Goglia M, Rosati A, Innocenzi C, Bizzarri N, Seeliger B, Mascagni P, Ferrari FA, Forgione A, Testa AC, Fagotti A, Fanfani F, Querleu D, Scambia G, Akladios C, Marescaux J, Lecointre L. Unveiling the real benefits of robot-assisted surgery in gynaecology: from telesurgery to image-guided surgery and artificial intelligence. Facts Views Vis Obgyn 2025; 17:50-60. [PMID: 40297947 PMCID: PMC12042076 DOI: 10.52054/fvvo.2024.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 11/19/2024] [Indexed: 04/30/2025] Open
Abstract
Background Several new robotic platforms are being commercialised, with different features in terms of types of consoles, numbers of arms, and targeting transabdominal or natural orifice approaches. The benefits of robotic surgery over laparoscopy have yet to be conclusively demonstrated in gynaecology, as several studies comparing perioperative and postoperative patient outcomes have reported no significant differences, leading to a lack of precise recommendations in surgical guidelines for both gynaecologic oncology and benign gynaecology. In addition, these outcomes must be balanced against the high costs of robotic surgery, in particular when considering building an infrastructure for safe telesurgery to democratise access to telementoring and remote interventions. Objectives Drawing from the expertise gained at the IRCAD Research and Training Center in Strasbourg, France, this article aims to provide an overview of the unveiled benefits of robotic-assisted surgery in gynaecology, investigating the role of digital surgery integration. Methods The objective of this narrative review is to provide an overview of the latest advancement in digital robotic-assisted surgery in gynaecology and illustrate the benefits of this approach related to the easiest integration with new technologies. To illustrate such evidence, PubMed, Google Scholar, and Scopus databases were searched. Main Outcome Measures In the era of surgical innovation and digital surgery, the potential of robotic surgery becomes apparent through the capacity to integrate new technologies. Image-guided surgery techniques, including the analysis of preoperative and intraoperative images, 3D reconstructions and their use for virtual and augmented reality, and the availability of drop-in robotic ultrasound probes, can help to enhance the quality, efficacy and safety of surgical procedures. Results The integration of artificial intelligence, particularly computer vision analysis of surgical workflows, is put forward to further reduce complications, enhance safety, and improve operating room efficiency. Additionally, new large language models can assist during procedures by providing patient history and aiding in decision-making. The education and training of young surgeons will undergo radical transformations with robotic surgery, with telementoring and shared procedures in the side-by-side double-console setup. Conclusions Robotic systems play a fundamental role in the transition towards digital surgery, aiming to improve patient care through integration of such new technologies. What is New? While the advantages of robotic surgery in terms of perioperative outcomes have yet to be demonstrated, the benefits of its easiest integration with new technologies are evident.
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Affiliation(s)
- Matteo Pavone
- IRCAD France Research Institute Against Digestive Cancer, Strasbourg, France
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- ICube, Laboratory of Engineering, Computer Science and Imaging, Department of Robotics, Imaging, Teledetection and Healthcare Technologies, University of Strasbourg, Strasbourg, France
| | - Marta Goglia
- IRCAD France Research Institute Against Digestive Cancer, Strasbourg, France
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Rosati
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
| | - Chiara Innocenzi
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
| | - Nicolò Bizzarri
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
| | - Barbara Seeliger
- IRCAD France Research Institute Against Digestive Cancer, Strasbourg, France
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICube, Laboratory of Engineering, Computer Science and Imaging, Department of Robotics, Imaging, Teledetection and Healthcare Technologies, University of Strasbourg, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Pietro Mascagni
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Antonello Forgione
- IRCAD France Research Institute Against Digestive Cancer, Strasbourg, France
| | - Antonia Carla Testa
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Denis Querleu
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, UOC Ginecologia Oncologica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cherif Akladios
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IRCAD France Research Institute Against Digestive Cancer, Strasbourg, France
| | - Lise Lecointre
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICube, Laboratory of Engineering, Computer Science and Imaging, Department of Robotics, Imaging, Teledetection and Healthcare Technologies, University of Strasbourg, Strasbourg, France
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
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5
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Heemeyer F, Boehler Q, Kim M, Bendok BR, Turcotte EL, Batjer HH, Madder RD, Pereira VM, Nelson BJ. Telesurgery and the importance of context. Sci Robot 2025; 10:eadq0192. [PMID: 40009655 DOI: 10.1126/scirobotics.adq0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 01/28/2025] [Indexed: 02/28/2025]
Abstract
Telesurgery has the potential to overcome geographical barriers in surgical care, encouraging its deployment in areas with sparse surgical expertise. Despite successful in-human experiments and substantial technological progress, the adoption of telesurgery remains slow. In this Review, we analyze the reasons for this slow adoption. First, we identify various contexts for telesurgery and highlight the vastly different requirements for their realization. We then discuss why procedures with high urgency and skill sparsity are particularly suitable for telesurgery. Last, we summarize key research areas essential for further progress. The goal of this Review is to provide the reader with a comprehensive analysis of the current state of telesurgery research and to provide guidance for faster adoption of this exciting technology.
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Affiliation(s)
| | | | - Minsoo Kim
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
- Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Otolaryngology Head and Neck Surgery/Audiology, Mayo Clinic, Phoenix, AZ, USA
| | - Evelyn L Turcotte
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- University of Texas at Tyler School of Medicine, Tyler, TX, USA
| | - Ryan D Madder
- Frederik Meijer Heart and Vascular Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Vitor M Pereira
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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6
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Srivastava SP, Srivastava VP, Singh A, Dwivedi S, Batra M, Gupta S, Singh S, Kulkarni SS, Paul A, Kumar A, Agwan M. Evaluating the efficacy of telesurgery with dual console SSI Mantra Surgical Robotic System: experiment on animal model and clinical trials. J Robot Surg 2024; 18:391. [PMID: 39485625 PMCID: PMC11530477 DOI: 10.1007/s11701-024-02148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/18/2024] [Indexed: 11/03/2024]
Abstract
The field of robotic surgery has grown exponentially over the past few decades. Surgical robots offer numerous benefits that enhance surgical precision, improve patient outcomes, and expand the capabilities of surgeons. Telesurgery, also known as a remote surgery, is a branch of telemedicine, which offers to perform surgical procedures requiring expertise of a surgeon located at a distance from a patient by using robotic systems and telecommunications technology. In a previous reported case, an animal experiment and clinical trial telesurgery using a dual console were performed. However, the mean latency time and data packet loss were considerably high. As a result, the performance of the telesurgery got severely impacted. This paper evaluates the feasibility, safety, and efficacy of remote telesurgery to precisely carryout predetermined surgical procedures using dual console SSI Mantra Surgical Robotic System. The trials were registered prospectively with trial registration number CTRI-2024-06-068361.
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Affiliation(s)
- Sudhir Prem Srivastava
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Vishwajyoti Pascual Srivastava
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Avinesh Singh
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Suraj Dwivedi
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Munish Batra
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Shivam Gupta
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Sonu Singh
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Shubhankar Sanjiv Kulkarni
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Anson Paul
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Amit Kumar
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India
| | - Manjusha Agwan
- Sudhir Srivastava Innovations Pvt. Ltd., iLabs Info Technology Centre Phase-III, Udyog Vihar, Plot No. 404-405, 3rd Floor, Gurugram, 122016, Haryana, India.
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7
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Mori M, Hirano S, Hakamada K, Oki E, Urushidani S, Uyama I, Eto M, Ebihara Y, Kawashima K, Kanno T, Kitsuregawa M, Kinugasa Y, Kobayashi J, Nakamura H, Noshiro H, Mandai M, Morohashi H. Clinical practice guidelines for telesurgery 2022 : Committee for the promotion of remote surgery implementation, Japan Surgical Society. Surg Today 2024; 54:817-828. [PMID: 38829562 PMCID: PMC11266380 DOI: 10.1007/s00595-024-02863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/20/2024] [Indexed: 06/05/2024]
Abstract
Telesurgery is expected to improve medical access in areas with limited resources, facilitate the rapid dissemination of new surgical procedures, and advance surgical education. While previously hindered by communication delays and costs, recent advancements in information technology and the emergence of new surgical robots have created an environment conducive to societal implementation. In Japan, the legal framework established in 2019 allows for remote surgical support under the supervision of an actual surgeon. The Japan Surgical Society led a collaborative effort, involving various stakeholders, to conduct social verification experiments using telesurgery, resulting in the development of a Japanese version of the "Telesurgery Guidelines" in June 2022. These guidelines outline requirements for medical teams, communication environments, robotic systems, and security measures for communication lines, as well as responsibility allocation, cost burden, and the handling of adverse events during telesurgery. In addition, they address telementoring and full telesurgery. The guidelines are expected to be revised as needed, based on the utilization of telesurgery, advancements in surgical robots, and improvements in information technology.
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Affiliation(s)
- Masaki Mori
- Japan Surgical Society, Tokyo, Japan.
