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Video Over IP Permits South Pole Surgery
Henry Malmgren writes "Last week at the South Pole research station, we successfully completed knee surgery using a video over IP link back to the United States. The article is light on technical details, but what we did was to use a Polycom VTC unit to send a video signal to Raytheon Polar Services HQ in Colorado. Our signal went primarily over a Marisat satellite at T1 speeds, and then HQ redistributed the video to Boston via a dedicated ISDN line. We had signal problems several times during the transmission with Marisat, so we had to switch to a NASA TDRS satellite towards the end of the surgery. We also used an Iridium phone as a voice backup for the times when we couldn't get decent quality over either bird. During the surgery there were three cameras that we used to send back video to the states. One was the built in camera on the VTC unit, a second was a handheld Sony 8mm unit, and a third was a black and white "Doc Cam". This was a head mounted camera with a LED light unit that was built on station by our Senior Communications Technican, Jon Berry. This allowed the transmission of video from the Doctor's perspective. Unfortunately, while the Doc cam worked great locally, and we got great recordings of the surgery from it, it didn't work well over the satellite link. The camera view jumped around so much that it didn't compress well over the satellite link. The best video was obtained by putting the hand held camera on a tall tripod which was able to look directly into the surgical wound."
You didn't read the article, moron. The guy damaged a tendon in a fall. The article you link to is about arthritis. Hardly the same thing...
I cannot remember the particulars, but this is quite an innovation since the last major medical emergency in the south pole. A scientist had breast cancer, and she ended up performing self chemo on herself. Imagine if they had this technology a few years sooner! Usually on slashdot all we hear is the typical Linux yaddyaddayadda (not that i dont appreciate that), but it is nice to hear such a great use of technology
"Martha Stewart can lick my Scrotum......do i have a scrotum?" -- Sharon Osbourne
Well, let's see...except for the facts that the surgery in the article was to repair a damaged tendon, and was not performed using arthroscopic techniques, and was not related to osteoarthritis, you're right on the money.
Oh wait, no you're not.
Why yes, I AM a rocket scientist!
Since the doctor at the pole was the one really in control, this almost seems more like a virtual consult than actual telesurgery.
Also, the problem with the cancer before wasn't such a big deal b/c of surgery, etc, just b/c they couldn't transmit a good microscopic image of the biopsy back w/ existing equipment, once more equip was dropped they were fine.
So they had a wireless T1 link at the south pole and The best they could do in Boston was ISDN??? Maybe i should move to the Sou1th Pole, if the wireless offerings are that good!!
The technology is very neat but, I dont quite understand why it was needed. Was it really neccesary for the physician in the pole to be talked through the operation. I am truely curious about this and would like to know more.
I'm glad to see some competent technology used in a complicated and potentially dangerous situation. After seeing the Volvo & Windows98 topic, I was afraid this one could've been Surgery & AOL. The one thing someone dosn't want to here during surgery is "You've got mail!!!", or pop-up add might not be good either. I've been wondering for years when we would get to see these amazing network infrastructures around the world put to some advanced use. What the future holds?... we will see.
so close .....
only a fool calls others fools, or something.
you're winner!!
The would need to take it a step further and do the surgery use cams and a remote robot. Outfit the doc with vr gloves and helmet and your set.
I'm actually surprised that there hasn't been more telesurgery experiments; I find the whole idea fascinating, and that the process can be made to work at all really amazing and impressive.
But I think that the referenced article had a better take on it than this posting, whose "additional technical details" are, at best, unintentionally misleading.
The implication of "video over IP" is that you did this over the public IP network, which in fact is not the case.
The fact that you did this over what was effectively a dedicated point-to-point link means that the use of the IP transport was irrelevant (worse; it added unnecessary overhead, subtracting from the total data rate).
I understand not wanting to risk someone's knee on a link succeptible to a DOS (or only succeptible as a result of a substantial investment of effort on the part of the attacker). But your posting implies that this is something which took place over the public Internet, or *could* take place over the public Internet, when it's not.
-- Terry
we told him to watch his step. the driveway was covered in ice.
i like natalie portman. petrified, of course.
you're winner!!
You had me at "T1 over satellite."
El Karma: excelente(principalmente la suma de moderación hecha a los comentarios de los usuarios)
What I'd like to see is a web cast of this sort of thing.
I have no sig
They were able to show me video of the inside of my knee! It was great, even though my mom really didn't seem to like it much (I was 16 at the time). I wanted to take a copy home, but they wouldn't let me. I'm still a little bit sad about that.
