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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."

13 of 211 comments (clear)

  1. hmm performance by hfastedge · · Score: 4, Interesting

    I wonder if any of the special IP priorities that rarely get used outside of LANS (or in) were used.

    Also, if any encryption was done, because id be concerned with achieving maximum latency possible.

    They said over a commercial network, so I'd have to assume encryption, possibly with special hardware for it.

    --

    -- -- --

    Help my mini cause: My journal

    1. Re:hmm performance by Anonymous Coward · · Score: 1, Interesting

      I would assume this would be done over a dedicated CBR or rt-VBR type point to point atm connection, to guarantee QOS. I doubt very much if this was done through IP over the WAN. I don't think it would be prudent to allow an operation to be subject to IP network problems

      As for encryption, I doubt this would be used as its not really needed on a point to point dedicated circuit.

      I simply cannot see the medical profession doing something of this seriousness over the internet or somesuchthing...

  2. TeleRobotics is almost a like a video game. by anubi · · Score: 5, Interesting
    Being I work in robotics a lot, this technology is typical of what we are trying to do.

    We already use micro-manipulators to do things so fine that we humans find it hard to control our own hands to do. There are many things a machine just does much better than we can.. things like zoom vision, ability to see from angles where we can not get our heads to, and doing precision tasks. Ever tried to make stitches as precise as a sewing machine?

    The business end of the machines can be much smaller than our fingers, and tools on the machine are designed expressly for needed things. None of this "hand me the scapel, nurse" stuff. The machine can have as many arms and tools as the designers deem necessary.

    And the machines can be made absolutely sterile. It is really hard to sterilize a human, and still have us functional.

    It is really a tiny, very tiny, step from going to having a surgeon sitting next to a patient doing the surgery, to having one on the other side of the world doing it... ( the main problem is latency ).

    The biggest advantage to the patient is that his need of surgical services may happen at any time - what it means is there is a world-wide pool of surgeons available to help - right now. They do not need to get scrubbed. If they are a critical care surgeon, by golly, they may have their end right in their den at their personal residence. Even if the surgeon was in a most unsanitary condition at the time of need, that would not be a factor. Time is. And that is what this technology gives us. Who is best equipped to meet the need... NOW.

    This is what dreams are made of. This is why we go to work. To make things like this.

    This is why we need technology.

    --
    "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]

    1. Re:TeleRobotics is almost a like a video game. by Evil+Adrian · · Score: 4, Interesting

      I don't mind this kind of stuff being done over a LAN, but over the Internet? Packet loss, DDoS, a critical routing point decides to crap out in the middle of surgery...

      Halfway across the world seems retarded to me. In the same room using robotics seems absolutely delightful.

      Speaking of long-distance stuff, though, it's a shame the FuFme site is no longer running... :-)

      --
      evil adrian
  3. Well okay... by dotgain · · Score: 2, Interesting
    ..but when it's my life (or anybody elses, for that matter) in question, was there any good reason for doing it remotely, other than the fact that he can?

    No link, no matter how fast or secure, will let a physician monitor the status of his patient nearly as much as actually being there. I could do my job from remote at home, but my boss prefers I actually come in to work, in case something goes wrong I can be there first hand to see what's going wrong.

    It's not like 400km is a great divide. Drive it. fly it. Okay, the operation was a success, but say it wasn't. The first question that's going to be asked is, "and you decided to perform the operation from beside your swimming pool watching it on your 14" TFT why?"

    I'm not surprised this is possible, nor would I bother with the risk. What do we need airplane pilots or taxi drivers for, if these jobs can ben done by someone sitting behind a console or in a cafe. Hell, someone could fly two planes at once.

    Get my drift?

  4. Tangental Thought ... by peatbakke · · Score: 4, Interesting

    ... if we can perform surgery via telerobotics, why wouldn't we be able to perform, say, guided experiments in space?

    Given the inherent safety issues with routine space travel, how difficult would it be to create a remotely manned orbiter to carry out space based experiments?