- School of Medicine, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, Japan.
| | - Satoshi Hirano
- Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kenichi Hakamada
- Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University, Hirosaki, Aomori, Japan
| | - Eiji Oki
- Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeo Urushidani
- Information Systems Architecture Science Research Division, National Institute of Informatics, Tokyo, Japan
| | - Ichiro Uyama
- Japan Surgical Society, Tokyo, Japan
- Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuma Ebihara
- Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kenji Kawashima
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | | | - Masaru Kitsuregawa
- National Institute of Informatics, The University of Tokyo, Tokyo, Japan
| | - Yusuke Kinugasa
- Japan Surgical Society, Tokyo, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junjiro Kobayashi
- Japan Surgical Society, Tokyo, Japan
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshige Nakamura
- Japan Surgical Society, Tokyo, Japan
- Department of General Thoracic Surgery and Breast and Endocrine Surgery, Tottori University, Tottori, Japan
| | - Hirokazu Noshiro
- Japan Surgical Society, Tokyo, Japan
- Department of Gastroenteology and General Surgery, Saga University, Saga, Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Hajime Morohashi
- Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University, Hirosaki, Aomori, Japan
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8
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Rocco B, Moschovas MC, Saikali S, Gaia G, Patel V, Sighinolfi MC. Insights from telesurgery expert conference on recent clinical experience and current status of remote surgery. J Robot Surg 2024; 18:240. [PMID: 38833111 PMCID: PMC11150305 DOI: 10.1007/s11701-024-01984-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024]
Abstract
Remote surgery provides opportunity for enhanced surgical capabilities, wider healthcare reach, and potentially improved patient outcomes. The network reliability is the foundation of successful implementation of telesurgery. It relies on a robust, high-speed communication network, with ultra-low latency. Significant lag has been shown to endanger precision and safety. Furthermore, the full-fledged adoption of telerobotics demands careful consideration of ethical challenges too. A deep insight into these issues has been investigated during the first Telesurgery Consensus Conference that took place in Orlando, Florida, USA, on the 3rd and 4th of February, 2024. During the Conference, the state of the art of remote surgery has been reported from robotic systems displaying telesurgery potential. The Hinotori, a robotic-assisted surgery platform developed by Medicaroid, experienced remote surgery as pre-clinical testing only; the Edge Medical Company, Shenzen, China, reported more than one hundred animal and 30 live human surgeries; the KanGuo reported human telesurgical cases performed with distances more than 3000 km; the Microport, China, collected more than 100 human operations at a distance up to 5000 km. Though, several issues-cybersecurity, data privacy, technical malfunctions - are yet to be addressed before a successful telesurgery implementation. Expanding the discussion to encompass ethical, financial, regulatory, and legal considerations is essential too. The Telesurgery collaborative community is working together to address and establish the best practices in the field.
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Affiliation(s)
- Bernardo Rocco
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, via Rudini 8, Milan, Italy
| | | | - Shady Saikali
- Adventhealth, Global Robotic Institute, Celebration, FL, 34747, USA
| | - Giorgia Gaia
- Gynecology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Vipul Patel
- Adventhealth, Global Robotic Institute, Celebration, FL, 34747, USA
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9
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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10
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Zeng N, Liu MC, Zhong XY, Wang SG, Xia QD. Knowledge mapping of telemedicine in urology in the past 20 years: A bibliometric analysis (2004-2024). Digit Health 2024; 10:20552076241287460. [PMID: 39421308 PMCID: PMC11483830 DOI: 10.1177/20552076241287460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/10/2024] [Indexed: 10/19/2024] Open
Abstract
Telemedicine refers to the process of utilizing communication technologies to exchange disease information, perform surgery and educate care providers remotely, breaking through the distance limit and promoting the health of individuals and communities. The fifth-generation (5G) technology and the COVID-19 pandemic have greatly boosted studies on the application of telemedicine in urology. In this study, we conduct a comprehensive overview of the knowledge structure and research hotspots of telemedicine in urology through bibliometrics. We searched publications related to telemedicine in urology from 2004 to 2024 on the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace and R package "bibliometrix" were employed in this bibliometric analysis. A total of 1,357 articles from 97 countries and 2,628 institutions were included. The number of annual publications on telemedicine in urology witnessed a steady increase in the last two decades. Duke University was the top research institution. Urology was the most popular journal, and Journal of Medical Internet Research was the most co-cited journal. Clarissa Diamantidis and Chad Ellimoottil published the most papers, and Boyd Viers was co-cited most frequently. Effectiveness evaluation of telemonitoring, cost-benefit analysis of teleconsultation and exploration of telesurgery are three main research hotspots. As the first bibliometric analysis of research on telemedicine in urology, this study reviews research progress and highlights frontiers and trending topics, offering valuable insights for future studies.
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Affiliation(s)
- Na Zeng
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei-Cheng Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-Yu Zhong
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-Gang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi-Dong Xia
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Faris H, Harfouche C, Bandle J, Wisbach G. Surgical tele-mentoring using a robotic platform: initial experience in a military institution. Surg Endosc 2023; 37:9159-9166. [PMID: 37821559 PMCID: PMC10709226 DOI: 10.1007/s00464-023-10484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Surgical tele-mentoring leverages technology by projecting surgical expertise to improve access to care and patient outcomes. We postulate that tele-mentoring will improve surgeon satisfaction, procedural competence, the timeliness of operative intervention, surgical procedure efficiency, and key intra-operative decision-making. As a first step, we performed a pilot study utilizing a proof-of-concept tele-mentoring process during robotic-assisted surgery to determine the effects on the perceptions of all members of the surgical team. METHODS An IRB-approved prospective feasibility study to determine the safety and efficacy of remote surgical consultation to local surgeons utilizing robotic surgery technology in the fields of general, urology, gynecology and thoracic surgery was performed. Surgical teams were provided a pre-operative face-to-face orientation. During the operation, the mentoring surgeon was located at the same institution in a separate tele-mentoring room. An evaluation was completed pre- and post-operatively by the operative team members and mentor. RESULTS Fifteen operative cases were enrolled including seven general surgery, four urology, one gynecology and three thoracic surgery operations. Surveys were collected from 67 paired survey respondents and 15 non-paired mentor respondents. Participation in the operation had a positive effect on participant responses regarding all questions surveyed (p < 0.05) indicating value to tele-mentoring integration. Connectivity remained uninterrupted with clear delivery of audio and visual components and no perceived latency. Participant perception of leadership/administrative support was varied. CONCLUSIONS Surgical tele-mentoring is safe and efficacious in providing remote surgical consultation to local surgeons utilizing robotic surgery technology in a military institution. Operative teams overwhelmingly perceived this capability as beneficial with reliable audio-visual connectivity demonstrated between the main operative room and the Virtual Medical Center. Further study is needed to develop surgical tele-mentoring to improve patient care without geographic limitations during times of peace, war and pandemic outbreaks.
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Affiliation(s)
- Hunter Faris
- Department of General Surgery, Navy Medicine Readiness & Training Command -San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
| | - Cyril Harfouche
- Department of General Surgery, Navy Medicine Readiness & Training Command -San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Jesse Bandle
- Department of General Surgery, Navy Medicine Readiness & Training Command -San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Gordon Wisbach
- Department of General Surgery, Navy Medicine Readiness & Training Command -San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
- Virtual Medical Center, Navy Medicine Readiness & Training Command - San Diego, San Diego, CA, USA
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12
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Nakanoko T, Oki E, Ota M, Ikenaga N, Hisamatsu Y, Toshima T, Kanno T, Tadano K, Kawashima K, Ohuchida K, Morohashi H, Ebihara Y, Mimori K, Nakamura M, Yoshizumi T, Hakamada K, Hirano S, Ikeda N, Mori M. Real-time telementoring with 3D drawing annotation in robotic surgery. Surg Endosc 2023; 37:9676-9683. [PMID: 37935920 DOI: 10.1007/s00464-023-10521-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND In telementoring, differences in teaching methods affect local surgeons' comprehension. Because the object to be operated on is a three-dimensional (3D) structure, voice or 2D annotation may not be sufficient to convey the instructor's intention. In this study, we examined the usefulness of telementoring using 3D drawing annotations in robotic surgery. METHODS Kyushu University and Beppu Hospital are located 140 km apart, and the study was conducted using a Saroa™ surgical robot by RIVERFIELD Inc. using a commercial guarantee network on optical fiber. Twenty medical students performed vertical mattress suturing using a swine intestinal tract under surgical guidance at the Center for Advanced Medical Innovation Kyushu University. Surgical guidance was provided by Beppu Hospital using voice, 2D, and 3D drawing annotations. All robot operations were performed using 3D images, and only the annotations were independently switched between voice and 2D and 3D images. The operation time, needle movement, and performance were also evaluated. RESULTS The 3D annotation group tended to have a shorter working time than the control group (25.6 ± 63.2 vs. - 36.7 ± 65.4 min, P = 0.06). The 3D annotation group had fewer retries than the control group (1.3 ± 1.7 vs. - 1.1 ± 0.7, P = 0.006), and there was a tendency for fewer needle drops (0.4 ± 0.7 vs. - 0.5 ± 0.9, P = 0.06). The 3D annotation group scored significantly higher than the control group on the Global Evaluate Assessment of Robot Skills (16.8 ± 2.0 vs. 22.8 ± 2.4, P = 0.04). The 3D annotation group also scored higher than the voice (13.4 ± 1.2) and 2D annotation (16.2 ± 1.8) groups (3D vs. voice: P = 0.03, 3D vs. 2D: P = 0.03). CONCLUSION Telementoring using 3D drawing annotation was shown to provide good comprehension and a smooth operation for local surgeons.