This was a head mounted camera with a LED light unit that was built on station by our Senior Communications Technican, Jon Berry.
.... uh... important stuff to frag^H^H^H^H do.
Now this is a Capital G Geek in the best of all possible meanings.
"You wanna what? OK, I got some LEDs and shit...(madly digging through toolbox).Some wires hmmm.. soldering iron over here. Right on surgical lamp, heh. One of these days you'll come up with a challenge for me. Hey, when you're done with the surgery, can we keep the T1 satellite link up for a few. I have some
Seriously, there's a guy who actually earned the "Senior" in his title.
If you read the article it states that arthroscopy of the knee is ineffective in osteoarthritic knees - i.e. knees in older people who probably need knee replacements. In people who don't have OA, it's an effective and valuable operation
..........FULL STOP.
You'll have to stop doing this sort of thing, 17 penguins beached themselves because of the intense satellite transmissions causing mass confusion on the Ross Ice Shelf.
You bunch of meanies...
He's right you know. Have you ever seen Lech Walesa walk?
I don't mean the story happening on July 5th, I mean in the transmission. I'd hate to be the surgeon cutting, like, even 100ms before I see what I'm cutting. I Take that back. I'd really hate to be the patient, being a surgeon can't be a bad thing, anyway you look at it. Seriously, anybody has numbers on this, or is it just something you get used too? Like if you had real long arms, impecceble vision, and had to operate 30,000km away..?
So do you suppose there were any penguins involved...? :)
I am concerned about any program, any piece of hardware, any treaty, any law that treats me as a consumer, not a citizen
Now the surgeon can scratch his ass as much as he likes during surgery without having to wash his hands and change gloves.
Anyway, my sister is only 27 and she's had one hip replaced for two years; and needs the other done ASAP. So it's not only old people that have osteo or need joints replaced.[1]
I don't post this for pity, or anything, but more simply to point out that one of the most difficult things for my sister and I with this disease is that no one expects people as young as we are to have such substantial problems just walking around. So I have a bit of a vested interest in pointing out that although rare, it isn't just old people that have osteoarthritis. By the way, my dad and sister have also had several arthroscopic surgeries on their knees, elbows, ankles, and shoulders. They did seem to help at least for a limited amount of time. But the joints just keeps on falling apart and making bony grit that crunches around in there; so it's temporary at best. I did read about that recent study with interest, though.
[1] I should mention that my sister actually resists the "osteoarthritis" non-professional diagnosis of our genetic disorder. It has a real, technical name that's no more descriptive, in my opinion, than "osteoarthritis" actually is; but does have the virtue, in her opinion, of being harder to fail to take seriously. She claims the actual degree of our joint deterioration is much greater than that of, say, the average 70 year-old with osteo. I have no idea. It seems bad, but these are the only joints I've ever had. Our doctors have always said that it's very, very bad.
disclaimer: I'm not a medical doctor, but am a researcher in bimechanics/lubrication of joints (in the body). I'll try not to ramble on too much !
To back up another poster - osteoarthritis is not confined to older people, though it is much more prevalent in older age groups.
Arthroscopy is a procedure which does not require the knee to be opened completely - much better for the patient (faster recovery, no general anaesthetic, etc) and a much simpler and cheaper procedure. You most likely hear about it with sports people who have damaged knees (cruciate ligaments particularly), and it is often used as an exploratory procedure so the surgeon can see exactly what is wrong inside the joint.
"Because it's there." - George Mallory, when asked why he wanted to climb Mt Everest, March 18, 1923 (New York Times)
Not at all like over here in Ethiopia, where a quarter of us don't have food*.
So sorry... you've got a rough life there in the United States, having to go to work for a large company or your government in order to get access to health insurance, and where, by law, if you show up at a hospital emergency room with a problem (like needing anti-inflamatory medication), they have to take you, regardless of your ability to pay. I guess you must notbe able to type well enough to work for your IRS -- oh wait, you posted your whine.
(*) Yes, I think it's assinine to guarantee health insurance in a country where food clothing and shelter are not guaranteed, first. And where the cost of medical care is so high in the first place because the whole country is chock full of litigous bastards complaining about their lives being saved, and the insurance companies charge the medical industry so much for malpractice insurances, that costs on the other side are so high you can't afford it -- without insurance... are you seeing a pattern here?
And so, this is the second time they've needed remote medical help because the doctor there wasn't capable of handling the job themselves. Seems to me that this will necessarily lead to the creation of the EMH (Emergency Medical Hologram). These South Pole people really need to talk to the Star Trek people and get to work.
