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Florida Hospital Shows Normal Internet Lag Time Won't Affect Remote Robotic Surgeries

Lucas123 writes: Remote robotic surgery performed hundreds or even thousands of miles away from the physician at the controls is possible and safe, according to the Florida Hospital that recently tested Internet lag times for the technology. Roger Smith, CTO at the Florida Hospital Nicholson Center in Celebration, Fla., said the hospital tested the lag time to a partner facility in Ft. Worth, Texas and found it ranged from 30 to 150 milliseconds, which surgeons could not detect as they moved remote robotic laparoscopic instruments. The tests, performed using a surgical simulator called a Mimic, will now be performed as if operating remotely in Denver and then Loma Linda, Calif. The Mimic Simulator system enables virtual procedures performed by a da Vinci robotic surgical system, the most common equipment in use today; it's used for hundreds of thousands of surgeries every year around the world. With a da Vinci system, surgeons today can perform operations yards away from a patient, even in separate but adjoining rooms to the OR. By stretching that distance to tens, hundreds or thousands of miles, the technology could enable patients to receive operations from top surgeons that would otherwise not be possible, including wounded soldiers near a battlefield. The Mimic Simulator was able to first artificially dial up lag times, starting with 200 milliseconds all the way up to 600 milliseconds.

125 comments

  1. Spikes by MyLongNickName · · Score: 4, Insightful

    Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.

    --
    See my journal for slashdot ID's by year. Mine created in 2005. http://slashdot.org/journal/289875/slashdot-ids-by-year
    1. Re:Spikes by thedonger · · Score: 3, Interesting

      Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.

      Maybe they should queue up sets of movements that are dependent. It would also suck if the internet connection dropped right after a cut but before the bleeding could be stopped. Although I'm sure they have physical staff present in case of emergency.

      --
      Help fight poverty: Punch a poor person.
    2. Re:Spikes by tlambert · · Score: 1

      Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.

      If only you could LEASE a LINE... (hint hint)

    3. Re:Spikes by Swave+An+deBwoner · · Score: 1

      Sure they do. A fresh out of school resident who has been awake and running scut work for 48 hours. No point paying a surgeon big bucks to stand around when the money can go to the hospital's CEOs.

    4. Re:Spikes by NMBob · · Score: 2

      ...or one who is constantly checking Twitter and Facebook on their phone.

    5. Re:Spikes by Minwee · · Score: 2

      "By stretching that distance to tens, hundreds or thousands of miles, the technology could enable patients to receive operations from top surgeons that would otherwise not be possible, including wounded soldiers near a battlefield."

      If only you could LEASE a LINE... (hint hint)

      ...to a battlefield.

      "Hello? Comcast? Can you transfer me to the Kabul office? I need gigabit service to a hillside fifteen miles outside of... Hello? Hello?"

    6. Re:Spikes by antiperimetaparalogo · · Score: 3, Insightful

      It would also suck if the internet connection dropped right after a cut but before the bleeding could be stopped. Although I'm sure they have physical staff present in case of emergency.

      They have, and they are not just for "emergency" - they prepare the patient, start the operation (including inserting -and hopefully removing- the laparoscop and the other surgical "tools"), and finish the job. Plus: usually they are those doing the actual operation, with the more expert doctor just observing, making suggestions, and performing *some* "cuts" that the less experienced doctors are not so confident doing.

      --
      Antisthenes: "Wisdom begins by examining the words/names." - excuse my English, i am (slightly...) better with my Greek!
    7. Re:Spikes by countSudoku() · · Score: 1

      Exactly!

      Ever try and get AT&T or any other big carrier to listen to you while you explain in detail how their "bullet-proof service" is down and needs to be fixed? They have no fucking clue! How about if the PO has a problem and they think you're trying to get free data connections? No, nothing short of home-running a private, extendable to 24,000 miles, "bullet-proof", tamper-proof, Ethernet cable with an infinite:1 s/n ratio will be good enough for me. Thanks, but I'll go with the local surgeon for now. Let the early-adopters try this out.

      --
      This is the NSA, we're gonna geet U h@x0r5! Also, what is a h@x0r5?
    8. Re:Spikes by Anonymous Coward · · Score: 0

      Its easy. Solve the problem like any other medical type thing. Have latency insurance. If someone sends a DDOS at your da vinci while you're under the robo-knife, insurance pays out to your loved ones when the latency spike hits, lol. (I'm half serious.)

    9. Re:Spikes by Anonymous Coward · · Score: 0

      Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.

      Don't worry. Your nose might light up red, and the buzzer may go *BZZZZZZZZZZZ*, but the game will realize that the buzzer was triggered by faulty motion estimation , and it wasn't actually your doctor's fault because he was already lagged out. If you're lucky, he'll reconnect before the anesthesia wears off, and you won't remember any pain after the surgery.

    10. Re:Spikes by NormalVisual · · Score: 1

      Ever try and get AT&T or any other big carrier to listen to you while you explain in detail how their "bullet-proof service" is down and needs to be fixed?

      I have. Even telling them where the packets are being dropped often doesn't help. My favorite was when my service went out, and after four days of going back and forth with them, it turned out that they'd somehow accidentally dropped the DSL router's MAC address from the authentication list.

      --
      Please stand clear of the doors, por favor mantenganse alejado de las puertas
    11. Re: Spikes by Anonymous Coward · · Score: 1

      I fly UAVs professionally. It's not the latency itself, but the jitter in the latency that's "not good"

    12. Re:Spikes by cdrudge · · Score: 1

      I've never seen a leased line have a 100% uptime guarantee as it's impossible to provide. There is always some chance out an outage.