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Affiliation(s)
- Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takeo Toshima
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | | | - Kotaro Tadano
- RIVERFIELD Inc, Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- RIVERFIELD Inc, Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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13
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Moustris G, Tzafestas C, Konstantinidis K. A long distance telesurgical demonstration on robotic surgery phantoms over 5G. Int J Comput Assist Radiol Surg 2023; 18:1577-1587. [PMID: 37095315 PMCID: PMC10124680 DOI: 10.1007/s11548-023-02913-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Using robotic technology and communications infrastructure to remotely perform surgery has been a persistent goal in medical research in the past three decades. The recent deployment of the Fifth-Generation Wireless Networks has revitalized the research efforts in the telesurgery paradigm. Offering low latency and high bandwidth communication, they are well suited for applications that require real-time data transmission and can allow smoother communication between surgeon and patient, making it possible to remotely perform complex surgeries. In this paper, we investigate the effects of the 5 G network on surgical performance during a telesurgical demonstration where the surgeon and the robot are separated by nearly 300 km. METHODS The surgeon performed surgical exercises on a robotic surgery training phantom using a novel telesurgical platform. The master controllers were connected to the local site on a 5 G network, teleoperating the robot remotely in a hospital. A video feed of the remote site was also streamed. The surgeon performed various tasks on the phantom such as cutting, dissection, pick-and-place and ring tower transfer. To assess the usefulness, usability and image quality of the system, the surgeon was subsequently interviewed using three structured questionnaires. RESULTS All tasks were completed successfully. The low latency and high bandwidth of the network resulted into a latency of 18 ms for the motion commands while the video delay was about 350 ms. This enabled the surgeon to operate smoothly with a high-definition video from about 300 km away. The surgeon viewed the system's usability in a neutral to positive way while the video image was rated as of good quality. CONCLUSION 5 G networks provide significant advancement in the field of telecommunications, offering faster speeds and lower latency than previous generations of wireless technology. They can serve as an enabling technology for telesurgery and further advance its application and adoption.
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Affiliation(s)
- George Moustris
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
| | - Costas Tzafestas
- School of Electrical and Computer Engineering, National Technical University of Athens, Zographou Campus, 15773 Athens, Greece
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14
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Watanabe M, Kuriyama K, Terayama M, Okamura A, Kanamori J, Imamura Y. Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives. Ann Thorac Cardiovasc Surg 2023; 29:168-176. [PMID: 37225478 PMCID: PMC10466119 DOI: 10.5761/atcs.ra.23-00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023] Open
Abstract
Robotic-assisted minimally invasive esophagectomy (RAMIE) has been rapidly spreading worldwide as a novel minimally invasive approach for esophageal cancer. This narrative review aimed to elucidate the current situation and future perspectives of RAMIE for esophageal cancer. References were searched using PubMed and Embase for studies published up to 8 April 2023. Search terms included "esophagectomy" or "esophageal cancer" and "robot" or "robotic" or "robotic-assisted." There are several different uses for the robot in esophagectomy. Overall complications are equivalent or may be less in RAMIE than in open esophagectomy and conventional (thoracoscopic) minimally invasive esophagectomy. Several meta-analyses demonstrated the possibility of RAMIE in reducing pulmonary complications, although the equivalent incidence was observed in two randomized controlled trials. RAMIE may increase the number of dissected lymph nodes, especially in the left recurrent laryngeal nerve area. Long-term outcomes are comparable between the procedures, although further research is required. Further progress in robotic technology combined with artificial intelligence is expected.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Kuriyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayoshi Terayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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15
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Ning S, Chautems C, Kim Y, Rice H, Hanning U, Al Kasab S, Meyer L, Psychogios M, Zaidat OO, Hassan AE, Masoud HE, Mujanovic A, Kaesmacher J, Dhillon PS, Ma A, Kaliaev A, Nguyen TN, Abdalkader M. Robotic Interventional Neuroradiology: Progress, Challenges, and Future Prospects. Semin Neurol 2023; 43:432-438. [PMID: 37562456 DOI: 10.1055/s-0043-1771298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Advances in robotic technology have improved standard techniques in numerous surgical and endovascular specialties, offering more precision, control, and better patient outcomes. Robotic-assisted interventional neuroradiology is an emerging field at the intersection of interventional neuroradiology and biomedical robotics. Endovascular robotics can automate maneuvers to reduce procedure times and increase its safety, reduce occupational hazards associated with ionizing radiations, and expand networks of care to reduce gaps in geographic access to neurointerventions. To date, many robotic neurointerventional procedures have been successfully performed, including cerebral angiography, intracranial aneurysm embolization, carotid stenting, and epistaxis embolization. This review aims to provide a survey of the state of the art in robotic-assisted interventional neuroradiology, consider their technical and adoption limitations, and explore future developments critical for the widespread adoption of robotic-assisted neurointerventions.
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Affiliation(s)
- Shen Ning
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Hal Rice
- Neurointerventional Section, Gold Coast University Hospital, Queensland, Australia
| | - Uta Hanning
- Klinik und Poliklinik für Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Lukas Meyer
- Klinik und Poliklinik für Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Basel University Hospital, University of Basel, Switzerland
| | - Osama O Zaidat
- Department of Neurology, Mercy Vincent Hospital, Toledo, Ohio
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas
| | - Hesham E Masoud
- Division of Cerebrovascular, Department of Neurology, Upstate University Hospital, Syracuse, New York
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Permesh S Dhillon
- Interventional Neuroradiology, University of Nottingham, Nottingham, United Kingdom
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
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16
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Wu CT, Lin TY, Lin CJ, Hwang DK. The future application of artificial intelligence and telemedicine in the retina: A perspective. Taiwan J Ophthalmol 2023; 13:133-141. [PMID: 37484624 PMCID: PMC10361422 DOI: 10.4103/tjo.tjo-d-23-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
The development of artificial intelligence (AI) and deep learning provided precise image recognition and classification in the medical field. Ophthalmology is an exceptional department to translate AI applications since noninvasive imaging is routinely used for the diagnosis and monitoring. In recent years, AI-based image interpretation of optical coherence tomography and fundus photograph in retinal diseases has been extended to diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. The rapid development of portable ocular monitoring devices coupled with AI-informed interpretations allows possible home monitoring or remote monitoring of retinal diseases and patients to gain autonomy and responsibility for their conditions. This review discusses the current research and application of AI, telemedicine, and home monitoring devices on retinal disease. Furthermore, we propose a future model of how AI and digital technology could be implemented in retinal diseases.
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Affiliation(s)
- Chu-Ting Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Yi Lin
- Doctoral Degree Program of Translational Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Cheng-Jun Lin
- Department of Biological Science and Technology, Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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17
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Ebihara Y, Hirano S, Takano H, Kanno T, Kawashima K, Morohashi H, Oki E, Hakamada K, Urushidani S, Mori M. Technical evaluation of robotic tele-cholecystectomy: a randomized single-blind controlled pilot study. J Robot Surg 2023; 17:1105-1111. [PMID: 36602754 DOI: 10.1007/s11701-023-01522-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
Although robotic telesurgery is growing in popularity, the benefits of telesurgery compared to local surgery are unclear. This study aimed to evaluate the performance of robotic tele-cholecystectomy with a commercial line using the Saroa™ (Riverfield, Inc., Tokyo, Japan) system. The operation rooms of the Hokkaido University Hospital and Kushiro City General Hospital were connected using a best effort-type line (1 Gbps), with a distance of 250 km between the two hospitals. In this experimental single-blind randomized crossover trial, eight expert robotic surgeons performed robotic cholecystectomy in an artificial organ model using the Saroa™ system and were randomized to begin with either local surgery or telesurgery. All surgeons were assessed on task completion time, total path length of the right- and left- hand forceps and camera, Global Evaluative Assessment of Robotic Skills (GEARS), Global Operative Assessment of Laparoscopic Skills (GOALS), and System and Piper Fatigue Scale-12 (PFS-12). In all experiments, the communication environment was stable and the mean communication delay was 8 ms (3-31 ms). All tele-cholecystectomies were performed safely. There was no significant difference in completion time (P = 0.495), score of GEARS (P = 0.258), GOALS (P = 0.180), or PFS-12 (P = 0.528) between local surgery and telesurgery. The total path of the forceps tended to be longer in tele-cholecystectomy, particularly with significantly longer left-hand forceps total path length (P = 0.041). Robotic tele-cholecystectomy using a commercial line can be performed safely as same as local robotic surgery, but the total path of the left-hand forceps was prolonged in robotic tele-cholecystectomy due to overshoot. Therefore, a solution for overshooting will be required in the future.