    It seems like there would be a tremendous number of benefits -- no direct risk to human life, smaller shuttle / more room for payloads, 24/7 operation (split shifts behind the controls), etc. ... of course, we'd have to deal with staying in contact with the shuttle while it orbited the Earth, and the lag associated with such distances ... and it wouldn't be quite so exciting ...

    Just a thought. Any ideas?

  5. One of the most useful applications... by A+Rabid+Tibetan+Yak · · Score: 5, Interesting
    From the article:

    Using telerobotics will enable patients living in remote locations to be able to undergo procedures they would normally have to travel to city locations to receive, Dr. McKinley said. Telerobotic surgery will also assist with medical training, enabling experienced surgeons to assist from a distance those who are still learning.

    This is probably the killer app. Being a med student myself (and having just watched Scrubs) I think the ability to have someone watching over your shoulder during an important operation would greatly assist confidence during learning surgical procedures -- especially during unusual times of the morning when the hospital is understaffed etc., and you're the house surgeon lumped with everyone walking in the door.

    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.
    1. Re:One of the most useful applications... by anubi · · Score: 2, Interesting
      "The only real theoretical advantage over a regular videotaped operation would be the interactivity of a simulator, at which point you might as well use a model/cadaver/etc anyway."
      I agree with you... I don't think videotapes could teach surgery near as good as doing the surgery itself.. whether simulated or on real cadavers. No more than watching videotapes of others doing analog design is going to make me a good designer.

      I get the idea nothing is going to replace the genuine cadaver ( once you get over the smell ). We have one over at our college, and when I saw it and got a whiff, I got a whole new respect for the class of pre-med students. I don't recall having a thing in my engineering training that smelled quite like that.

      I would think the simulator would mostly be for training how to apply the surgical knowledge through the telesurgical robot. There would be advantages and disadvantages to using the bot. Having an assortment of tools all ready to go, with macros in place so that repetitive things such as stitching could be automated, but there is also the drawbacks of latency and use of unfamiliar tools. I noted in another post how important I feel it is to standardize the interface if we expect surgeons worldwide to be able to use it. Hopefully, as we engineers and robotocists hone our skills to produce better products, doctors hopefully will find these products more useful in the OR. The idea being to make a surgical assistant that contains all the tools a surgeon needs and can perform under the direction of the surgeon what has to be done. Hopefully, the idea is that the surgeon will find the robots to be a useful aid in the OR so that the surgeons will be comfortable working through them. When the surgeons can see through the robot's eyes and work through the robot's hands, the distance between surgeon and robot falls out of the equation. And if the robots are standardized - then it does not make any difference which robot the surgeon works through, just as I have several identical tools I use, it does not make any difference which oscilloscope I get, they all work the same. Same concept - just extended.

      Because the robot is not as constrained as we humans are, I get the idea a lot of work may be done out the end of catheter-style tools so we can minimize invasive surgery. Advances in miniaturization of cameras, optics, light sources, and actuators could make for some dandy tiny yet powerful operating tools.

      But then, if we have telesurgical robots, it only follows that interactive simulation would be the only way to go. Kinda like a videogame. It would make videotapes obsolete , as nobody wants to learn how to play a videogame by watching instructional tapes!

      For review though, the images and the action taken by the surgeon could be stored so it could be reviewed and used for demonstration, it would probably become part of the patient record. Hopefully it would replace that long essay my surgeon had to prepare when I had surgery once. Surgeons should not have to spend their time messing with all that paper.

      I definitely side with you about elective and convenience surgeries. I feel as you about the bot being primarily for when time is of the essence. I do not think we are quite there yet, and I'll hold off for the Doctor's opinion on what they feel right with. I would expect no less.

      --
      "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]

  6. Murder by pyrote · · Score: 2, Interesting

    with this perverse investment in technology it brings to light the possibility of murder by Virus.

    Hack a machine being prepared for the surgery and have it send a horizontal slice 30 minutes into Mr. Gates open heart surgery.

    There is no stopping this kind of crime unless the computers involved are Bios flashed, loaded from ROM media(from a locked and certified source), and tested immediately before the procedure. quite like putting all your physical devices in an autoclave.

