Telesurgery has come a long way since surgeons made the first virtual incision more than 12 years ago. But impediments still remain.
That historic event happened back in February 2001, when two surgeons in New York City used IP-based technology to successfully remove the gallbladder of a patient located 6,000 kilometers away in Strasbourg, France. Using a three-armed robot, the surgeons directed two of the robotic arms to cut tiny incisions into the patient's abdomen, while the third arm inserted a mini-camera into her abdominal cavity to provide the doctors with visibility into the patient's internal area for guidance during the surgery.
In 2011, Kenyan surgeons from Aga khan University hospital performed a successful telesurgery over a dedicated 15 megabits per second connection -- building hope that urban surgical skills could be leveraged to remote and rural areas around the world. This marked the first telesurgery in Kenya, and generated optimism for improved healthcare in that region.
Indeed, telesurgery provides enormous potential for life-saving medicine wherever people are, and will undoubtedly assume its rightful place in the future. But technological and governance issues are impeding adoption today.
Communications QoS
Guaranteeing quality of service (QoS) across Internet, even with dedicated pipelines, is a major issue in telesurgery -- as is latency of communications. One of the major concerns in the Strasbourg telesurgery was the communications latency that staff encountered when signals from the surgeon's control board in New York City were sent to the operating room in France. The signals being transmitted also had to be translated into robotic actions that were executed during the course of surgery.
While these robotic actions were being carried out in France, the surgeon in New York had to wait for incoming video signals to observe (and confirm) that operating room activities were correct. Each passing millisecond of latency introduced a modicum of delay-induced risk. To correct this, work is underway to perfect the various layers of network communications that potentially impede the flow of telesurgery instructions and observations, but we are not there yet.
Medical procedure failovers
Medical procedures need to be rewritten and tested for a telesurgery scenario. In early telesurgery work, a stand-by surgeon was positioned at the site of the operation, fully prepared to take over if the telesurgery communications line was interrupted. To prevent this from happening on the IT side, provisions have been made for failover lines so that communications are continuous and uninterrupted, even if there is a disruption to the primary communications conduit. These failover systems can stand further improvement, and will continue to incorporate best-practices as healthcare providers gain more empirical knowledge of telesurgery.
Legal and regulatory barriers
In the US, doctors (like lawyers) are certified and licensed in the states where they practice -- and cannot necessarily traverse state boundaries with their medical services. The plot can become even more complicated with international borders.
Some states have reciprocity agreements that facilitate an event like a telesurgery with an out-of-state doctor, but in other cases, surgeons must first meet time-consuming licensing and certification requirements.
Looking at the future
An aging population with greater health needs is projected to create a shortage of more than 130,000 doctors in the United States alone by 2024. The need for more medical care is also being felt in other parts of the world.
Meanwhile, demands for telesurgery and other forms of telemedicine in rural areas, third world countries, and perhaps even space will increase. Public organizations and private enterprises are coming forward with funding, at the same time that communications consortiums like Internet2 build 100G networks that can facilitate the level of communications QoS that telesurgery demands.
This is welcome news because the evolution of telesurgery into standard practice will certainly be at the forefront of modern medicine.
Thanks for bringing up this point. It's an important one I hadn't thought of as part of the discussion, but one with potential that can't be overstated.
@hiranya: Same thing occurred to me as well but then I realized there is nobody to blame on this matter so I kept quiet. Anyway I think we should take the initiative and push this project forward as much as possible.
@Mr.Roques: I think you are been a bit mean here :). True there are certain spots which has to be taken into serious consideration before going forward but the can start from the towns itself and test the success ratio of the technology and then take other steps in moving towards the remote areas.
You brought forward a very important consideration that of building an ecosystem around telesurgery. There is often this temptation to believe that if only we can roll oiut the network infrastructure, telesurgery will become a reality. However, as you rightly noted, the success of telesurgery goes beyond technology. If Telesurgery should become mainstream and widely adopted that ecosystem that will make it function technologically, financially and legally has to be created.
Agreed, Jason. Here in California, telemedicine is advancing rapidly, and leading health providers are embracing it as a cost effective way to deliver care/services.
I think the infrastructure issues you point out will be solved, and the driving forces for advancing telesurgery will mirror telemedicine - access to expertise/care, reduced cost of delivery. But it definitely needs to have an ecosystem that makes it function technologically, financially, and legally.
I agree, telemedicine seems to have a stronger foothold at the moment. It's less intense and requires less bandwidth, etc. I know hospitals and even hospices that are exploring this technology as we speak. It's pretty cool, really.
I agree, the technology is just not there. I personally believe bandwidth is the largest set back at this point, especially in remote areas where military probably is more often than not.
Good point. It's really not hard to imagine who lawyers would prey on this sort of technology, especially in the U.S. The question is, like you said, who will they prey on more?
more over, ok, lets forget about the patient and think about lawyers- if something happens to theis that treated patient, whose fault is that? Who will be a "victim" of lawyers?
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