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Affiliation(s)
- Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | | | - Kenji Kawashima
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Tokai University School of Medicine, Isehara, Japan
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18
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Takahashi Y, Hakamada K, Morohashi H, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Reappraisal of telesurgery in the era of high-speed, high-bandwidth, secure communications: Evaluation of surgical performance in local and remote environments. Ann Gastroenterol Surg 2023; 7:167-174. [PMID: 36643359 PMCID: PMC9831893 DOI: 10.1002/ags3.12611] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/27/2022] [Indexed: 01/18/2023] Open
Abstract
Aim Communication and video transmission delays negatively affect telerobotic surgery. Since latency varies by communication environment and robot, to realize remote surgery, both must perform well. This study aims to examine the feasibility of telerobotic surgery by validating the communication environment and local/remote robot operation, using secure commercial lines and newly developed robots. Methods Hirosaki University and Mutsu General Hospital, 150 km apart, were connected via a Medicaroid surgical robot. Ten surgeons performed a simple task remotely using information encoding and decoding. The required bandwidth, delay time, task completion time, number of errors, and image quality were evaluated. Next, 11 surgeons performed a complex task using gallbladder and intestinal models in local/remote environments; round trip time (RTT), packet loss, time to completion, operator fatigue, operability, and image were observed locally and remotely. Results Image quality was not so degraded as to affect remote robot operation. Median RTT was 4 msec (2-12), and added delay was 29 msec. There was no significant difference in accuracy or number of errors for cholecystectomy, intestinal suturing, completion time, surgeon fatigue, or image evaluation. Conclusion The fact that remote surgery succeeded equally to local surgery showed that this system has the necessary elemental technology for widespread social implementation.
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Affiliation(s)
- Yoshiya Takahashi
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
| | - Kenichi Hakamada
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
| | - Hajime Morohashi
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
| | - Harue Akasaka
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
- Department of Surgery and ScienceKyushu UniversityFukuokaJapan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery ImplementationJapan Surgical SocietyTokyoJapan
- Tokai University School of MedicineIseharaJapan
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19
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Salkowski M, Checcucci E, Chow AK, Rogers CC, Adbollah F, Liatsikos E, Dasgupta P, Guimaraes GC, Rassweiler J, Mottrie A, Breda A, Crivellaro S, Kaouk J, Porpiglia F, Autorino R. New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology. Ther Adv Urol 2023; 15:17562872231177781. [PMID: 37325289 PMCID: PMC10265325 DOI: 10.1177/17562872231177781] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.
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Affiliation(s)
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | | | - Craig C. Rogers
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Adbollah
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Evangelos Liatsikos
- Department of Urology, University General Hospital of Patras, Patras, Greece
| | - Prokar Dasgupta
- King’s Health Partners Academic Surgery, King’s College London, London, UK
| | | | - Jens Rassweiler
- Department of Urology and Andrology, Danube Private University, Krems, Austria
| | - Alexander Mottrie
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Simone Crivellaro
- Department of Urology, University of Illinois Chicago, Chicago, IL, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology and San Luigi Gonzaga Hospital, University of Turin, Torino, Italy
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20
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Takahashi Y, Hakamada K, Morohashi H, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Verification of delay time and image compression thresholds for telesurgery. Asian J Endosc Surg 2022; 16:255-261. [PMID: 36479621 DOI: 10.1111/ases.13150] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Telerobotic surgery relies on communication lines, causing delays, and video information requires pre-transmission compression. Such delays and video degradation will continue to be unavoidable making communication conditions verification essential. Understanding the network specification values required for telerobotic surgery entails determining acceptable levels of delay and degradation due to the video compression and restoration processes during surgery. METHODS The hinotori™ surgical robot from Medicaroid was used. Eight surgeons, skilled in robotic surgery, performed gastrectomy or rectal resection on pigs. Image compression (bitrate: 120, 60, 30, 20, 10 Mbps) was random, changing encoder settings during surgery, and delay times (30, 50, 100, 150 milliseconds) were pseudo-randomly inserted, changing emulator settings. Acceptable video levels were evaluated. Subjective evaluations by surgeons and evaluators regarding image degradation and operability, and objective evaluations of image degradation and operability were given five-point ratings. RESULTS Regarding delay time, 30 and 50 millisecond periods garnered average ratings of 3.6 and 4.0, respectively, signifying that surgery was feasible. However, at 100 and 150 millisecond, average ratings were 2.9 and 2.3, respectively, indicating surgery was not feasible for the most part in these cases. The average rating for image compression was 4.0 or higher for bitrates of 20, 30, 60, and 120 Mbps, suggesting that surgery is possible even at bitrates as low as 10 Mbps, with an average rating of 4.0. CONCLUSION In remote robotic surgery using the hinotori™, image compression and delay time are largely acceptable, so surgery can be safely performed.
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Affiliation(s)
- Yoshiya Takahashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Tokai University School of Medicine, Isehara, Japan
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21
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Nakauchi M, Suda K, Nakamura K, Tanaka T, Shibasaki S, Inaba K, Harada T, Ohashi M, Ohigashi M, Kitatsuji H, Akimoto S, Kikuchi K, Uyama I. Establishment of a new practical telesurgical platform using the hinotori™ Surgical Robot System: a preclinical study. Langenbecks Arch Surg 2022; 407:3783-3791. [PMID: 36239792 PMCID: PMC9562055 DOI: 10.1007/s00423-022-02710-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/09/2022] [Indexed: 12/02/2022]
Abstract
AIM The recent development of new surgical robots and network telecommunication technology has opened new avenues for robotic telesurgery. Although a few gastroenterological surgeries have been performed in the telesurgery setting, more technically demanding procedures including gastrectomy with D2 lymphadenectomy and intracorporeal anastomosis have never been reported. We examined the feasibility of telesurgical robotic gastrectomy using the hinotori™ Surgical Robot System in a preclinical setting. METHODS First, the suturing time in the dry model was measured in the virtual telesurgery setting to determine the latency time threshold. Second, a surgeon cockpit and a patient unit were installed at Okazaki Medical Center and Fujita Health University, respectively (approximately 30 km apart), and connected using a 10-Gbps leased optic-fiber network. After evaluating the feasibility in the dry gastrectomy model, robotic distal gastrectomies with D2 lymphadenectomy and intracorporeal B-I anastomosis were performed in two porcine models. RESULTS The virtual telesurgery study identified a latency time threshold of 125 ms. In the actual telesurgery setting, the latency time was 27 ms, including a 2-ms telecommunication network delay and a 25-ms local information process delay. After verifying the feasibility of the operative procedures using a gastrectomy model, two telesurgical gastrectomies were successfully completed without any unexpected events. No fluctuation was observed across the actual telesurgeries. CONCLUSION Short-distance telesurgical robotic surgery for technically more demanding procedure may be safely conducted using the hinotori Surgical Robot System connected by high-speed optic-fiber communication.
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Affiliation(s)
- Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan.
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Tatsuhiko Harada
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan
| | - Masanao Ohashi
- Global Management Division, Sysmex Corporation, Kobe, Japan
| | - Masayuki Ohigashi
- MR Business Division, Sysmex Corporation, Kobe, Japan
- Medicaroid Corporation, Kobe, Japan
| | | | - Shingo Akimoto
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Kikuchi
- Medicaroid Corporation, Kobe, Japan
- Department of Surgery, Okazaki Medical Center, Fujita Health University, Okazaki, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
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22
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Nankaku A, Tokunaga M, Yonezawa H, Kanno T, Kawashima K, Hakamada K, Hirano S, Oki E, Mori M, Kinugasa Y. Maximum acceptable communication delay for the realization of telesurgery. PLoS One 2022; 17:e0274328. [PMID: 36201429 PMCID: PMC9536636 DOI: 10.1371/journal.pone.0274328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
AIM To determine acceptable limits of communication delays in telesurgery, we investigated the impact of communication delays under a dynamic environment using a surgical assist robot. Previous studies have evaluated acceptable delays under static environments. Effects of delays may be enhanced in dynamic environments, but studies have not yet focused on this point. METHODS Thirty-four subjects with different surgical experience (Group1: no surgical experience; Group2: only laparoscopic surgical experience; Group3: robotic surgery experience) performed 4 tasks under different delays (0, 70, 100, 150, 200, or 300 ms) using a surgical assist robot. Task accomplishment time and total movement distance of forceps were recorded and compared under different communication delays of 0-300 ms. In addition, surgical performance was compared between Group1or Group2 without delay and Group3 with communication delays. RESULTS Significant differences in task accomplishment time were found between delays of 0 and 70 ms, but not between delays of 70 and 100 ms. Thereafter, the greater the communication delay, the longer the task accomplishment time. Similar results were obtained in total movement distance of forceps. Comparisons between Group3 with delay and Group1 or Group2 without delay demonstrated that surgical performance in Group3 with delay was superior or equal to that of Group1 or Group2 without delay as long as the delay was 100 ms or less. CONCLUSIONS Communication delays in telesurgery may be acceptable if 100 ms or less. Experienced surgeons with more than 100 ms of delay could outperform less-experienced surgeons without delay.