    13. Re:Spikes by Anonymous Coward · · Score: 0

      Sounds like something just asking for some bad guys to find and DDoS the link as part of an extortion racket.

      It also would put a terrorist group on the map if they actively interfered with a surgery enough (especially if the link is unencrypted and they could hijack the robot) to kill someone.

    14. Re:Spikes by Anonymous Coward · · Score: 0

      These spikes happen because someone on your connection is using it heavily. A hospital would make sure that that doesn't happen.

    15. Re:Spikes by Anonymous Coward · · Score: 0

      Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.

      If only you could LEASE a LINE... (hint hint)

      I need gigabit service

      Nobody is disputing a private network is even more betterer than commercial leased lines but this would never fly over the Internet.

    16. Re:Spikes by ohearn · · Score: 1

      It could definitely be a way for doctors to get out of a liability claim in the future, just say that it was a case of network lag.

    17. Re:Spikes by ohearn · · Score: 2

      Even scarier, how long until we see someone charged with murder because they did a DDOS against a system like this where the patient ends up dead on the table?

    18. Re:Spikes by Anonymous Coward · · Score: 0

      You should have Verizon Fios.... Ho boy.. Once, my neighbor ordered service and during the install the technician apparently swapped the fiber jumpers between his house and mine. Due to their security settings neither of us had service because the ONT answering at the other end of the fiber wasn't the one they expected. It took them more than two weeks to sort that out while all the time they where telling me it was my equipment. Then, once they figured it out, though I'd been out of service for half a month due to their error, they didn't offer a credit on my next bill and when I asked for one, gave me a hard time before they gave me a small credit.. But they still are better than TWC.... Those people couldn't find a rouge DNS server that kept killing things in my neighborhood for something like 6 months, even after I told them what was happening and how they could trace it down... After all, they where the ones that had access to the cable modem provisioning....

    19. Re:Spikes by Anonymous Coward · · Score: 0

      These spikes happen because someone on your connection is using it heavily. A hospital would make sure that that doesn't happen.

      I can tell you don't work in a hospital's IT department....

    20. Re:Spikes by Anonymous Coward · · Score: 0

      They would have to prove the lag, just saying so won't be enough.

    21. Re:Spikes by jd2112 · · Score: 1

      "Hello? Comcast? Can you transfer me to the Kabul office? I need gigabit service to a hillside fifteen miles outside of... Hello? Hello?"

      Sure, We can be there next tuesday sometime between 8am and 4pm local time.
      (3 weeks later, after 5 cancelled appointments)
      Sorry, that location is outside of our service area.

      --
      Any insufficiently advanced magic is indistinguishable from technology.
    22. Re:Spikes by petermgreen · · Score: 1

      They happen because somewhere on the path a connection is overloaded and it's buffers fill up, maybe that is at your end, maybe it's at the other users end. Maybe it's somewhere in between. The internet is not and was never designed to be a network that provides bandwidth and latency gaurantees. If you want those you need to negotiate a specific route and priority access to that route between two specific locations. At that point I don't think you can reasonablly consider the conenction to be "the internet" anymore.

      --
      note: i'm known as plugwash most places but i screwd up registering that here somehow in the past and now can't register
    23. Re:Spikes by antdude · · Score: 1

      I just hope they don't dump these humans to let bots take over.

      --
      Ant(Dude) @ Quality Foraged Links (AQFL.net) & The Ant Farm (antfarm.ma.cx / antfarm.home.dhs.org).
    24. Re:Spikes by Anonymous Coward · · Score: 0

      I just hope they don't dump these humans to let bots take over.

      It's ok if they use all bots, so long as they make enough to have one local and not network dependent.

    25. Re:Spikes by Anonymous Coward · · Score: 0

      Hopefully the use of the term "Internet" when referring to the "lag time" is simply an in-artful use, and they actually mean TCP/IP network protocol. I sure as hell don't want to be operated on by a surgeon commanding a robot over the actual Internet.

    26. Re: Spikes by Anonymous Coward · · Score: 0

      Does anyone ever actually fly a UAV except for take-offs and landings? They're pretty much 98% auto-pilot now like the commercial airliners.

    27. Re:Spikes by thedonger · · Score: 1

      ...or one who is constantly checking Twitter and Facebook on their phone.

      "...lol i luv catz 2 oops patient bled out fml"

      --
      Help fight poverty: Punch a poor person.
  2. Ya, it's this simple by Anonymous Coward · · Score: 1, Insightful

    How are DoS attacks going to be handled?

    How is the data encrypted? (ECC I hope)

    What about viruses? Is a Windows PC being used in the doctors office to communicate or are these actual real time embedded systems?

    Even 1 mile away scares me.

    What happens when a router between the two buildings goes down for 12 hours in the middle of open heart surgery and the surgeon is 2 hours away?

    Who is liable for accidental death? The ISP, the doctor on site? The remote doctor? The robotics company?

    1. Re:Ya, it's this simple by Coren22 · · Score: 1

      Error Checking Code for encryption? That sounds odd...

      --
      APK likes to ask for responses to the same things over and over. Maybe he just likes the responses?
    2. Re:Ya, it's this simple by Anonymous Coward · · Score: 0

      Under the GOP system doctor malpractice will go away as in the payouts will be caped to be very low and it will do little to cut over all costs.

    3. Re:Ya, it's this simple by GTRacer · · Score: 2

      How are DoS attacks going to be handled?

      Denial of Surgery attacks? Handled by the lawyers, I'd expect.

