An Insight into The Emerging Field of Telesurgery

By Amirali Banani

Telesurgery is a field that has always fascinated me. Not only does it allow for more surgeries to be done globally without having to worry about geographical location, but it is also a testament to the future of the medical field as well as surgical operations. I find it very fascinating that a surgeon can do surgery with high precision from his/her home which may be thousands of kilometers away from the operating room. The surgeon may be in North America while their patient is in an operating room at a hospital in Australia.

The Technology Behind Telesurgery and its Innovative Future

This form of telemedicine takes advantage of a surgical system that uses wireless networking and robotic technology to connect surgeons and patients who are unable to meet at a particular place at a particular time. As with other forms of the broader field of telemedicine, telesurgery offers numerous healthcare benefits for patients. This includes, but is not limited to: a significant reduction in healthcare and travel costs, more timely access to emergency care, greater communication, and collaboration between different physicians, greater efficiency as less physical effort is needed by the surgeon to operate, and most importantly, telesurgery allows for the ability to provide crucial emergency healthcare services to remote and underserved areas of the world such as Sub-Saharan Africa and parts of Southern Asia. In addition to these benefits, it is also a more sanitary method of surgery for both the surgeon and the patient. This is because there is no risk for the surgeon of ingesting potentially contaminated substances such as blood and at the same time it lowers the risk of infection for the patient as the robot and the general environment of the operating room are completely sterilized after every operation.

Ever since the world’s first successful telesurgery operation, the development of remote surgery has faced significant obstacles in wireless networking technology. However, we are currently living through the fourth industrial revolution in all the fields of our lives – and surgery is no exception. The future of surgery and therefore medicine is transforming with the development of modern technological innovations such as 5G networks, artificial intelligence and machine learning technology, 3D printing, nanotechnology, and haptic feedback technology.

The Lindbergh Operation — Telesurgery’s First Success

It has now been over twenty years since the famous “Lindbergh Operation” was conducted in New York City in 2001, and the robotic and health-tech industry’s tremendous technological advancements throughout the years are undeniable.

The initial procedure, a laparoscopic cholecystectomy (or gallbladder removal), was completed by a team of surgeons using the ZEUS Robotic Surgical System (ZRSS). The patient was a 68-year-old female with a history of abdominal pain and cholelithiasis (gallstones). While the patient was in a hospital in Strasbourg, France, her surgeons were diligently operating the robot almost 14,000 km away. At the time, high-speed terrestrial networks – the same transmission system used in television broadcasting – were used to connect the medical robot in Strasbourg to the surgeon console in New York. The operation lasted about 114 minutes, with an additional 16 minutes spent on trocar placement and setting up the surgical apparatus. No difficulties or complications were encountered throughout the process. Despite the extraordinary distance between the physicians and the patient, the average lag time for transmission was estimated at just about a sixth of a second. Following the surgery, the patient had an uneventful recovery and returned to her normal activities two weeks later. This was a huge milestone for the telesurgery industry.

Fast forward less than two decades later, and the field has witnessed some dramatic improvements. In 2019, telerobotic spinal surgeries using 5G network technology were performed on 12 patients with spinal disorders (4 thoracolumbar fractures, 6 lumbar spondylolisthesis, 2 lumbar stenosis) in six hospitals across six different cities in China. Sixty-two pedicle screws were implanted out of which 59 screws were grade A, and three were grade B in the Gertzbein-Robbins classification, which assesses the position of transpedicular screws. A new concept of remote surgery known as “one-to-many’’ was being explored with these clinical series, in which the surgeon in the master control room performs surgery on multiple physically isolated patients simultaneously. This is a method through which surgical operations can be done on more patients in less time, which is especially crucial when the patient’s condition must be urgently treated.

Previously, the concept of one-to-many remote surgeries faced many restrictions and limitations regarding time lag and communication delays. These 12 cases, however, demonstrated that it is possible to provide reliable medical services with nearly zero telecommunication error or network delay – a massive advancement in telesurgery and the broader field of telemedicine.

A Pioneer of Telesurgery

Dr. Howard A. Paul was a huge contributor to telerobotic surgery as he was the developer of the world’s first robotic surgical arm. He was widely known for his research in applying three-dimensional imaging and robotics in the operating room, and the result of his research was an orthopedic surgical device known as Robodoc, a five-foot robotic arm with a high-speed drill and complex imaging technology designed to provide surgeons with far greater accuracy in orthopedic surgeries than their hands could insure. The innovative robotic system allowed surgeons to perform high-precision complex hip and knee surgeries using Computed Tomography (CT) scans that were converted into three-dimensional virtual images for preoperative planning and computer-guided bone drilling. This groundbreaking device has been used in more than 28,000 procedures worldwide with a very high success rate and remains the only robotic surgical device approved by the United States Food and Drug Administration (FDA). Many new and more technologically advanced robotic surgical devices have been developed after Robodoc for other procedures such as ligament repairs and the removal of brain tumors, but Dr. Paul’s pioneering invention will go down as one of the most significant contributions in the history of telerobotic surgery.

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