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Affiliation(s)
- Akitoshi Nankaku
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Hiroki Yonezawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kenji Kawashima
- Riverfield Corporation, Tokyo, Japan
- Department of Information Physics and Computing, the University of Tokyo, Tokyo, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University, Aomori, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Hokkaido, Japan
| | - Eiji Oki
- Department of Gastrointestinal Surgery, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Tokai University School of Medicine, Kanagawa, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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23
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Bhattacharya S. The Impact of 5G Technologies on Healthcare. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Akasaka H, Hakamada K, Morohashi H, Kanno T, Kawashima K, Ebihara Y, Oki E, Hirano S, Mori M. Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue. PLoS One 2022; 17:e0270039. [PMID: 35709190 PMCID: PMC9202925 DOI: 10.1371/journal.pone.0270039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important. Objectives To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments. Methods Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance. Results Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041). Conclusions In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue.
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Affiliation(s)
- Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- * E-mail:
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
| | - Takahiro Kanno
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- RIVERFIELD Inc., Tokyo, Japan
| | - Kenji Kawashima
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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25
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Moglia A, Georgiou K, Marinov B, Georgiou E, Berchiolli RN, Satava RM, Cuschieri A. 5G in Healthcare: from COVID-19 to Future Challenges. IEEE J Biomed Health Inform 2022; 26:4187-4196. [PMID: 35675255 DOI: 10.1109/jbhi.2022.3181205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Worldwide up to May 2022 there have been 515 million cases of COVID-19 infection and over 6 million deaths. The World Health Organization estimated that 115,000 healthcare workers died from COVID-19 from January 2020 to May 2021. This toll on human lives prompted this review on 5G based networking primarily on major components of healthcare delivery: diagnosis, patient monitoring, contact tracing, diagnostic imaging tests, vaccines distribution, emergency medical services, telesurgery and robot-assisted tele-ultrasound. The positive impact of 5G as core technology for COVID-19 applications enabled exchange of huge data sets in fangcang (cabin) hospitals and real-time contact tracing, while the low latency enhanced robot-assisted tele-ultrasound, and telementoring during ophthalmic surgery. In other instances, 5G provided a supportive technology for applications related to COVID-19, e.g., patient monitoring. The feasibility of 5G telesurgery was proven, albeit by a few studies on real patients, in very low samples size in most instances. The important future applications of 5G in healthcare include surveillance of elderly people, the immunosuppressed, and nano- oncology for Internet of Nano Things (IoNT). Issues remain and these require resolution before routine clinical adoption. These include infrastructure and coverage; health risks; security and privacy protection of patients' data; 5G implementation with artificial intelligence, blockchain, and IoT; validation, patient acceptance and training of end-users on these technologies.
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26
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Ebihara Y, Oki E, Hirano S, Takano H, Ota M, Morohashi H, Hakamada K, Urushidani S, Mori M. Tele-assessment of bandwidth limitation for remote robotics surgery. Surg Today 2022; 52:1653-1659. [PMID: 35546642 PMCID: PMC9095415 DOI: 10.1007/s00595-022-02497-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022]
Abstract
Purpose We investigated the communication bandwidth (CB) limitation for remote robotics surgery (RRS) using hinotori™ (Medicaroid, Kobe, Japan). Methods The operating rooms of the Hokkaido University Hospital and Kyushu University Hospital were connected using the Science Information NETwork (SINET). The minimum required CB for the RRS was verified by decreasing the CB from 500 to 100 Mbps. Ten surgeons were tested on a task (intracorporeal suturing) at different levels of video compression (VC) (VC1: 120 Mbps, VC2: 40 Mbps, VC3: 20 Mbps) with the minimum required CB, and assessed based on the task completion time, Global Evaluative Assessment of Robotic Skills (GEARS), and System and Piper Fatigue Scale-12 (PFS-12). Results Packet loss was observed at 3–7% and image degradation was observed at 145 Mbps CB. The task performance with VC1 was significantly worse than that with VC2 and VC3 according to the task completion time (VC1 vs VC2, P = 0.032; VC1 vs. VC3, P = 0.032), GEARS (VC1 vs VC2; P = 0.029, VC1 vs VC3; P = 0.031), and PFS-12 (VC1 vs. VC2; P = 0.032, VC1 vs. VC3; P = 0.032) with 145 Mbps. Conclusion Our findings provide evidence that RRS using hinotori™ requires a CB ≥ 150 Mbps. We also found that when there is insufficient CB, RRS can be continued by compressing the image.
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Affiliation(s)
- Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Mitsuhiko Ota
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.,Tokai University School of Medicine, Isehara, Japan
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27
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Remote telesurgery in humans: a systematic review. Surg Endosc 2022; 36:2771-2777. [PMID: 35246740 PMCID: PMC9923406 DOI: 10.1007/s00464-022-09074-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the conception of robotic surgery, remote telesurgery has been a dream upon which incredible technological advances haven been built. Despite the considerable enthusiasm for, there have been few published studies of remote telesurgery on humans. METHODS We performed a systematic review of the English literature (PubMed, EMbase, Inspec & Compendex and Web of Science) to report studies of remote telesurgery in humans. Keywords included telesurgery, remote surgery, long-distance surgery, and telerobotics. Subjects had to be human (live patients or cadavers). The operating surgeon had to be remote from the patient, separated by more than one kilometer. The article had to explicitly report the use of a long-distance telerobotic technique. Articles that focused on telepresence or tele-mentoring were excluded. RESULTS The study included eight articles published from 2001 to 2020. One manuscript (1 subject) described remote surgery on a cadaver model, and the other seven were on live humans (72 subjects). Procedure types included percutaneous, endovascular, laparoscopic, and transoral. Communication methods varied, with the first report using a telephone line and the most recent studies using a 5G network. Six of the studies reported signal latency as a single value and it ranged from 28 ms to 280 ms. CONCLUSIONS Few studies have described remote telesurgery in humans, and there is considerable variability in robotic and communication methods. Future efforts should work to improve reporting of signal latency and follow careful research methodology.
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Morohashi H, Hakamada K, Kanno T, Kawashima K, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network. Surg Today 2022. [PMID: 34668052 DOI: 10.1007/s00595-00021-02384-00595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. METHODS A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. RESULTS The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. CONCLUSIONS The social implementation of telesurgery using the currently available commercial communication network is feasible.
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Affiliation(s)
- Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | | | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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Morohashi H, Hakamada K, Kanno T, Kawashima K, Akasaka H, Ebihara Y, Oki E, Hirano S, Mori M. Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network. Surg Today 2022; 52:705-714. [PMID: 34668052 PMCID: PMC8948127 DOI: 10.1007/s00595-021-02384-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. METHODS A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. RESULTS The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. CONCLUSIONS The social implementation of telesurgery using the currently available commercial communication network is feasible.
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Affiliation(s)
- Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | | | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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Abstract
Telesurgery is not a foreign concept and dates to as early as the 1920s. The use of robots in medicine has had a very positive effect and improved outcomes with little to no adverse effects. Having global access to telemedicine and telesurgery during the COVID-19 pandemic and being able to provide top medical care to gravely ill and contagious patients without compromising the safety of the medical team would be a very big achievement. We explore the hurdles needed to make it a realistic goal and give recommendations to achieve it utilizing the major advancements that have occurred over the past few years in the fields of engineering, communication etc. The biggest issues needed to be addressed are of financial investment, legal concerns, and availability of high-speed uninterrupted data connections.
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Affiliation(s)
- Muhammad Hammad Malik
- Department of Radiology, RinggoldID:6915Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Waleed Brinjikji
- Department of Radiology, RinggoldID:6915Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Bailo P, Gibelli F, Blandino A, Piccinini A, Ricci G, Sirignano A, Zoja R. Telemedicine Applications in the Era of COVID-19: Telesurgery Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010323. [PMID: 35010581 PMCID: PMC8751214 DOI: 10.3390/ijerph19010323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 06/01/2023]
Abstract
Telemedicine allows for the effective delivery of health care to patients at a distance through the application of information technology to the field of medicine. This is optimal during the COVID-19 pandemic to reduce interpersonal contact to mitigate contagion. Among the possible Telemedicine applications, there is Telesurgery, which involves more and more surgical specialties thanks to the numerous benefits in quality and cost containment. In the growing field of Telesurgery, its technical and legal implications must be considered. In this study, a traditional review of the scientific literature was carried out to identify the most relevant issues of interest in Telesurgery. The problematic legal aspects identified are mainly related to the difference in legislation between different geographical areas, which is critical in the case of malpractice. In addition, there is the possibility of a malicious hacker attack on the transmitted data stream either to steal sensitive data or to harm the patient. Finally, there are inherent difficulties with the technology used, such as latency issues in data transmission. All these critical issues are currently not adequately addressed by current legislation. Therefore, one can only hope for a legislative action to allow Telesurgery to be used safely.