      --
      Defending IP by destroying access to it? That makes sense, RIAA/MPAA. Go to the corner until you can play nice!
    4. Re:Ya, it's this simple by sycodon · · Score: 1

      Give it up AC, we know who you are

      --
      When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
    5. Re:Ya, it's this simple by Anonymous Coward · · Score: 0

      Wouldn't that be handled by the Obamacare administrators?

    6. Re:Ya, it's this simple by Adriax · · Score: 1

      It's a form of quantum encryption. Someone snooping will change the bits, causing errors. Once you detect errors you can shift garbage data down the line till they give up.
      The idea came from observing teenagers talking to each other as a parent walks by.

      --
      I don't suffer from insanity, I enjoy every minute of it!
    7. Re:Ya, it's this simple by Anonymous Coward · · Score: 0

      If packets could be prioritized by source IP a DDoS attack would likely be unsuccessful.

      But that runs counter to the idea that all packets should be treated equally.

  3. Outsourcing by Anonymous Coward · · Score: 1

    Who knew it would hit the hospital operating rooms so quickly?

    1. Re: Outsourcing by Nukem,Duke · · Score: 1

      No kidding. How about we outsource something good like overpaid CEOs or Congress? :)

    2. Re: Outsourcing by ColdWetDog · · Score: 1

      No kidding. How about we outsource something good like overpaid CEOs or Congress? :)

      Should be pretty easy to do.

      --
      Faster! Faster! Faster would be better!
    3. Re: Outsourcing by Anonymous Coward · · Score: 0

      I'd rather right-size...say, minus a head.

  4. XSURGERY by NoNonAlphaCharsHere · · Score: 2

    I'm getting this image of a heart surgeon listening to canned music on Comcast's help line. "Your call is very important to us. Please stay on the line for another three days and...".

  5. 150ms?? by Mad+Quacker · · Score: 1

    If a surgeon doesn't have the hand eye coordination to notice 150ms delay, I do not want him operating on me.

    --
    "I don't know that atheists should be considered citizens, nor should they be considered patriots." George HW Bush
    1. Re:150ms?? by digsbo · · Score: 2

      Agreed. I can't play Wii when not using "game mode" to reduce delay on my TV, or record & monitor multitrack audio above a 6-8 ms delay. No way would I trust a surgery to anything more than 10ms in case something unexpected happened during surgery.

    2. Re:150ms?? by Anonymous Coward · · Score: 2, Interesting

      You won't have to worry about it for long. Da Vinci is almost certainly logging these surgeries for the purpose of training autonomous surgery robots.

      Just like autonomous cars: in the beginning you'll only see "simple" operations automated(with supervision) but as time goes on: you'll have perfect repeatability from patient to patient.

      There are plenty of third world countries where desperate people will sign up for a hair cut at a steep discount from an academy. By "hair cut" I mean "surgery" of course, and once the robots have better batting averages than the human surgeons: you'll see them integrated in first world countries like "self checkout" machines at the grocery store. E.G. 5 or so surgeries being supervised by a singly human surgeon who is present "for emergencies".

      When the robots go long enough without any major intervention: the ratio of concurrent surgeries to doctors present will continue to increase until the "human surgeon" is as real as elevator inspection records. Hypothetically available, but not necessarily real as nobody from the general public ever sees them.

    3. Re:150ms?? by dmgxmichael · · Score: 3, Insightful

      I'm guessing it isn't noticeable because of how slowly and deliberately they move to begin with. Surgery isn't exactly a twitch reflexes exercise.

    4. Re:150ms?? by plover · · Score: 4, Interesting

      I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.

      So I figured there has to be something else. The best hypothesis I could come up with is the current robotic surgery tools introduce their own lag such that the surgeons were unable to distinguish normal device response times from network latency. That, and the goals of a surgeon are completely different from an FPS shooter. A surgeon isn't trying to race anything or anyone - they don't have to shoot first. In a live operating theatre, they are methodical and cautious. It's not like there are sudden surprises that leap out at them that they have to instantly react to. Even a burst blood vessel takes a few moments to assess and plan a recovery from. So maybe if they're used to very slow approach, the latency doesn't impact them as much.

      --
      John
    5. Re:150ms?? by Anonymous Coward · · Score: 5, Funny

      I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.

      Uh...if you are worried about the patient moving faster than you, perhaps it would help if you sedated the patient before starting the operation?

    6. Re:150ms?? by Anonymous Coward · · Score: 0

      50ms is by no means "unplayable" and claiming such just shows that you don't play that many real time games.

    7. Re:150ms?? by wonkey_monkey · · Score: 1

      or record & monitor multitrack audio above a 6-8 ms delay.

      Do you mean because of the delay between the "live" sound and the monitor sound? Just move 2 metres further away from the live sound. Problem solved!

      --
      systemd is Roko's Basilisk.
    8. Re:150ms?? by digsbo · · Score: 1

      Should be an interesting bioengineering project for instruments like saxophone, which transmit sound to the inner ears through teeth and bone.

    9. Re: 150ms?? by Anonymous Coward · · Score: 0

      There aren't too many overhand-serves during surgery. What kind of action are you expecting in your operating room?

    10. Re:150ms?? by Anonymous Coward · · Score: 2, Insightful

      I hope you never need surgery then, since the typical delay between observing something and *starting* to react to it is an order of magnitude *larger* than your stated maximum. And that's for a *local* observer who is already hands on. [1]

      Of course, since *typical* internet lag (on a connection *not* routed through a satellite) is in the neighborhood of 30-150ms (round trip), you're still not in any actual danger since lags an order of magnitude higher than that didn't effect the surgical process.

