Telesurgery or remote surgery is an emerging surgical tool that utilizes both robotic technology and wireless networking to connect patients and surgeons who are geographically distant. Telesurgery harnesses a form of network-mediated robotic control; the word comes from the Greek ‘tele’ which means remote, ‘cheir’ (hand), and ‘ergein’ (to work).
The main utility of telesurgery is its ability to overcome the limitations of conventional surgery, namely the geographical inaccessibility of rapid and high-quality surgical care, a surgeon shortage/ logistical limitations of surgeon schedules, financial costs, and long-distance travel. This technology benefits both the patients and surgeons, providing both technical accuracy and enhancing the safety of procedures.
Robotic Surgery at UC Davis Health
How is telesurgery impacting the delivery of healthcare?
The rise of remote surgery, or telesurgery, has seen a surge in popularity following rapid advancements in computer technology, telecommunications, and robotics. Consequently, novel improvements in medical training and a broadening of the technological tools available to physicians has resulted in current means of telesurgery which offer the following benefits:
- The provision of high-quality surgery in medically underserved locations which may include rural areas, battlefields, and various forms of large space and sea mission vehicles such as submarines, outposts, and spacecrafts, where staff live for extended periods
- Eliminates the need for long-distance traveling which is associated with high costs and potential dangers; telesurgical tools combine several display systems to enable high-definition video feed to be transmitted to surgeons located remotely and simultaneously. These surgeons would otherwise be unable to participate in in-person surgery owing to scheduling conflicts
- Facilitates collaboration among surgeons, who may be separated by distance, in real-time; surgical accuracy and significantly reduced damage to adjacent healthy tissue is eliminated in real-time with accelerometer technology - this error is associated with the physiological tremor of human hands
- Minimal collateral damage to adjacent healthy tissues accelerates patient recovery
- Minimizes the risk of infection; as surgeons and patients are geographically separated, telesurgery eliminates the risk of viral transmission.
The limitations of telesurgery
Telesurgery is not without limitations, however. There are considerations towards patient safety and privacy, high costs of initial implementation and maintenance, as well as legal and ethical concerns.
Privacy, particularly when sensitive images of patient data are transferred through the internet is of utmost priority, however, cyber-attacks and unstable connections may complicate the ability to carry out telesurgery safely and ethically. Latency may also result from an unstable connection which can increase the chance of inaccuracy during the surgical procedure as well as extend the operation time.
Disadvantages of telemedicine include confusion for patients regarding the identity of their physician or extended healthcare team, in the absence of standard operating procedures. This may additionally complicate patient consent to telesurgical procedures.
The COVID-19 pandemic has highlighted a more recent and emerging problem in telesurgery; health inequality that disproportionately affects people of lower socioeconomic status and higher age categories. This is because many people from these groups do not meet prerequisites; a National Health Service digital figure showed that approximately 40% of people did not have access to online consultations in any form in 2019. Advancing telemedical technology is likely to widen inequity between those who are able and unable to access adequate healthcare.
Image Credit: Gorodenkoff/Shutterstock.com
How is telesurgery performed?
Telesurgery is a complex process. There are several key hardware-based, functionality, and technical requirements of data streaming. The first telerobotic surgery was performed on a patient in Strasburg, France by Professor Jacques Marescaux on September 7th, 2001. This was called the ‘Lindbergh operation’; a was a 54-minute telesurgerical cholecystectomy without any complications. It represented a milestone in surgical innovation.
Telesurgery systems are robotic surgery systems capable of receiving and transforming surgical real-time data and are also called teleoperative robotic surgery systems. Since the first practical telesurgery system was used, there have been several iterations of robot systems that have evolved.
Remote surgery has been used extensively since Operation Lindbergh in several locations. These more advanced robotic technologies enable more complicated procedures to take place; allowing surgeons to control different arms, switch between the command of any robotic device, and communicate with one another.
At present, the Da Vinci surgical system by Intuitive Surgical, is the leading company in the field of telesurgery, providing >210 devices. The company gained FDA approval in July 2000 to perform advanced surgical techniques.
This, and other surgical systems like it, allow the surgeon to operate while seated at a console at a remote distance, viewing a 3D image of the surgical field. The surgeon can use a master control by grasping their fingers below the display. The Da Vinci system provides either three or four robotic arms, one endoscope arm, and two or three instrument arms that carry out the commands of the surgeon.
The key components of the technology-mediated procedure are:
- High-resolution vision system: usually in the form of an endoscope with high-resolution image processing equipment to produce 3D images of the operative field.
- Telesensors: such as “cyber gloves” contain highly sensitive technology placed at critical points to pick up and measure the posture of the hands. They operate by measuring changes in resistance to an electrical current as the sensor is bent as the surgeon moves their hands.
- Haptic feedback technology: enables tactile feedback, allowing the surgeon to feel the tensile strength, texture, and depth of the tissue from a remote system
Though promising, telemedicine still faces several challenges from cybersecurity concerns to widening socio-economic divide; however, as technology evolves, limitations can be addressed.
Alongside these technological transformations, there are several challenges posed by society, politics, and economies, which need to evolve in tandem to provide accurate, accessible, and affordable telesurgery in the future.
- Choi PJ, et al. Telesurgery: Past, Present, and Future. Cureus. 2018;10(5):e2716. doi: 10.7759/cureus.2716.
- Zemmar A, et al. The rise of robots in surgical environments during COVID-19. Nat Mach Intell. 2020;2:566–572. doi: 10.1038/s42256-020-00238-2.
- Troccaz J, et al. Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation. Annu Rev Biomed Eng. 2019;21:193-218. doi: 10.1146/annurev-bioeng-060418-052502.
- Feizi N, et al. Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision . Front Robot AI. 2021;8:610677. doi: 10.3389/frobt.2021.610677.