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Affiliation(s)
- Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Andrea Piccinini
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
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Jin ML, Brown MM, Patwa D, Nirmalan A, Edwards PA. Telemedicine, telementoring, and telesurgery for surgical practices. Curr Probl Surg 2021; 58:100986. [PMID: 34895561 DOI: 10.1016/j.cpsurg.2021.100986] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Man Li Jin
- Resident in Ophthalmology, Henry Ford Hospital, Detroit, MI.
| | - Meghan M Brown
- Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Dhir Patwa
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Aravindh Nirmalan
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Paul A Edwards
- Chairman, Department of Ophthalmology, Henry Ford Hospital, Detroit, MI
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33
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In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hansen RN, Saour BM, Serafini B, Hannaford B, Kim L, Kohno T, James R, Monsky W, Seslar SP. Opportunities and Barriers to Rural Telerobotic Surgical Health Care in 2021: Report and Research Agenda from a Stakeholder Workshop. Telemed J E Health 2021; 28:1050-1057. [PMID: 34797741 PMCID: PMC9293678 DOI: 10.1089/tmj.2021.0378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: There are well-recognized challenges to delivering specialty health care in rural settings. These challenges are particularly evident for specialized surgical health care due to the lack of trained operators in rural communities. Telerobotic surgery could have a significant impact on the rural-urban health care gap, but thus far, the promise of this method of health care delivery has gone unrealized. With the increasing adoption of telehealth over the past year, along with the maturation of telecommunication and robotic technologies over the past 2 decades, a reappraisal of the opportunities and barriers to widespread implementation of telerobotic surgery is warranted. Here we report the outcome of a rural telerobotic stakeholder workshop to explore modern-day issues critical to the advancement of telerobotic surgical health care. Materials and Methods: We assembled a multidisciplinary stakeholder panel to participate in a 2-day Rural Telerobotic Surgery Stakeholder Workshop. Participants had diverse expertise, including specialty surgeons, technology experts, and representatives of the broader telerobotic health care ecosystem, including economists, lawyers, regulatory consultants, public health advocates, rural hospital administrators, nurses, and payers. The research team reviewed transcripts from the workshop with themes identified and research questions generated based on stakeholder comments and feedback. Results: Stakeholder discussions fell into four general themes, including (1) operating room team interactions, (2) education and training, (3) network and security, and (4) economic issues. The research team then identified several research questions within each of these themes and provided specific research strategies to address these questions. Conclusions: There are still important unanswered questions regarding the implementation and adoption of rural telerobotic surgery. Based on stakeholder feedback, we have developed a research agenda along with suggested strategies to address outstanding research questions. The successful execution of these research opportunities will fill critical gaps in our understanding of how to advance the widespread adoption of rural telerobotic health care.
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Affiliation(s)
- Ryan N Hansen
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, USA
| | | | - Brian Serafini
- Sociology Department, University of Washington, Seattle, Washington, USA
| | - Blake Hannaford
- Department of Electrical Engineering, University of Washington, Seattle, Washington, USA
| | - Lanu Kim
- School of Humanities and Social Sciences, Korea Advance Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Takayoshi Kohno
- Paul G. Allen School of Computer Science & Engineering University of Washington, Seattle, Washington, USA
| | - Ryan James
- Telerobotics, LLC, Seattle, Washington, USA
| | - Wayne Monsky
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Stephen P Seslar
- Department of Cardiology, University of Washington, Seattle, Washington, USA
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Abstract
Background: Most healthcare providers are unaware of the extraordinary opportunities for implementation in healthcare which can be enabled by 5G wireless networks. 5G created enormous opportunities for a myriad of new technologies, resulting in an integrated through 5G ‘ecosystem’. Although the new opportunities in healthcare are immense, medicine is slow to change, as manifest by the paucity of new, innovative applications based upon this ecosystem. Thus, emerges the need to “avoid technology surprise” - both laparoscopic and robotic assisted minimally invasive surgery were delayed for years because the surgical community was either unaware or unaccepting of a new technology. Database: PubMed (Medline) and Scopus (Elsevier) databases were searched and all published studies regarding clinical applications of 5G were retrieved. From a total of 40 articles, 13 were finally included in our review. Discussion: The important transformational properties of 5G communications and other innovative technologies are described and compared to healthcare needs, looking for opportunities, limitations, and challenges to implementation of 5G and the ecosystem it has spawned. Furthermore, the needs in the clinical applications, education and research in medicine and surgery, in addition to the administrative infrastructure are addressed. Additionally, we explore the nontechnical challenges, that either support or oppose this new healthcare renovation. Based upon proven advantages of these innovative technologies, current scientific evidence is analyzed for future trends for the transformation of healthcare. By providing awareness of these opportunities and their advantages for patients, it will be possible to decrease the prolonged timeframe for acceptance and implementation for patients.
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Affiliation(s)
- Konstantinos E Georgiou
- 1 Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Georgiou
- Medical Physics Laboratory Simulation Center (MPLSC), Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Richard M Satava
- Professor Emeritus of Surgery, University of Washington, Seattle, WA
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36
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Chen IHA, Ghazi A, Sridhar A, Stoyanov D, Slack M, Kelly JD, Collins JW. Evolving robotic surgery training and improving patient safety, with the integration of novel technologies. World J Urol 2021; 39:2883-2893. [PMID: 33156361 PMCID: PMC8405494 DOI: 10.1007/s00345-020-03467-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Robot-assisted surgery is becoming increasingly adopted by multiple surgical specialties. There is evidence of inherent risks of utilising new technologies that are unfamiliar early in the learning curve. The development of standardised and validated training programmes is crucial to deliver safe introduction. In this review, we aim to evaluate the current evidence and opportunities to integrate novel technologies into modern digitalised robotic training curricula. METHODS A systematic literature review of the current evidence for novel technologies in surgical training was conducted online and relevant publications and information were identified. Evaluation was made on how these technologies could further enable digitalisation of training. RESULTS Overall, the quality of available studies was found to be low with current available evidence consisting largely of expert opinion, consensus statements and small qualitative studies. The review identified that there are several novel technologies already being utilised in robotic surgery training. There is also a trend towards standardised validated robotic training curricula. Currently, the majority of the validated curricula do not incorporate novel technologies and training is delivered with more traditional methods that includes centralisation of training services with wet laboratories that have access to cadavers and dedicated training robots. CONCLUSIONS Improvements to training standards and understanding performance data have good potential to significantly lower complications in patients. Digitalisation automates data collection and brings data together for analysis. Machine learning has potential to develop automated performance feedback for trainees. Digitalised training aims to build on the current gold standards and to further improve the 'continuum of training' by integrating PBP training, 3D-printed models, telementoring, telemetry and machine learning.
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Affiliation(s)
- I-Hsuan Alan Chen
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.
- Department of Surgery, Division of Urology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying District, Kaohsiung, 81362, Taiwan.
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK.
| | - Ahmed Ghazi
- Department of Urology, Simulation Innovation Laboratory, University of Rochester, New York, USA
| | - Ashwin Sridhar
- Division of Uro-Oncology, University College London Hospital, London, UK
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | | | - John D Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Uro-Oncology, University College London Hospital, London, UK
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK.
- Division of Uro-Oncology, University College London Hospital, London, UK.
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Anvari M, Manoharan B, Barlow K. From telementorship to automation. J Surg Oncol 2021; 124:246-249. [PMID: 34245577 DOI: 10.1002/jso.26562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/05/2022]
Abstract
The effective integration of robotic technology and surgical tools has played a vital role in advancing surgical care by enabling telepresence in surgery to provide mentorship and surgical care across long distances in the absence of surgeons. This article describes our experiences with advancing surgical education and innovation through telementoring community surgeons, establishing the world's first telerobotic surgical service, and the integration of Artificial Intelligence and robotics to provide remote surgical care and training.
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Affiliation(s)
- Mehran Anvari
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Baanu Manoharan
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Karen Barlow
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
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38
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Latest Developments in Robotic Percutaneous Coronary Intervention. Surg Technol Int 2021. [PMID: 34081770 DOI: 10.52198/21.sti.38.cv1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interventional cardiovascular medicine has seen constant progress over the last few decades. Since the first angiograms and percutaneous transluminal coronary angioplasty were carried out, this progress has been tremendous and has led to a substantial decline in cardiovascular morbidity and mortality. The purpose of this article is to report and review the latest developments and evidence in robotics-assisted percutaneous coronary intervention (rPCI) and its potential future applications, opportunities, and limitations. Contemporary evidence shows that rPCI can lead to a significant reduction in radiation exposure as well as medical hazards for cardiologists. Rates of device and procedural success remain high and there is no evidence of a disadvantage for the patient. The accuracy of implantation with a reduced geographic mismatch is a further advantage that can result in a higher quality of treatment. Even in complex coronary lesions and procedures, rPCI seems to be safe and efficient. The latest developments include telestenting over hundreds of kilometers from a remote platform. Currently, the main limitations are the absence of large-scale randomized trials for the valid assessment of the benefits and disadvantages of rPCI as well as the technical limitations of the currently available rPCI systems. rPCI is a forward-looking innovation in cardiology that is applicable to a wide range of coronary interventions. Despite the present lack of knowledge and the limited data concerning the outcome for the patient, the available literature reveals promising results that should lead to improvements for physicians and patients.