      Seriously, if you think 1/100th of a second (10 ms) actually means anything in surgery, you're either severely mistaken, or no patient has ever survived a surgical procedure where anything unexpected has happened. Since we know the latter isn't true, we can state with confidence that you are mistaken.

      [1] The average reaction time for humans is 0.25 seconds to a visual stimulus, 0.17 for an audio stimulus, and 0.15 seconds for a touch stimulus. (That's 250ms, 170ms, and 150ms respectively.)

    11. Re:150ms?? by Hussman32 · · Score: 1

      Automated surgeries will come, but it will be a while. I've had five surgeries (three knee, one shoulder, one hernia), and all doctors say the same thing when I ask...each surgery is just different enough to keep it interesting, and they always have to adjust their plan once they are in there. Hence the difference between good and great surgeons, it's their art as well as their science.

      --
      "Who are you?" "No one of consequence." "I must know." "Get used to disappointment."
    12. Re:150ms?? by sconeu · · Score: 1

      My robot learned to work the saxophone
      It played just how I feel
      It drinks scotch whiskey all night long
      And dies behind the wheel...

      --
      General Relativity: Space-time tells matter where to go; Matter tells space-time what shape to be.
    13. Re:150ms?? by jittles · · Score: 1

      I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.

      So I figured there has to be something else. The best hypothesis I could come up with is the current robotic surgery tools introduce their own lag such that the surgeons were unable to distinguish normal device response times from network latency. That, and the goals of a surgeon are completely different from an FPS shooter. A surgeon isn't trying to race anything or anyone - they don't have to shoot first. In a live operating theatre, they are methodical and cautious. It's not like there are sudden surprises that leap out at them that they have to instantly react to. Even a burst blood vessel takes a few moments to assess and plan a recovery from. So maybe if they're used to very slow approach, the latency doesn't impact them as much.

      That 50ms lag in a game is noticeable because there are other people who are also experiencing latency and the game is doing things to compensate for everyone being at a slightly different point of reference. If you were just controlling a camera pointed out your window with a 100ms latency, your mind would not notice the latency between your motion with the hand and the results with your eye.

    14. Re:150ms?? by Falos · · Score: 1

      More autonomous nerves, sure. A deliberate reaction is typically at least 300-400ms for a conscious response, for a simple action from alert condition. Anything conditional/decision-making, (if red, elif green) and it goes up.

      But the performance of stuff can be affected by less. You can notice irregularity in, say, tempo or timed actions at the 10ms level.

      It may not necessarily affect surgical behaviors, but consider something like the all that calculus your brain does when it wants to catch a frisbee or swing a bat at a ball.

    15. Re:150ms?? by Livius · · Score: 1

      A surgeon isn't trying to race anything or anyone

      The surgeon is trying to finish the surgery before the patient dies.

      Surgeons are very skilled at doing their jobs quickly.

    16. Re:150ms?? by Altrag · · Score: 1

      Accuracy and stability are FAR more important than speed. 150ms delay isn't really all that much when you're only making small, deliberate movements.

      These doctors aren't trying to perform a rocket jump in your chest cavity. They're trying to line up the perfect headshot against a mostly unmoving target.

    17. Re:150ms?? by Anonymous Coward · · Score: 0

      I already question your statement about 50ms being unplayable as a player from the Caribbean where my base ping times to Miami are 60ms, typical is in the 80-100ms and I play quite well. Most people don't experience issues with VoIP until about 200ms (600ms RTT from satellite latency is usable but you have a noticeable delay between when you stop talking and the reply, you can use it but the average person will notice the delay vs a face-to-face conversation).

      But beyond that surgery does not depend on twitch reflexes, this is a "measure twice, cut once" type of scenario. Most common scenario the average person has experienced is going to the dentist. Do you want your dentist making twitchy movements while they are holding a drill in your mouth? Most are relatively slow careful movements ensuring that after each action you didn't do more damage than necessary. I can say that follows all the way up to oral surgery (imagine getting the bone of your jaw being cut open to remove your wisdom teeth).

    18. Re:150ms?? by digsbo · · Score: 1

      They got a name for the people in the world

      I want a name for 3PO

      The closest we got is Honda's bot

      They call him Asimo

  6. You have been kicked by Anonymous Coward · · Score: 0

    Your ping rate is too high.

  7. Am I the only one... by Anonymous Coward · · Score: 0

    ...who wonders what kind of redundancy there will be on these links.
    Would a distributed denial of service attack kill me during a robotic open heart surgery?

    1. Re:Am I the only one... by afidel · · Score: 2

      When I talked to one of our VAR's he said that one of the local hospital chains was one of his best and worst customers, best because of all the expensive gear they bought, worst because they were so demanding. They actually paid to have trenching done to make sure that their backup link at one facility went out a different CO which was on a different uplink facility (ie truly divergent paths with no single mode of failure), and that was just for PACS, not telesurgery.

      --
      There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
  8. Damn broadband by Anonymous Coward · · Score: 0

    LPBs get all the best procedures!

  9. Kids these days by penguinoid · · Score: 1

    Now even doctors are spending all their time playing online video games.

    --
    Don't waste your vote! Vote for whoever you want, unless you live in a swing state it won't matter anyways
    1. Re:Kids these days by Coren22 · · Score: 1

      As long as it isn't this game:

      http://en.wikipedia.org/wiki/S...

      I am all for gaming surgeons.