They're doing an unfamiliar procedure by video. Any kind of "oops" prolly wouldn't look to good to the viewing public ;-)
This is a lame story, as the people have showed! Been done before numerous times, it does not matter. It is not news. BFD.
Umm... What exactly are they doing to folks down there that causes their knees to blow out?
And no, nobody was exactly volunteering to be the first high-risk surgery attempt. It seems right that we'd try knee surgeries in a situation like this first; both the isolated patient and the lack of really bad potential outcomes make this a decent first choice.
The people with the remote heart surgery systems saw them as a training tool, for one example, first. They had some specific ideas about the steps that'd happen before the technology could be adapted for real surgery, anyway.
"Fundamentalism" isn't about divine morality. It's about human authority.
Let me say up front that this is way cool.
But reading the summary, I kept expecting to hear how you ID'd the limo from the vanity plate.
Party on!
"Consider yourself a member of a virtual corporation with Mr. Torvalds as your Chief Executive Officer." - Linux Advocac
Ah... Early morning... Coffee... Let's see what's on Slashdot...
OPEN KNEE SURGERY!!!
Ug... Not an image I want in the morning...
Why not have a Jon Katz article on Kurt Cobain's counter-society life, complete with vaporized head?
IP doesn't imply the Internet, of course.
IP was probably chosen because you could get an end to end link (most likely Ethernet at both ends of the satellite link). Satellite networks do clever things with TCP to make it work better on their high-latency links. Most video apps will be IP based these days, or require a single layer 2 (such as ISDN) end to end, which is restrictive.
I blew mine out skiing. My uncle however blew his out on an icy sidewalk. The right twist and tension will take out a tendon preaty good. Plus remember these guys are more than scientists down there, they have to more or less run a city by themselves. Catch the Discovery Channel special sometime on the Doc that got breast cancer down there.
I mod down any one who says "I'm sure I will get modded down for this"
I really wonder how practical remote surgery besides distance learning.
If we could leverage the impressive amount of cpu power currently to be found for relatively low price to replace current compression techniques with hybrid realtime 3D + Video.
For instance, easy prediction models (like the arms/smocks of the doctors, scalpels, hemostats, suction tubes) could with signatures and then compress the difficult to predict stuff (patient's entrails) with compressed video. Contrast in most operating environments means that this shouldn't be too hard to do. Then at the video destination build real-time 3D models of the cut objects to fill in the video. This should dramatically cut down on the ammount of video which needs to be compressed and transmitted.
My $0.02 will always be worth more than your â0.02, so
All the recent advances in telemedicine/remote surgery using video conferencing and robotic devices are interesting, but in the end they are not that useful. Personally, I would rather have an adequate surgeon operate on me than have the world's best surgeon do it from 3,000 miles away. The only time these devices are useful is for people that truly are stuck far from proper medical attention. If at all possible, any patient will certainly benefit from real medical attention in a hospital, but when things hit the fan in the middle of the antarctic ice, it's nice to know there is some recourse.
I suspect that surgeons participating in telesurgery must observe certain protocols themselves. "Are you certain this is where I cut?" "Yes, I am certain." "Is everyone certain this is where I make the incision?" "Yes, we are certain."
:)
If you think this is a hoot, wait til this happens on Mars.
Get off my virtual lawn, you damned virtual kids!
So, the have people capable, but no facilities for it, how is a satellite connection with an experienced doctor in Boston going to help?
Free unix account: freeshell.org
here...
Internet on south pole is tricky... not many sattelites going there.
(Always ask lots of questions - even if it pisses people off. If you don't like the setup (as in our situation) refuse to go along. In our case we told them to wait for the surgeon to arrive and be physically present in the operating room during the surgery. Who knows if he was mentally present, though.)
When I wintered over at Dumont d'Urville in '93 we broke all records with 7 surgeries, including one appendicitis. I have more info on how we coped with it and pictures as well on my site.
At the time all the doctor could rely on was a satellite voice link and a motley crew to assist him. Still much better than what the pioneers had to rely on. In Port-Martin in 1951 they did an appendicitis with sharpened kitchen knives and there's a great story about it but the link seems to be gone.
A russian doctor had to take out his own appendix in Antarctica in 1961.
Non-Linux Penguins ?
How the hell did parent get modded UP? Informative?
These were probably the most expensive surgeries ever. Why would someone go all the way to the south pole for knee surgery? I'm sure there are plenty of docs in highly populated areas where those needing the surgery live.