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Lombardo AM, Andolfi C, Deshpande AP, Aizen JM, Dangle PP, Gundeti MS. Pediatric urology amidst SARS-CoV-2 pandemic: Building the future with current knowledge. J Pediatr Surg 2021; 56:923-928. [PMID: 33483106 PMCID: PMC7816876 DOI: 10.1016/j.jpedsurg.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has ripped around the globe, stolen family members and forced healthcare systems to operate under an unprecedented strain. As of December 2020, 74.7 million people have contracted COVID-19 worldwide and although vaccine distribution has commenced, a recent rise in cases suggest that the pandemic is far from over. METHODS This piece explores how COVID-19 has explicitly impacted the field of pediatric urology and its patients with a focus on vulnerable subpopulations. RESULTS Various medical and surgical associations have published guidelines in reaction to the initial onset of the pandemic in early 2020. DISCUSSION AND CONCLUSION As the number of patients with COVID-19 increases, long-term recovery and future preparedness are imperative and should be cognizant of patient subpopulations that have been subject to disproportionate morbidity and mortality burden. Development of a dedicated response team would aid in achieving preparedness by drafting and implementing plans for resource allocation during scarcity, including logistic and ethical considerations of vaccine distribution. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alyssa M. Lombardo
- University of Chicago Pritzker, School of Medicine, 924 E 57th St. Ste. 104, Chicago, IL 60637, United States,Corresponding author
| | - Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States,The MacLean Center for Clinical Medical Ethics, The University of Chicago, 5841 S Maryland Ave. MC 6098, Chicago, IL 60637, United States
| | - Abhishek P. Deshpande
- University of Illinois, College of Medicine, 1853W Polk St. MC 785, Chicago, IL 60612, United States
| | - Joshua M. Aizen
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
| | - Pankaj P. Dangle
- Section of Pediatric Urology, Department of Urology, University of Alabama at Birmingham, Children's of Alabama, 1530 3rd Ave. S, Birmingham, AL 35233, United States
| | - Mohan S. Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
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Psota E, Carlson J, Rodrigues Armijo P, Flores L, Siu KC, Oleynikov D, Farritor S, Bills N. End-Effector Contact and Force Detection for Miniature Autonomous Robots Performing Lunar and Expeditionary Surgery. Mil Med 2021; 186:281-287. [PMID: 33499491 DOI: 10.1093/milmed/usaa443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 10/23/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The U.S. Space Force was stood up on December 20, 2019 as an independent branch under the Air Force consisting of about 16,000 active duty and civilian personnel focused singularly on space. In addition to the Space Force, the plans by NASA and private industry for exploration-class long-duration missions to the moon, near-earth asteroids, and Mars makes semi-independent medical capability in space a priority. Current practice for space-based medicine is limited and relies on a "life-raft" scenario for emergencies. Discussions by working groups on military space-based medicine include placing a Role III equivalent facility in a lunar surface station. Surgical capability is a key requirement for that facility. MATERIALS AND METHODS To prepare for the eventuality of surgery in space, it is necessary to develop low-mass, low power, mini-surgical robots, which could serve as a celestial replacement for existing terrestrial robots. The current study focused on developing semi-autonomous capability in surgical robotics, specifically related to task automation. Two categories for end-effector tissue interaction were developed: Visual feedback from the robot to detect tissue contact, and motor current waveform measurements to detect contact force. RESULTS Using a pixel-to-pixel deep neural network to train, we were able to achieve an accuracy of nearly 90% for contact/no-contact detection. Large torques were predicted well by a trained long short-term memory recursive network, but the technique did not predict small torques well. CONCLUSION Surgical capability on long-duration missions will require human/machine teaming with semi-autonomous surgical robots. Our existing small, lightweight, low-power miniature robots perform multiple essential tasks in one design including hemostasis, fluid management, suturing for traumatic wounds, and are fully insertable for internal surgical procedures. To prepare for the inevitable eventuality of an emergency surgery in space, it is essential that automated surgical robot capabilities be developed.
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Affiliation(s)
- Eric Psota
- Center for Advanced Surgical Technology, 986245 Nebraska Medical Center, Omaha, NE, 69818-6245, USA.,Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0511, USA
| | - Jay Carlson
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0511, USA
| | - Priscila Rodrigues Armijo
- Center for Advanced Surgical Technology, 986245 Nebraska Medical Center, Omaha, NE, 69818-6245, USA.,Department of Surgery, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 69818-6245, USA
| | - Laura Flores
- Center for Advanced Surgical Technology, 986245 Nebraska Medical Center, Omaha, NE, 69818-6245, USA
| | - Ka-Chun Siu
- Center for Advanced Surgical Technology, 986245 Nebraska Medical Center, Omaha, NE, 69818-6245, USA.,College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE, 69818-4220, USA
| | | | - Shane Farritor
- Virtual Incision Corporation, Lincoln, NE, 68508, USA.,Department of Mechanical and Material Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588-0526, USA
| | - Nathan Bills
- Center for Advanced Surgical Technology, 986245 Nebraska Medical Center, Omaha, NE, 69818-6245, USA.,Department of Surgery, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 69818-6245, USA
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Börner Valdez L, Datta RR, Babic B, Müller DT, Bruns CJ, Fuchs HF. 5G mobile communication applications for surgery: An overview of the latest literature. Artif Intell Gastrointest Endosc 2021; 2:1-11. [DOI: 10.37126/aige.v2.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
Fifth-generation wireless network, 5G, is expected to bring surgery to a next level. Remote surgery and telementoring could be enabled and be brought into routine medical care due to 5G characteristics, such as extreme high bandwidth, ultra-short latency, multiconnectivity, high mobility, high availability, and high reliability. This work explores the benefits, applications and demands of 5G for surgery. Therefore, the development of previous surgical procedures from using older networks to 5G is outlined. The current state of 5G in surgical research studies is discussed, as well as future aspects and requirements of 5G in surgery are presented.
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Affiliation(s)
| | - Rabi R Datta
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Benjamin Babic
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Dolores T Müller
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | | | - Hans F Fuchs
- Department of Surgery, University of Cologne, Cologne 50937, Germany
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De Silva K, Myat A, Strange J, Weisz G. Iterative Improvement and Marginal Gains in Coronary Revascularisation: Is Robot-assisted Percutaneous Coronary Intervention the New Hope? Interv Cardiol 2020; 15:e18. [PMID: 33376506 PMCID: PMC7756352 DOI: 10.15420/icr.2020.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022] Open
Abstract
Percutaneous coronary intervention (PCI) has undergone a rapid and adaptive evolution since its introduction into clinical practice more than 40 years ago. It is the most common mode of coronary revascularisation in use, with the scope, breadth and constellation of disease being treated increasing markedly over time. This has principally been driven by improvements in technology, engineering and training in the field, which has facilitated more complex PCI procedures to be undertaken safely. Robot-assisted PCI represents the next paradigm shift in contemporary PCI practice. It has the ability to enhance procedural accuracy for the patient while improving radiation safety and ergonomics for the operator. This state-of-the-art review outlines the current position and future potential of robot-assisted PCI.
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Affiliation(s)
- Kalpa De Silva
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust and University of Bristol Bristol, UK
| | - Aung Myat
- Frimley Park Hospital, Frimley Health NHS Foundation Trust Camberley, UK
| | - Julian Strange
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust and University of Bristol Bristol, UK
| | - Giora Weisz
- Columbia University Medical Center New York, NY, US
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Abstract
The advent of telerobotic systems has revolutionized various aspects of the industry and human life. This technology is designed to augment human sensorimotor capabilities to extend them beyond natural competence. Classic examples are space and underwater applications when distance and access are the two major physical barriers to be combated with this technology. In modern examples, telerobotic systems have been used in several clinical applications, including teleoperated surgery and telerehabilitation. In this regard, there has been a significant amount of research and development due to the major benefits in terms of medical outcomes. Recently telerobotic systems are combined with advanced artificial intelligence modules to better share the agency with the operator and open new doors of medical automation. In this review paper, we have provided a comprehensive analysis of the literature considering various topologies of telerobotic systems in the medical domain while shedding light on different levels of autonomy for this technology, starting from direct control, going up to command-tracking autonomous telerobots. Existing challenges, including instrumentation, transparency, autonomy, stochastic communication delays, and stability, in addition to the current direction of research related to benefit in telemedicine and medical automation, and future vision of this technology, are discussed in this review paper.
