Canadian Surgeons Perform Telerobotic Surgery

AndroidCat writes "While the equipment used isn't new, this operation was different because one of surgeons was 400km away. Dr. Mehran Anvari in Hamilton Ontario tele-operated instruments in North Bay General Hospital, supervised by Dr. Craig McKinley on site. The link was over a high priority routed Bell Canada connection. The patient, Ms. Fortier is doing quite well. Don't try this from home with a dialup connection."

Comments

Another justification for Internet2

[BWJones]

Lots of folks complained about internet2, but this should be a prime example of why it is important.

Just last week, we had a drop out of the Abilene node and most traffic from our lab was routed onto commodity routes where the performance degredation in terms of bandwidth and latency was pretty noticeable. I have become used to the gigabit ethernet performance in my dual G4 and degradation in performance with it due to Internet2 downtime is frustrating.

Potential

[bjkoning]

I think this has great potential. Some operations can only be done by a select group of surgeons, this technology makes it possible to perform operations that wouldn't normally be performed in a hospital. I think this is going the save lives on the long run. Let's just hope they don't run Windows, I wouldn't like a crash when I'm on the table.

Latency

[ashkar]

I don't think latency would be such a big deal. It would be rather simple to write some sync code. That way the surgery might lag, but at least the surgeon's movements would never be ahead of the operation itself. His commands could be ignored until the two ends were in sync again.

Re:Latency

[SoupIsGoodFood_42]

His commands could be ignored until the two ends were in sync again.

Read that line again...very carefully. Don't you think there could be some problems there?

Best/Worst

[Evil Adrian]

Best case: surgery is fine, patient recovers.
Worst case: link gets disrupted, surgery machine goes Max Headroom on the patient -- "sl-sl-sl-sl-slice!!"

a thought on security

[Geaty]

Could you imagine what would happen if there were security issues with something like this? The implications would keep me out from under the remote-controlled knife. One could conceivably go in to get your tonsils removed, and some kid could take over the connection and carve their initials on your forehead or something. Albeit my understanding of network security is almost non-existent, but I think this is still something somebody should think about.

Obligitory bad joke: "So would all operations be done calling collect?"

Re:One of the most useful applications...

[anubi]

From Yak's comment:

"However, allowing dangerous operations to be undertaken in remote locations is probably not a great idea... without qualified staff physically on hand, I don't think you'd want to trust someone's life to an IP connection; otherwise, the next time some DDoS or Outlook worm strikes, servers aren't the only thing we lose. "

Good consideration and caution. Nicest to err on the side of safety if at all possible.

Consider I am driving down some back woods road and have my accident. I am tore up bad. They run me into the hospital. No-body there is really up to doing open-heart surgery to fix where the steering column tore into me. But they do have a robot in the OR. I am bleeding to death NOW. Sure, I would love to have qualified staff on hand standing by to see to it my needs are met, but that is just not an option here. Inside of two minutes, they can probably connect to somebody in some time zone somewhere in the world who knows what to do. Wheel me in and let the guy over in Australia fix me up while I lay bleeding to death in Kansas at 2AM. If the system goes down while I am under the knife, I am really still no worse off than if I did not have the option of telesurgical care in the first place. There is maybe a 0.1% chance of system failure, but there is 99.9% chance there won't be technical problems. Its that probability I am betting my life on.

And, as noted, the whole operation, being digitized, is a movie record of what happened so it can be later reviewed for doing it better next time and training students.

Can't you imagine the simulation software we can come up with so students can run simulations until they feel comfortable with the real thing? Kinda like flight simulators for pilots, so you can crash a few times without getting all the next of kin on your tail.

Re:TeleRobotics is almost a like a video game.

[anubi]

Adrian:

As you indicated, the main problem is indeed latency.

I note many corporations use live video teleconferencing over the net... so the idea of streaming video back to the surgeon does not seem all that off. Motor control has much less need of bandwidth than video. Packet loss can be handled by redundant packet technologies. I am very confident that suitable compression/encryption/data integrity assurance can be implemented to mitigate disruption or eavesdropping of the surgical procedures. I am afraid nothing can be done about DDoS or critical router failures, but consider the alternatives are no help at all.

In a time of need, I am willing to grab for any help I can find. Consider how reliable the net is and how little it is really crippled from technical issues such as this.. its something I am willing to bet my life on, given what the alternative is.

Thanks for the reply.

C'mon...

[WebCowboy]

Wait a minute...it's not like there was a lady on an operating table, being prodded by a robot and no-one around save perhaps a pimply-faced computer geek to make sure everything was going well. There WAS a doctor overseeing events at the site. Conversely, it's not like the doctor on the other end was lounging by the pool, tweaking the trackpoint of his IBM ThinkPad. This technology wouldn't be used on a person unless it was proven safe and the benefits for outweighed possible risks (also, remember they weren't doing brain surgery on their maiden voyage--it was surgery to correct an acid-reflux problem, so if there were problems the risk of death would be quite low).