      --
      APK likes to ask for responses to the same things over and over. Maybe he just likes the responses?
  10. Concast 150ms... Right... by Nukem,Duke · · Score: 1

    Better hope they're not using Concast! Just imagine. Latency goes into seconds during surgery, equipment stops working because of poor signal and your patient's blood winds up all over the floor because too many people are streaming Netflix? (Surgeon) My patient is dying! At the other end of the phone, "press 1 for English..."

  11. It's about time.... by Anonymous Coward · · Score: 0

    ...we started outsourcing surgery to India..Or China!!!!!!

    Next is holograms lawyers in courtrooms!!!

    Doing anything in the west is too pricey!!!!! These pesky humans and their requirement to be adequately compensated....peugh!

    1. Re:It's about time.... by drjoe1e6 · · Score: 5, Funny

      Next is holograms lawyers in courtrooms!!!

      Please state the nature of the legal proceeding...

      --
      Lose = not win ...... Loose = not tight
    2. Re:It's about time.... by plover · · Score: 2

      Next is holograms lawyers in courtrooms!!!

      Don't fret. Congress is staffed almost entirely by lawyers, and there is zero chance they'll let their bread-and-butter be outsourced or replaced by machines. They already won't even pass laws to simplify laws, in order to keep their jobs as clever interpreters of the cracks between the laws.

      They'll damn everyone else to a subcontracted devil running an outsourced version of hell, but they've proven they're going to protect their jobs forever.

      --
      John
  12. What about severe lag? by sjbe · · Score: 4, Insightful

    Florida Hospital Shows Normal Internet Lag Time Won't Affect Remote Robotic Surgeries

    So what? It's not normal lag you are worried about. It's severe lag which on the normal internet you cannot guarantee you can eliminate. It's interesting information but I'm not sure if it's really useful information.

    1. Re:What about severe lag? by del_diablo · · Score: 1

      Does packet drop actually exists in the wild? Outside of noise over long distances? In the normal world? That is my question to that.
      Packet loss means whoever is between A and B, is fucking up. Somewhere.
      Be it having wireless transfer somewhere on the backbone, faulty infrastructure, or destroyed wires. I don't think Packet Loss and "loss of Connection" actually exists in the actual wild.
      Add in 3-4 extra paths for packages, and we might got something robust.

    2. Re:What about severe lag? by Anonymous Coward · · Score: 1

      Packet loss isn't a sign of breakage, it's a necessary part of a working network.

      Without the packet loss, protocols can't tell that they need to throttle their packets.

      If you stick the packets in a queue, then you'll continue to receive them faster than you can deal with them, since you've broken the mechanism protocols are using to detect throughput, and since memory is finite, you'll still end up needing to discard packets, so all you've succeeded in doing is having just as much packet loss as before but with a whole lot more latency while the packets make their way through the queue you added.

      If your route is congested, throwing the excess packets away is the correct thing to do. TCP streams will detect the packet loss, and reduce their send rate, and retransmit the dropped packets. Real-time stuff like VoIP won't even bother, because if it doesn't arrive on time, there's no point in delivering it at all.

    3. Re:What about severe lag? by Anonymous Coward · · Score: 0

      There's two kinds of packet loss. External and internal. External packet loss happens outside of the host and outside of the destination. This can be caused by physical problems with the line, congestion, or malfunctioning equipment along the line. Internal is inside of the host or the destination, and can be due to hardware or software problems.

      Generally dropped packets are not a problem because protocols and handling are both set up to work around them...it's only a problem when you get a lot of dropped packets. A 30% packet loss in a game is significantly disrupting, and I haven't seen a game that'll stay connected much higher than that.

      Data paths are usually very robust...even if one pathway is straight up cut in the middle of a surgery, a new pathway starts to be used almost instantly. Worst case scenario (outside of nuclear attack at multiple points) would be several pathways are cut in rapid succession, and latency/PL would skyrocket for any new connections due to congestion.

  13. Just wait... by dmgxmichael · · Score: 1

    If this becomes remotely commonplace someone is going to get murdered when Comcast mistakes one of these transmissions for a Netflix packet and throttles it up past 3 or 4 seconds. Personally, I think it would be poetic justice if Ted Cruz dies this way.

    1. Re:Just wait... by Em+Adespoton · · Score: 4, Interesting

      I have to admit, this one had me scratching my head.

      Don't medical safety guidelines always require safe handling of the *worst* case scenario, not the *average* case scenario? Hospitals have network outages, and have plans in place to mitigate that. How do you mitigate a surgeon losing link while he's cutting the right ventricle? When you're yards away and the link goes down, you just scrub in. When you're on the other side of the world....

    2. Re:Just wait... by Anonymous Coward · · Score: 0

      You're an idiot.

    3. Re:Just wait... by Anonymous Coward · · Score: 1

      When you're on the other side of the world....

      You either get surgery like this, or likely no surgery at all. A chance at a good outcome, or no good outcome at all. Sorta like surgery itself.

    4. Re:Just wait... by plover · · Score: 2

      You solve this by running the remote surgery in a hospital that still has local doctors and nurses. One general doctor can be in house and prepped for surgery, on call for one or more operating theatres. The patients will still need local nurses to prep the patients, physically administer the anesthesia (in the case of a remote anesthetist), and handle all kinds of tasks. The remote surgeon makes the cuts, does the work, then closes up behind himself as he leaves. The whole time the local nurse(s) is(are) monitoring vitals, and watching for problems. If anything comes up that can't be remotely managed, the nurse signals for the on-call doctor to come in and handle the situation. All the local doctor really needs are the skills required to close up and remove the machine from the patient - they don't have to complete the delicate surgery if it's beyond their capabilities.

