As robotic surgery technology continues to advance, so does the need for medical research around the standard of care and true capabilities of the technology in a surgical setting. Many industry leaders, including Fortune 500 companies and the Florida Hospital Nicholson Center, are interested in taking robotic surgery to the next step to allow for telesurgery, or remote surgery.
Ethicon, a medical device company in the Johnson & Johnson family, recently entered into a partnership with the Life Sciences team at Google to develop surgical robotics, and perhaps prepare them for telesurgery. What do Ethicon and Google have in common for creating surgical robots? Ethicon is eager to get into robotically-assisted surgical devices where Intuitive Surgical has dominated for years. On the other hand, Google is eager “to do things that are likely to produce big returns in five to 10 years that solve some specific problems,” according to Eric Schmidt, former CEO of Google.
But what is being done in the immediate future to revolutionize robotic surgery? The Florida Hospital Nicholson Center, a medical training facility specializing in robotic and laparoscopic surgery, is conducting research to test latency, or lag time, in remote surgeries. Once tested across varying distances with success, telesurgery could be feasible both domestically and abroad.
Telesurgery has existed for years, but there have been substantial barriers to its implementation, including adequate bandwidth, delays in video feedback and societal issues. The Nicholson Center’s research is focused on testing lag times across technology-rich locations, such as domestic hospital campuses. Lag time is particularly important for telesurgery, because it determines how much of a delay there is between when a surgeon makes a cut or a stitch, and that action being reflected in the video feedback.
To launch the test, we first had to discover how much latency a surgeon could tolerate while still performing a successful surgery. Using surgical robot simulators, because surgical robots are not enabled to be connected to the Internet for remote surgery, we inserted latency into a training exercise where surgeons had to move rings to and from different pegs with increasing lag each time.
During the latency test, it was determined that surgeons began to feel the lag at 300 milliseconds and higher, and by the 300 to 500 milliseconds range, surgeons attempted to compensate for the feeling by slowing their movements and becoming more conscious about every step. After some practice, the surgeons’ movements at this level were no longer one fluid stroke, but a sequence of individual steps connected together. Beginning at 600 milliseconds, most surgeons could no longer handle the latencies and performed the tasks unsafely. Using this tolerance as a scale, a test was successfully completed across 1,200 miles from Celebration, FL, to Fort Worth, TX, under the 300 milliseconds threshold.
Based on our current tests, we have determined that telesurgery is possible and generally safe, and we remain confident that the networks that exist between hospitals today are more than developed enough to sufficiently support telesurgery.
Roger Smith is the Chief Technology Officer for Florida Hospital’s Nicholson Center. He was previously the CTO for U.S. Army Simulation, Training and Instrumentation and a Research Scientist at Texas A&M University. He remains on the Graduate Faculty at University of Central Florida and President of Modelbenders LLC.