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Collins JW, Ghazi A, Stoyanov D, Hung A, Coleman M, Cecil T, Ericsson A, Anvari M, Wang Y, Beaulieu Y, Haram N, Sridhar A, Marescaux J, Diana M, Marcus HJ, Levy J, Dasgupta P, Stefanidis D, Martino M, Feins R, Patel V, Slack M, Satava RM, Kelly JD. Utilising an Accelerated Delphi Process to Develop Guidance and Protocols for Telepresence Applications in Remote Robotic Surgery Training. EUR UROL SUPPL 2020; 22:23-33. [PMID: 34337475 PMCID: PMC8317899 DOI: 10.1016/j.euros.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/15/2023] Open
Abstract
CONTEXT The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standardised approach to training candidates in skill acquisition via telepresence technologies. We aim to describe an approach based on the current evidence and available technologies, and define the key elements within optimised telepresence services, by seeking consensus from an expert committee comprising key opinion leaders in training. EVIDENCE ACQUISITION This project was carried out in phases: a systematic review of the current literature, a teleconference meeting, and then an initial survey were conducted based on the current evidence and expert opinion, and sent to the committee. Twenty-four experts in training, including clinicians, academics, and industry, contributed to the Delphi process. An accelerated Delphi process underwent three rounds and was completed within 72 h. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement. EVIDENCE SYNTHESIS There was 100% consensus regarding an urgent need for international agreement on guidance for optimised telepresence. Consensus was reached in multiple areas, including (1) infrastructure and functionality; (2) definitions and terminology; (3) protocols for training, communication, and safety issues; and (4) accountability including ethical and legal issues. The resulting formulated guidance showed good internal consistency among experts, with a Cronbach alpha of 0.90. CONCLUSIONS Using the Delphi methodology, we achieved international consensus among experts for development and content validation of optimised telepresence services for robotic surgery training. This guidance lays the foundation for launching telepresence services in robotic surgery. This guidance will require further validation. PATIENT SUMMARY Owing to travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic, development of remote training and support via telemedicine is becoming increasingly important. We report a key opinion leader consensus view on a standardised approach to telepresence.
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Affiliation(s)
- Justin W. Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Department of Uro-Oncology, University College London Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Andrew Hung
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Tom Cecil
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Anders Ericsson
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mehran Anvari
- Department of Surgery, St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | - Yanick Beaulieu
- Division of Cardiology and Critical Care, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nadine Haram
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Department of Uro-Oncology, University College London Hospital, London, UK
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Hani J. Marcus
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Jeffrey Levy
- Institute for Surgical Excellence, Philadelphia, PA, USA
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Kings College London, London, UK
| | | | | | - Richard Feins
- Division of C Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | - Mark Slack
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | | | - John D. Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Department of Uro-Oncology, University College London Hospital, London, UK
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Compensatory motion scaling for time-delayed robotic surgery. Surg Endosc 2020; 35:2613-2618. [PMID: 32514831 DOI: 10.1007/s00464-020-07681-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Round trip signal latency, or time delay, is an unavoidable constraint that currently stands as a major barrier to safe and efficient remote telesurgery. While there have been significant technological advancements aimed at reducing the time delay, studies evaluating methods of mitigating the negative effects of time delay are needed. Herein, we explored instrument motion scaling as a method to improve performance in time-delayed robotic surgery. METHODS This was a robotic surgery user study using the da Vinci Research Kit system. A ring transfer task was performed under normal circumstances (no added time delay), and with 250 ms, 500 ms, and 750 ms delay. Robotic instrument motion scaling was modulated across a range of values (- 0.15, - 0.1, 0, + 0.1, + 0.15), with negative values indicating less instrument displacement for a given amount of operator movement. The primary outcomes were task completion time and total errors. Three-dimensional instrument movement was compared against different motion scales using dynamic time warping to demonstrate the effects of scaling. RESULTS Performance declined with increasing time delay. Statistically significant increases in task time and number of errors were seen at 500 ms and 750 ms delay (p < 0.05). Total errors were positively correlated with task time on linear regression (R = 0.79, p < 0.001). Under 750 ms delay, negative instrument motion scaling improved error rates. Negative motion scaling trended toward improving task times toward those seen in non-delayed scenarios. Improvements in instrument path motion were seen with the implementation of negative motion scaling. CONCLUSIONS Under time-delayed conditions, negative robotic instrument motion scaling yielded fewer surgical errors with slight improvement in task time. Motion scaling is a promising method of improving the safety and efficiency of time-delayed robotic surgery and warrants further investigation.
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The shifting trends towards a robotically-assisted surgical interface: Clinical and financial implications. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Collins JW, Wisz P. Training in robotic surgery, replicating the airline industry. How far have we come? World J Urol 2019; 38:1645-1651. [PMID: 31624867 PMCID: PMC7303079 DOI: 10.1007/s00345-019-02976-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/20/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. We aim to compare current robotic training curricula with training in aviation, to evaluate current similarities and to provide insight into how healthcare can further learn from replicating initiatives in aviation training. Methods A systematic literature review of the current evidence was conducted online and relevant publications and information were identified. Evaluation and comparison between training in robotic surgery and the aviation industry was performed. Results There are significant similarities between modern robotic training curricula and pilot training. Both undergo basic training before proceeding to advanced training. Aviation training methods include classroom instruction, e-learning and practical training, in both the aircraft and flight simulation training devices. Both surgeon and pilot training include technical and procedural instruction as well as training in non-technical skills such as crisis management, decision making, leadership and communication. However, there is more regulation in aviation, with international standards for training curricula, simulation devices and instructors/trainers that are legally binding. Continuous learning with re-qualification with benchmarked high stakes tests are also mandatory throughout a pilot’s and instructor’s career. Conclusion Robotic surgeons and pilots roles have many fundamental similarities. Both work with expensive and complex technology requiring high levels of skills, within working environments with high physiological and psychological stress levels. Whilst many initiatives in aviation training have already been replicated in surgical training there remain considerable differences in regulation. Adopting established and proven aviation methods of assessment and regulation could help robotic surgical training become more efficient, more effective and ultimately safer.
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Affiliation(s)
- Justin William Collins
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Orsi Academy, Melle, Belgium.
- Department of Uro-oncology, UCLH (University College London Hospital), London, UK.
| | - Pawel Wisz
- Orsi Academy, Melle, Belgium
- OLV Hospital, Aalst, Belgium
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Huang EY, Knight S, Guetter CR, Davis CH, Moller M, Slama E, Crandall M. Telemedicine and telementoring in the surgical specialties: A narrative review. Am J Surg 2019; 218:760-766. [PMID: 31350010 DOI: 10.1016/j.amjsurg.2019.07.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology. DATA SOURCES A search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients. CONCLUSIONS Telemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.
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Affiliation(s)
- Eunice Y Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N. Dunlap St., Second Floor, Memphis, TN, 38105, USA.
| | - Samantha Knight
- Southern Illinois School of Medicine, 701 N. First Street, PO Box 19638, Springfield, IL, 62702, USA.
| | - Camila Roginski Guetter
- Federal University of Parana, Medical School. Rua Padre Camargo, 285. Alto da Glória, Curitiba, PR, 80060-240, Brazil.
| | | | - Mecker Moller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, Fl, 33131, USA.
| | - Eliza Slama
- Department of Surgery, St. Agnes Hospital, 900 S. Caton Avenue, Baltimore, MD, 21229, USA.
| | - Marie Crandall
- University of Florida College of Medicine, Jacksonville 655 W. 8th Street Jacksonville, FL, 32209, USA.
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Sulaiman N, Guraya S, Hasswan A. Mapping the perceptions of trainees for promoting surgical competence at the Sharjah clinical training centre. J Taibah Univ Med Sci 2019; 14:31-38. [PMID: 31435387 PMCID: PMC6695043 DOI: 10.1016/j.jtumed.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Despite the pressing need for a standard, worldwide surgical training program, there is a dearth of accredited surgical training centres that harmonize learning experiences. Following concerns about patient safety and the long learning curve in surgical training, the role of accredited surgical training centres is being emphasized. This research reports on the perceptions of surgical trainees at an accredited training centre in the UAE. METHODS We used a questionnaire with 10 close-ended statements about demographic data and the quality of course contents in dry and wet labs as well as in theoretical training sessions. Quantitative and qualitative analyses were conducted using SPSS software, and NVIVO was used to identify common themes. RESULTS Of 2124 respondents who attended 934 courses, 1866 (87.6%) were men and 258 (12.1%) were women. Most respondents (1848; 87%) represented the Middle East, and 1093 (51.5%) of them worked in hospitals. Although most attendees were satisfied with the quality of the contents and materials used for surgical training, they were dissatisfied for 'Would you prefer to have more surgical training by lectures, oral interactive sessions, or videos'? A significant number of respondents proposed more hands-on surgical training and did not like theoretical sessions (p ˂ 0.05). Furthermore, there were great variations in responses in terms of the participants' regional and workplace profiles. CONCLUSION This study underlines the need for more hands-on surgical training. These findings urge educators to modify surgical training programs to embed more practical and hands-on surgical training.
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Affiliation(s)
- Nabil Sulaiman
- Family and Community Medicine and Behavioural Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Salman Guraya
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmed Hasswan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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