      --
      John
    5. Re:Just wait... by plover · · Score: 1

      Oh, and if it's a time-critical disaster scenario, the patient is still better off with a remote surgeon than with no doctor at all. If the surgeon physically cannot get to the field hospital in the next two hours, and your choices are limited to:

      A) bleed to death from a punctured lung because there's nobody here to sew you up, or
      B) take your chances with Comcast delivering enough bytes for a doctor two states away to sew you up,

      most people will opt for B.

      --
      John
    6. Re:Just wait... by countSudoku() · · Score: 1

      Apparently not. There was a recent article about some kind of medical pump with a network connection for "ease of use" but it was a huge security hole with direct root access to the device. And with the unknown quantity of the local hospital's IT staff, who the hell knows what kind of security nightmare is brewing in there?!

      No, the medial community is blissfully unconcerned with real-world Internet and Intranet security when it comes to "new," "fancy," ultra-modern equipment that will jack up the fucking medical charges they can apply to unwitting(all) patients. HIPPA merely protects personal medical info, it does not protect life in case of a network-connected medical device error or breach. Possibly covered under the normal medical practices guidelines, but then how do these types of aforementioned devices get inside a hospital in the first place? Probably expensive kick-backs, freebies, or vacations for the hospital execs and administrators to "try this new device!" People usually end up dying before the facts and procedures are examined in detail and rectified.

      --
      This is the NSA, we're gonna geet U h@x0r5! Also, what is a h@x0r5?
    7. Re:Just wait... by Anonymous Coward · · Score: 0

      * HIPAA

    8. Re:Just wait... by jedidiah · · Score: 1

      No. Data is data. So are doctors apparently. Both act the same way. You can't just run some shoddy network connection and then kid yourself that you're good. It's far better to forget the network entirely and just ship the actual doctor. It's much like shipping physical media.

      There remain jobs and tasks for which Cloud hype snake oil just doesn't cut it. The network isn't good enough and probably will never be. So you just need to stop pretending.

      If you're on the other side of the world, you're still better of if everyone understands there's no real replacement for doctors or physical media.

      --
      A Pirate and a Puritan look the same on a balance sheet.
    9. Re:Just wait... by jedidiah · · Score: 1

      Most people are idiots.

      You're far better off depending on a warm body on the ground that can be told what to do if necessary. In an actual disaster, some random schmuck with a medical kit is going to be much more reliable than any sort of fancy cloud enabled robotic surgery kit.

      In an actual disaster, a field surgeon would probably be easier and quicker to set up than some overwrought bit of civilized technology.

      --
      A Pirate and a Puritan look the same on a balance sheet.
    10. Re:Just wait... by Em+Adespoton · · Score: 1

      Well, in this case, the device itself is standard issue for many hospitals; the novel bit is accessing it over the internet instead of leaving it on the intranet as has traditionally been the case.

      Having been part of the "let's make this emulator do multiplayer over the internet" group back in the day, I agree with you... there's a LOT that can go wrong. If they're not designing for failure (in both software and operating protocol), they're in for a world of hurt eventually.

    11. Re:Just wait... by plover · · Score: 1

      just ship the actual doctor.

      Do you know how many doctors they have in America? How about in Liberia?

      According to the CIA World Factbook, in 2008 the U.S. had 2.4 doctors per every 1000 people. In Liberia, they had 0.01 per 1000, but that was before ebola killed 40 of their 120 physicians. Volunteer doctors have helped a little, but not too many want to risk their own lives in such a hot zone. The need is almost beyond comprehension.

      Oh, and of those 80 remaining doctors, how many do you think specialize in surgery, and have hours in their day to operate on you? How many specialize in the kind of surgery you may need at that moment?

      You can't 'just ship the actual doctor' any more than you can send them a stack of gold bars. There aren't enough who have time or the inclination to go.

      --
      John
    12. Re:Just wait... by Swave+An+deBwoner · · Score: 1

      The hospitals won't want to schedule just one surgery at a time, they have lots of operating theatres. So the link goes dead with a whole bunch of patients open on the tables. "One general doctor .. on call for one or more operating theatres"? Ha ha. That doctor is going to be called "Marathon Man" if he survives that scene, let alone the patients.

  14. 50ms might not sound like much by ihtoit · · Score: 1

    but when you're playing World of Tanks, 50ms is the difference between getting the first shot in and losing.

    I would not want anything with comparable or worse lag poking around inside me particularly when the one thing that the whole shebang relies on (POWER) is the one thing that's out of control of any person directly involved in the operation.

    --
    Political debates have me rolling my eyes so much I think I got optical whiplash. I should sue. - Foamy The Squirrel
    1. Re:50ms might not sound like much by wonkey_monkey · · Score: 1

      but when you're playing World of Tanks, 50ms is the difference between getting the first shot in and losing.

      And when you're trying to collide protons in the LHC, 0.0001ms is the difference between discovering the Higgs and not.

      Remote surgery is about as similar to FPS gameplay as FPS gameplay is to running the LHC.

      when the one thing that the whole shebang relies on (POWER) is the one thing that's out of control of any person directly involved in the operation.

      Modern hospital surgery has relied on power for decades, and they usually get by without an electrician in the room. It's connectivity that's going to cause the problems here.

      --
      systemd is Roko's Basilisk.
    2. Re:50ms might not sound like much by NormalVisual · · Score: 1

      Modern hospital surgery has relied on power for decades, and they usually get by without an electrician in the room.