You're right--400 km isn't exactly a cross-continent trek, but keep in mind that a round trip by car would eat up eight hours of a skilled surgeon's time (and time is money), and even flying would take a few hours. Also, remember the surgery was in North Bay and performed by a doctor in Hamilton. North Bay isn't exacly a metropolitan hub--there's maybe what...50,000 people there? I don't think there are gonna be direct flights leaving hourly from Hamilton. Besides, do you know what the weather has been like in Ontario lately? Cold and horrible! Flight schedules aren't going to be reliable, and driving 400 km through a blizzard would be quite treacherous!

The next step is to start using this technology in places like Yellowknife. Yellowknife! Not exactly the kind of place that's teeming with specialised surgeons, and a doctor in Toronto can't easily hop a train, plane or taxi there, nor can the patient be safely relocated to Toronto without great expense and risk. You'd have to hop a 727 in Toronto to Edmonton, a lear jet to Ft. McMurray and a turboprop to Yellowknife (at best you might be able to avoid the stopover in Ft. McMurray)--or else spend a great deal of taxpayer's money in an already strained socialised haelthcare system on a special private direct flight.

Yup, telesurgery starts to look pretty appealing if you've been suffering on a long waiting list typical of the healthcare system in Canada, and it offers you the chance to get it done not only properly, but much sooner as well.

And if we put a taxi driver out of a job who the hell cares--he's probably an immigrant with 10 years of medical training and a long history of performing surgery in Pakistan, scaping out a living until all the immigration bullshit has been shoveled and he can get certified to work as a doctor in Canada. Maybe the money saved with this technology can make that process go faster so he can "do surgery by the pool" with Dr. Anvari. That old farmer in Cowcrap, Saskatchewan who needs his hernia fixed might appreciate the resulting shorter waiting time too...

Re:C'mon...

[RobinH]

Yup, telesurgery starts to look pretty appealing if you've been suffering on a long waiting list typical of the healthcare system in Canada

I'd just like to point out that there are long waiting lists in the U.S. too; it's just that you are allowed to jump ahead in line if you have more money. If don't have enough money, you're not allowed to get in line. I'll take the Canadian system any day.

i wouldn't be so sure about that

[n3k5]

In fact, it will be cheaper to fly the surgeon to a tiny island in the east china sea than to fly in the robotics.

This might be true, but misses the point, which is not about moving robots around, not at all (in the civilian field, at least). The 'robo-doc' would be permanently installed in a nearby hostpital anyway. And you don't need a huge crew of 'robotic technicians' (The technicians are robotic? So who's gonna do their maintenance? ;-), you just need someone who is able to take care of delicate medical high-tech equipment. Hospitals have that kind of personnel anyway.

The actual point is that there are very peculiar operations that only a few surgeons in the world are able and willing to perform; e.g. the seperation of twins conjoined at their heads. Now compare flying them around from continent to continent to having them stay at home, where they could still be able to do the same job.

Of course it would be nice for our Chinese friend if someone set up a whole operating room in his home, but this is still science fiction. Flying him over to a nearby hospital on the mainland (or another island, wherever the nearest one is) and promptly starting the operation would still be an huge improvement over having him to transport to Beijing or having to wait days for a surgeon.

Re:i wouldn't be so sure about that

[mgv]

you just need someone who is able to take care of delicate medical high-tech equipment

These sort of people aren't cheap. The equipment isn't cheap. It has to be regularly serviced to ensure its ok. Its not the sort of stuff you stick in a remote place.

Hospitals have that kind of personnel anyway.

Big hospitals do. Small hospitals don't.


The actual point is that there are very peculiar operations that only a few surgeons in the world are able and willing to perform; e.g. the seperation of twins conjoined at their head

Right. And you think they perform solo? That you can just use any old scrub nurse to get this sort of equipment to work? That you can use any old anaesthetist to separate conjoined twins? That the twins can then just be dumped in any old hospital that probably doesn't even have an intensive care unit of any standard?

Now compare flying them around from continent to continent to having them stay at home, where they could still be able to do the same job.

You are still going to have to fly the rest of the team, so why not fly the surgeon too?

I work in this sort of environment, day in, day out. Its more than just the surgeon. Its a whole team, plus alot of technology. Most of which the people tend to forget happens. Half the time these sorts of places don't even have the equipment to make the diagnosis, never mind fix the problem.

Michael

My congratulations!

[Gallowglass]

It is so rare for someone on Slashdot to accept criticism, and acknowledge it, and admit that he was not absolutely correct. In other words, to behave like an adult seeking truth.

Thank you for raising the level of discourse.

Re:TeleRobotics is almost a like a video game.

[AndroidCat]

The operation was probably something of a trial. It wasn't exactly groundbreaking. Pretty routine, acid reflux isn't exactly life-threatening (IANAD), the equipment had been used locally before. They could have shifted the patient to the doctor or vice versa easily.

The worrisome part comes when they try to automate the process. Would you trust an operation to Dr Clippy? "I see that you're trying to take out the heart..."