Physician-scientists from Japan and Singapore have tested the feasibility of robotic telesurgery as a treatment option.
Last week, a surgical team from National University Hospital (NUH), the flagship hospital of the National University Health System (NUHS) in Singapore, performed a gastrectomy remotely at Fujita Health University (FHU) in Japan. From a cockpit at the NUH Advanced Surgery Training Centre, the Singaporean surgeons orchestrated the procedure on a simulated stomach in a robotic operating room at FHU in Nagoya, Japan, more than 5,000 kilometers away.
Its behavior, a first between the two countries, was made possible by a surgical robot system capable of replicating the movements of the Singapore surgeons, which were transmitted via a special international fiber optic network. The FHU team used medical robotics company Medicaroid’s hinotori surgical robot system, Japan’s first approved and domestically developed robot-assisted surgery system.
WHY IT MATTERS
In a statement, the NUHS said the pre-clinical trial of remote surgery between NUH and FHU aims to evaluate, clarify and address potential issues arising from such a procedure.
“Some of the challenges and potential issues arising from telesurgery include transmission delay over the network, patient safety, ethical and medico-legal aspects, as well as the various regulatory approvals required from related authorities,” said Professor Jimmy So, head and senior consultant of general surgery at the NUH department of surgery, explained to Healthcare IT news.
According to a 2022 judgement of robotic surgery, a maximum delay of approximately 300 milliseconds is still acceptable for safe performance of robotic surgery. It is said that the delay can be further reduced with 5G internet and asynchronous transfer mode (ATM) fibers.
Initial findings from the NUH-FHU study showed there was a delay of around 100 milliseconds in the robot’s movement, although surgeons were able to adapt to the delay, said FHU co-leader Professor Ichiro Uyama -surgical team, in one news report.
“The delay resulting from the trial was minimal and within acceptable industry benchmarks,” noted Prof. So too.
The trial also aimed to prove that long-distance telesurgery can be performed safely using a robotic system connected via high-speed fiber optic communications. “The trial went smoothly with safe results and proved that such robotic telesurgery across borders and long distances is indeed feasible,” said Prof. So.
Also through the trial, the research teams see the potential for remote surgery to become a more accessible option for patients in the near future.
When considering the implementation of robotics in surgery, cost easily comes to the fore. A single robotic surgical system can cost approximately $1.3 million, while the costs per procedure ranges between $3,000 and $5,000.
Nevertheless, its perceived benefits, including prevention of unnecessary postoperative deaths and disability and protection against personal and social losses from dealing with surgical complications, could potentially “outweigh the high initial installation, training and maintenance costs of robotics programs”, especially for lower-middle-income countries, argued a recent one article published in the American Medical Association Journal of Ethics.
Prof. So hopes that with improved accessibility to robotic surgical systems and an improved telecommunications network, the cost of telesurgery will decrease in the future.
Other potential benefits of remote telesurgery according to Prof So include:
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improved global access to specialized care;
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reduced travel and waiting times for patients;
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minimized health risks during emergencies and pandemics;
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training and collaboration among medical professionals worldwide; And
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contribution to surgical expertise for complex cases.
THE GREATER CONTEXT
The conduct of remote surgical experiments is part of ongoing activities agreed in a memorandum of understanding between FHU and the National University of Singapore Yong Loo Lin School of Medicine (NUS Medicine), which was signed in August. The NUH is the main teaching hospital for NUS Medicine.
The first recorded transnational robot operation took place in 2001 between France and the United States. An uncomplicated cholecystectomy was performed on a patient in Strasbourg by remote surgeons in New York City. An ATM fiber optic network with a bandwidth of 10 megabits per second facilitated the transmission of movements from a console in the US to the robotic arms in France.