      I'm guessing he hasn't seen the big standby generators with big fuel tanks that hospitals have. Lots of grocery stores too, for that matter.

      --
      Please stand clear of the doors, por favor mantenganse alejado de las puertas
    3. Re:50ms might not sound like much by Anonymous Coward · · Score: 0

      Yes, being the professionals that they are, they recognized a potential issue, analyzed the possible solutions, and implemented several mitigating factors (only one of which you seem to be aware). That's why they have those generators, and why they don't need an electrician sitting around watching the power lines, much less one in the surgical theater.

    4. Re:50ms might not sound like much by NormalVisual · · Score: 1

      Yes, being the professionals that they are, they recognized a potential issue, analyzed the possible solutions, and implemented several mitigating factors (only one of which you seem to be aware).

      You know what they say about assuming...

      --
      Please stand clear of the doors, por favor mantenganse alejado de las puertas
    5. Re:50ms might not sound like much by wonkey_monkey · · Score: 1

      You know what they say about assuming...

      It makes an ass out of u... and... Ming?

      --
      systemd is Roko's Basilisk.
    6. Re:50ms might not sound like much by NormalVisual · · Score: 1

      "Klytus, I'm boooored. What plaything can you offer me today?"

      --
      Please stand clear of the doors, por favor mantenganse alejado de las puertas
    7. Re:50ms might not sound like much by wonkey_monkey · · Score: 1

      Hungry Hungry Hippos?

      --
      systemd is Roko's Basilisk.
  15. Over the Internet = miserable failure. by Anonymous Coward · · Score: 1

    Are they _really_ trying to do this over conventional global Internet backbone? I sincerely hope not. It is simply not reliable enough, and WILL experience drop-outs, latency spikes, and other disruptions due to all kinds of different scenarios.

    You CAN buy non-Internet data links you know. There is lots of dark fiber available for this kind of thing and providers willing to sell it. It may be expensive, but at least it's not a miserable failure of a design and taking extreme chances with surgery.

  16. At Least by sexconker · · Score: 1

    At least they're not using UDP.

  17. 404 Patient Not Found by Irate+Engineer · · Score: 1

    Talk about a dead link.

    --

    Left MS Windows for Linux Mint and never looked back!

    Vote for Bernie in 2016!

  18. Cause of death? by meta-monkey · · Score: 4, Funny

    Wow. "How'd he die?" "Lag." Been true plenty of times in World of Warcraft, and now possible IRL.

    --
    We don't have a state-run media we have a media-run state.
  19. A dedicated connection... by Anonymous Coward · · Score: 0

    I would hope, or there are lawsuits in their future.

    1. Re:A dedicated connection... by Anonymous Coward · · Score: 0

      dedicated connection to india are kinda expensive especially redundant ones. and the whole idea here is to save money.

  20. Sourceforge by Scotsman,+True · · Score: 1
    1. Re:Sourceforge by NormalVisual · · Score: 1

      Thanks for the links. It's especially interesting reading Tim Kosse's argumentative responses to people experiencing problems.

      --
      Please stand clear of the doors, por favor mantenganse alejado de las puertas
  21. Dear Prospective Patient... by seven+of+five · · Score: 5, Funny

    For your upcoming remote surgery, please note that fast Internet response times ensure an effective procedure with the best post-operative outcomes. Your insurance carrier, however, covers only basic Internet service. If you wish, you may elect to have faster guaranteed response times for an additional fee. Please select from one of the following four options:

    1. 500ms response time $500.00
    2. 250ms response time $750.00
    3 100ms response time $2000.00
    4. 50ms response time $5000.00

    Sincerely, AT&T
    We Appreciate Your Patronage

    1. Re:Dear Prospective Patient... by Anonymous Coward · · Score: 0

      but the people on the prison insurance plan (inmates) get a better then the basic and the state get's the bill.

    2. Re:Dear Prospective Patient... by KGIII · · Score: 1

      Stop putting so many people in prison?

      --
      "So long and thanks for all the fish."
    3. Re:Dear Prospective Patient... by Livius · · Score: 1

      Why did you have to say that? It might have taken them a while before they thought of it on their own.

  22. Get ready medical professionals... by SeaFox · · Score: 1

    Looks like you're the next group to get your jobs outsourced.

  23. What about... by Anonymous Coward · · Score: 0

    Comcast turning your speed down during a procedure because the video kicked your account over the "unlimited" threshold?
    Cell phone hot-spots dropping to the older, slower speeds when a limit is reached, a thunderstorm blocks the "line"?
    Disc-based network during thunderstorms?
    Burglars cutting the "line"?
    Power outages?

    The latency is the least of concerns for surgery.
    Silly

    1. Re:What about... by KGIII · · Score: 1

      Wires like these (even for my business - an OC3 in new construction) go and stay fully underground coming up through a chase in the basement/floor, it could be cut inside but that is why internal security of your data is important. If the hospital is doing this they have IT there all the time - and security. It is unlikely (not impossible) that they will have an issue with anything you are worried about. They also use disparate connections with failover built in I suspect.

      --
      "So long and thanks for all the fish."
  24. Eventually this will be the Norm by DumbSwede · · Score: 1

    Surgery is a scary thing. Having robots or remote surgeons makes us nervous because it amplifies the unknowns. We are already very good at imagining bad what-if scenarios in these situations.