    I like tech, but I'll stick to live docs for a while, or get it done quickly before this type of crime comes to surface.

    --
    THE WORLD IS GOING TO END!!!! eventually.
  7. Hardly a first... by Renaud · · Score: 2, Interesting

    400km is nice, but how about New York to Strasbourg, France, 2 years ago, using the same Zeus robot ?

    Unfortunately it was drowned under the 9/11 news at the time.

    Google for "Operation Lindbergh"

  8. i wouldn't do it by frankmu · · Score: 4, Interesting

    as a surgeon, i have my misgivings about these types of surgery. the easy surguries a 4th year medical student can do. the hard ones are what we get paid for. laparoscopic surgery can have severe complications, like poking a big vessel called the AORTA. you need someone who can open up a patient and stop the bleeding RIGHT AWAY. there are times when you just can't use laparoscopy also, and you need actual feel. cost-wise, it may be cheaper buy a bus ticket for the patient to get the consultation 400 km away, than for every hospital in the country to have these robots in the OR.

    --
    Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.
  9. Clifford D. Simak and the net by kfg · · Score: 2, Interesting

    In his classic 1946 novel "City" Clifford Simak predicted the fall of the city as the focal point of human life and interaction. Telecomunications and globally networked computers were going allow people to live anywhere, and work from wherever that was, over the network, creating a dispersed culture with minimal "face time" in people's lives.

    Independant robots with artificial intelligence were, of course, a major part of that invisioned future, taking over the tasks of housemaid and gardener, thus further reducing the overall level of interhuman interaction. ( Can you say automatic vacuum cleaner? I knew you could)

    Truely visionary. In 1946 the American suburb and "planned community", as we know it, was still a gleam in the Levitt's eyes. Computers themselves were the crude and expensive dinosaurs of geek myth and networks didn't exist, let alone anything on the scale of the internet.

    What makes all of this relevant to the article is that Simak predicted one of the side effects of this would be an increasing social isolation of humanity, to the point where we were actually unable to deal with each other face to face, or even leave our homes with any comfort. To an extent the evidence suggests that there is a certain truth to this and all of us here are well familiar with the stereotype of the net connected and sophisticated geek huddling in some dark hole somewhere (like his mother's basement) but essentially inept at face to face confrontation.

    To illustrate this he chose to tell the story of a supremely gifted surgeon who allowed a friend to die, a friend with the answer to life, the universe and everything ( as yet unrevealed to the public), simply because his isolationist produced agoraphobia didn't allow him to travel to perform the needed surgery.

    Simak's prescience in this novel is absolutely stunning in scope ( and the story is masterful as well, read it), but the one thing he did not forsee was that even *surgery* would one day be performed from our isolated aeries in the Himalayas ( well, to be fair, he did actually take this partially into account by placing the surgeon on Earth and the patient on Mars, thus net lag was a significant factor in the requirement that the surgeon actually be *present* on Mars, but we can already forsee ways around this problem).

    Perhaps only our geometrically increasing numbers stand between us and his vision of an isolated future lived over the net.

    KFG

  10. Re:New meaning of the Slashdot effect by mgv · · Score: 2, Interesting

    Being that I am currently living on a tiny island in the middle of the East China Sea, I would love to have the comfort of knowing a critical operation could be done on me within hours as opposed to the days it would take to either get me to the doctor or vice versa

    This will not happen, but not for the reason you think.

    If you think it through, you will realise that there are far more surgeons than robotic technicians. You might get away without the surgeon at one end, but who is going to fix the robot, or the internet connection? At this stage, robots, computers and networks generally die in operation far more often than their human equivalents.

    Which means that the support crews are going to be huge.

    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. No to mention that you are going to keep the operating rooms equipped with stuff to do every complex operation that can be done?

    This sort of thing may happen one day, but by then we will have robots doing much simpler tasks all the time; including things like driving taxi's around town, cleaning up your house and seeking election to another term of government.

    Final take - experienced surgeons and teams are cheaper and more portable than this sort of technology, and its going to be a long time before that changes.

    Michael

    --
    There is no cryptographic solution to the problem where the intended receiver and the attacker are the same entity.