Dangerous delays? The trouble with telsurgery

Have you ever tried to move your computer's mouse and the on-screen cursor didn't respond right away? It can be frustrating, but it's nothing compared to what some surgeons are facing. Now researchers and doctors are trying to beat a surgical snafu that is hindering a breakthrough.

Jannett Matthews has had two robotic surgeries, one for weight loss and one to remove her gallbladder.

"It's really exciting to see how far I've come," explains Jannett Matthews a robotic surgery patient.

Her surgeons were just feet away, but what if they were far away?

Robotic surgery have been done, "at a distance of five or 600 miles," says Dr. Roger Smith, PhD, Chief Technology Officer Florida Hospital Nicholson Center.

But Telesurgery Expert Roger Smith says operating from more than 100 miles from a patient is a big challenge because of internet lag. It causes delays between when a surgeon moves his hands, to when the robot responds.

"Above half a second you see some of them totally fall apart," explains Dr. Smith.

While doctors cannot speed up communication technology, they could adapt to it.

Smith is conducting studies with surgeons to help them get used to the lag. These exercises simulate the delays.

"If the latency is very high you sometimes feel frustrated,” explains Haidar Abdul Mushin, Robotic Urology Fellow. “The more exercises you do the better you get."

Smith says if doctors do adjust their techniques to deal with lag or if telecommunications catch up to surgical robots, "the best surgeon in the world could be on call for the most critical cases in the world."

A $4 million grant from the Department of Defense is funding Smith's Telesurgery Study. He's still recruiting surgeons.

Along with performing telesurgeries across the U.S., the hope is someday doctors stateside could perform surgery on wounded warriors in battlefield hospitals overseas.


Dangerous delays? The trouble with telsurgery
REPORT: MB # 3565

BACKGROUND: Robotic surgery is a type of minimally invasive surgery. Instead of operating on patients through large incisions, doctors use miniaturized surgical instruments that can fit through series of quarter-inch incisions. When surgery is performed with the robot, the instruments are mounted on three robotic arms. The fourth arm contains a magnified high-definition 3D camera that will guide the surgeon during the procedure. (Source: www.robotic-surgery.med.nyu.edu)
HOW IT WORKS: The surgeon controls the instruments and camera from a location in the operating room. The doctors can place their fingers into the master controls to operate all four arms simultaneously. Every movement made with the master controls is replicated precisely by the robot. The surgeon can change the scale of the robot's movements. If the doctor selects a three-to-one scale, the tip of the robot's arm moves one inch for every three inches the surgeon's hand actually moves. By using this technology, surgeons are able to perform a number of complex procedures. This technology allows the patient to have fewer traumas on their bodies, minimal scarring, and faster recovery times. (Source: www.robotic-surgery.med.nyu.edu)
NEW TECHNOLOGY: Robotic surgery is a huge breakthrough in medicine. It was originally developed by the US Army and DARPA as a tool to enable telesurgery at a distance. Researchers are now looking for ways to perform surgery across transoceanic distances by using telecommunication technology. An experiment at Florida Hospital Nicholson Center was carried out with the Mimic dV-Trainer (a simulator of the da Vinci robot), which was designed to insert defined levels of latency into the visual and command data streams between the operating field and a surgeon. Participants were asked to perform four basic robotic surgical exercises. The experiment measured the degradation of human surgical performance across a range of latency conditions. The next phase of the research project will involve telesurgery exercises from city to city. The DoD gave the Florida Hospital Nicholson Center a $4.2 million grant to understand how robotic surgery can be performed over long distances. (Source: www.floridahospitalnews.com)

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Jennifer Roberts
Media Relations Manager
Florida Hospital Nicholson Center

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