Dados do Trabalho

Título

TELESURGERY: A NEW FRONTIER IN SURGICAL HEALTHCARE EQUITY

Resumo

Introduction: the evolution of telecom technology to 5G in parallel with new innovative and more cost-effective robotic platforms has opened a new era in surgery that has the potential to benefit healthcare equity globally. We report our initial experience with telerobotic remote surgery in urology. Methods: Eight partial nephrectomies were performed in the porcine model at distances between 1500- 2500km remote from the surgeon. We used Edge medical, Microport and Kang Duo robos. We then were able to transfer our experience to real human patients and 3 robotic radical prostatectomies were performed. The surgeon (VP) was in Beijing and the surgeon’s native team was with the local team and the patient at 3 different locations between 1500km and 2700km away. The transmission was performed using 5G in two patients and direct connect fiber in one other. The latency was measured at less than 100ms with no drop in signal and no perceptible latency to the surgeon or remote assistant. Further testing has also been performed using 5G to connect to robotic platforms from Orlando, Florida to Shanghai China and Dubai UAE. These distances are round trip about 26000km. In the inanimate model significant latency of over 400ms was noted. Results: We had no issues with mechanical or video latency or communication between the surgeon and assistant. The median roundtrip network latency was less than 100ms and the median time to live was 64 bits (64-64), with no Frame loss. The median operative time for the prostatectomies was 65 minutes (59-67) and for the partial nephrectomies 45 minutes (43-53). The roundtrip latency from Orlando to Dubai and Shanghai was 475ms and presented a considerable delay to perform the activity, the median time to live was 256 bits, with no Frame loss. The three radical prostatectomy patients underwent an uneventful surgical procedures and recovery from surgery. Conclusions: our initial experience with telesurgery has been promising as we have been able to connect and operate at significant distances without failure or significant latency. Our experience with telesurgical robotic radical prostatectomy is one of the first reported in the literature. The concept of telesurgery has huge humanitarian implication for the ability to potentially deliver healthcare equity to underserved areas, bringing acess to quality care. Significant barriers to adoption remain in terms of further testing, medicolegal, training, and credentialling issues.