Give serendipity a chance.
...for penguins, I guess.
Wow!!! I just came so hard I thought I was gonna puke... great story!
Not really ground-breaking. This was done several years ago by NASA. See http://ctd.grc.nasa.gov/5610/telemedicine.html
If you want to know more about life in antarctica, and the realities of being a doctor, a friend of mine resigned a top surgeon's job to spend a year in antartica as medical officer (plus dentist, plus hairdresser).
Great diary, the real issues of life at the south pole, great photos... have a read of Ingrid On Ice
I spent a lot of money on booze, birds and fast cars. The rest I just squandered. - George Best
Your explicit and implicit analysis is screwed up in all sorts of different ways. You seem to assume that I assert that health care should be recognized as some fundamental right; and so you are arguing that food and shelter should be prior. But I'm not arguing any such thing. IN fact, I prefer to keep the language of "rights" out of this as I think it clouds the issue too much with emotion. Instead, I'll merely point out that food and shelter is, as a practical matter, far, far more available to Americans than basic health care is. We could do better, I certainly agree; but the percentage of Americans living without food or shelter is in the single digits, while the percentage living without health care is in the double-digits. It is, in fact, a bigger problem.
My main concern is that it's a bigger economic problem. The health care system is badly broken, and it's extreme deviations from market economics for those to whom it's still available is also destroying it by destroying efficiency and misallocating resources. It's not ever working for the people that it's supposedly working for. And so, as a matter of national security -- such as defense, education, transportation -- health care is vitally important and it's a disaster in the US.
My anger about it has much less to do with my own particular problems -- I'm not sure that I think that expensive operations like joint replacement are in the national interest to casually and universall subsidize. But I do think that basic health care is, that pre and post natal health care is, that preventive medicine health care is. And my access to anti-immflamatory and pain medications makes a huge difference in my ability to go out and work, and were I to be able to do so, I'd pay more in taxes than my medication costs.
By the way, for two of the last four years I was in the highest marginal tax bracket in the US and paid about $200,000 dollars in federal taxes to the US government. Unfortunately, I kept a big port of the money I kept in the stock of the company I worked for, and I lost most of it. That's my fault, I'm not blaming anyone. But because of both my medical condition(s) and the current tech job economy, my getting a job with health insurance is no easy matter. And, as a matter of fact, while I do continue to type, I have a lot of pain in my right arm and especially my shoulder that is increasingly a problem for me for working at the computer.
Finally, just because I could show up at the ER and ask for meds doesn't mean that it's right for me to do so. (And you're wrong about this anyway. They might have to give me actual meds for that one day, but ER's don't give you prescriptions and then fill them as part of the bill. Probably for this very reason.) There's huge overhead associated with emergency room care, and this (understandable) abuse of it is a big contributing factor to the problem. A bill for such a trivial thing as a visit to get medication might be $750 or more. That cost is borne by someone, and it's not right for me to make those people bear it. For now, I whittle away at my assets by spending about $350 a month on medications. That includes antidepressents that I could get for free at a state agency (here in Texas, believe it or not) that provides services and medication for the mentally ill. Their income and asset checks are not very dilligent. I know one person who owns three homes and a nice vehicle who gets her several hundred dollars worth of antidepressents every month from this agency. I have friends and family who've been encouraging me to do this for two years. But I did do this when I was very poor about six years ago, and I've seen the people this agency helps. It would be immoral, in my opinion, for me to take hundreds of dollars of aid that I don't actually qualify for, that must inevitably come out of aid that would go elsewhere -- probably to more of those street people and the like that I saw that are made almost or actualy functional through the avilability of relatively inexpensive anti-schizophrenic drugs.
My point is, just because something's available to me (or people like me) doesn't mean that it's the right thing for us to do to avail ourselves of it. A sane, nationalized health care system would allocate health care resources incredibly more efficiently, and fairly, than the current system does. We all would benefit, not just me. That's why I support it, and am angry at the people that resist it. Not just out of my personal self-interest.
I'm 37, and the only reason I don't have two artificial hips, perhaps one artificial knee and one artificial shoulder is because I live in the US where a quarter of the population doesn't have health insurance.
No, the reason you don't have all these expensive bionic thingies is that YOU didn't have health insurance. You were either too stupid or too lazy or else you gambled on assumed health and lost.
It isn't my fault, and I shouldn't have to pay for it. Everyone I know has health insurance- it isn't that hard to come by.