    Likely if lag times become too great the machines will go into a safe mode until a better connection is restored, and yes there may be unlikely/unlucky scenarios where the patent dies from not being able to receive timely treatment/intervention because no qualified surgeon is close by. Of course thousands if not hundreds of thousands (millions?) already die from less than ideal surgeries at the hands of all too fallible doctors. All doctors are fallible, it is a spectrum of very competent (and yet still human) to incompetent.

    Likely autonomous robotic surgery and remote surgery (and various hybrids of the two) are the wave of the future. A future many don’t want, but largely for naked fear of the unknown. Ideally quality of care will go up, access to care will go up, cost will go down (though not initially while we work out the kinks) .

    Ideally automated (and largely infallible) robots will conduct the majority of surgeries and an elite squad of human surgeons will be on stand by to take over if the robot gets into trouble (though this will still be done remotely). Longer term the elite surgeons will be needed less and less until unneeded completely.

    ER facilities will morph into prep-banks to stabilize patents just long enough for them to be worked on by the remotely guided or autonomous robots they keep nearby. Stabilization my include emergency cooling the body (induced hypothermia) so the patent can live long enough to receive remote care.

    Patients with deadly communicable decreases will be able to receive surgery without major risks to hospital staff.

    It will all be quite unnerving to witness, but what surgical intervention isn’t? If statistically lives are saved, then this is the way to go. Doing the right thing in medicine often involves overcoming a yuck factor.

  25. Florida hospital? Where #FLORIDAMAN frequents? by Thud457 · · Score: 1, Troll

    I don't think Texas surgeons are going to be properly trained in the procedure to remove the alligator you stapled to your face during a meth binge.

    --

    the preceding comment is my own and in no way reflects the opinion of the Joint Chiefs of Staff

  26. Hack it up! by Anonymous Coward · · Score: 0

    And, of course, there's absolutely no way the system can be hacked, right?

  27. That sounds good until by Anonymous Coward · · Score: 0

    https://www.youtube.com/watch?v=ILVfzx5Pe-A

  28. The brain adapts well to lag by wonkey_monkey · · Score: 3, Insightful

    The brain adapts very well to lag. If you rig up a button and a light, so the light lights up when you push the button, then gradually introduce a delay, the brain will - up to a certain point - adapt and you'll still think the button push and light are happening at the same time. Remove the delay without warning, and you'll be convinced that the light lit up before you pushed the button.

    Surgery isn't like a first-person shooter, cries of "but the lag!" notwithstanding. Surgeons aren't, for the most part, waiting for the right bit of aorta to bob into their crosshairs so they can jab it with a scalpel, nor are they competing against other surgeons to get the first stitch in.

    Of course spikes in lag - and connections dropping entirely - are a big concern. But I don't think anyone's suggesting hospitals all move to remote working just because they can just yet.

    --
    systemd is Roko's Basilisk.
  29. Their worst case better than Windstream DSL by Anonymous Coward · · Score: 0

    My Windstream DSL is usually far above their "worst case".

  30. This will give new meaning to the term... by toadlife · · Score: 1

    ..."Ping of Death".

    --
    I don't always use unix-like operating systems; but when I do, I prefer FreeBSD.
  31. Jitter by DarkOx · · Score: 2

    I would expect much like digital telephony lag is not much of challenge to overcome unless its really really big.

    Jitter would be a problem. The human brain is pretty good at adapting to consistent latency, anticipating events, delaying or cramming inputs as required to compensate. Where that breaks down is when the latenecy is sometimes 200ms and other-times 500ms without predictability. Controlling jitter on the public parts of the Internet is hard.

    --
    Repeal the 17th Amendment TODAY! Also Please Read http://www.gnu.org/philosophy/right-to-read.html
  32. Errr... that's not that unusual by sirwired · · Score: 1

    I work in DR Architecture, and diverse routes are a pretty common customer request, and for us that just means diverse routes from the customer's IT facility to our DR data canters. Industrial firms, banks, health insurance companies, whatever.

  33. Re:Florida hospital? Where #FLORIDAMAN frequents? by Anonymous Coward · · Score: 0

    The good news is, if there is an alligator attached to your face because of your meth binge, it is probably not actually stapled there, other evidence to the contrary. The bad news is, they probably won't accept you into the clinic until you have your alligator surgically removed.

  34. No. by hey! · · Score: 1

    The hospital didn't show that normal lagtime won't affect remote robotic surgeries. It looked for possible effects of that sort and didn't find any. That's a good result, but it's only the start of a process that might show that doing this is reasonably safe for patients.

    The real world is much more demanding and uncontrollable than simulation. Remember the Therac-25 incident. Thorough functional testing apparently showed that the machine was perfectly safe; it didn't take into account the difference between testers and people who would actually be using the device every day. While you can never prove the non-existence of some unknown and unpredictable factor, that doesn't mean that a long and critical search for things you might have overlooked is useless.

    --
    Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
  35. Texas to FL Maybe not the fairest comparison by Anonymous Coward · · Score: 0

    As anyone in Florida who plays pc games probably knows, the lowest ping servers outside of Florida are very often located in Texas. I live in central Florida (about an hour east of Celebration) and get similar latency connecting to servers in Dallas as I do connecting to servers in Miami.

  36. Excuses! by existentialvoid1061 · · Score: 1

    how about dealing with the bottle-neck and not say "we don't need Internet anyway."

  37. Coming soon: the ad revenue stream .. by Swave+An+deBwoner · · Score: 1

    Your surgical procedure will continue in 60 seconds. Meanwhile please enjoy this brief in-stream advertisement.

    Wha?! Where's the "Skip This Ad" button? Wha?!

  38. Comment removed by account_deleted · · Score: 1

    Comment removed based on user account deletion