Robotic Telesurgery
Long
Distance Robotic Surgery- During
the recent 86th Annual Clinical Congress of the American College of Surgeons, a
live robotic Telesurgery session was organized between the convention hall at
McCormick Place in Chicago, Illinois, and the Johns Hopkins Bayview Medical
Center in Baltimore, Maryland. The male patient underwent a successful
remote-controlled and computer-assisted minimally invasive operation to treat
chronic groin pain. The telerobotic system which was utilized, has been
developed by the Johns Hopkins School of Medicine, Applied Physics Laboratory,
and ICE Communications Inc. in 1993 to serve initially as a remote surgical
training system for laparoscopic procedures.
Leaders
in Robotic Telesurgery
Dr.
Louis Kavoussi, a Johns Hopkins urologist, who has done a great deal of
scientific research on the accuracy and use of robotic surgical arms compared to
human surgical assistants during urological laparoscopic surgery, operated the
computer console and video screen which graphically displayed the patient's
abdomen before the congress audience at the Chicago site. At a distance of some
850 kilometers, his colleague, Dr. Thomas Jarrett from the Johns Hopkins Bayview
Medical Center assisted him. With a simple mouse-click, Dr. Louis Kavoussi
directed a tiny camera attached to a slender robotic arm as to control the rate
of gas injected into the abdomen to create a workspace for the minimally
invasive operation.
Both Dr. Kavoussi and Dr. Jarrett were able to view the nerve that caused the chronic groin pain. Dr. Jarrett cut the nerve while Dr. Kavoussi, using the robotic arm, cauterized the area to stop bleeding. A microphone allowed the two physicians to constantly communicate with each other during the entire intervention. The telerobotic system has originally been designed to be interactive and provide coordinated co-operation between the remote expert and the local surgeon to assure optimal results of the operative procedure. To accomplish this, the system includes real time video display from either the laparoscope for internal body view or an externally mounted camera for overview of the operating room, and full two-way audio communication.
Telesurgical
assisted surgery is bound to produce a new frontier in medicine. Dr. Kavoussi is
one of the few physicians in the United States who has done long-distance
robotic surgery. Since his first procedure about four years ago, Dr. Kavoussi
has performed remote procedures from Baltimore to Bangkok, Thailand; Innsbruck,
Austria; Rome, Italy; and Singapore. Last September, from the library of his
Maryland home, he assisted in a robotic varicose vein surgery on a patient in
Brazil. Dr. Kavoussi's long experience and research has demonstrated that a
robotic device can more effectively manipulate and more accurately control the
video endoscope than a human assistant during laparoscopic procedures do.
As
a result, any novel operative procedure could be performed anywhere in the world
with the same standards as those at the institution in which the procedure was
developed. This system is the platform for future Telesurgical interventions. As
robotic devices are developed for the operating room, the data features of this
system will eventually allow for complete Telesurgical intervention. This is
21st century telemedicine, the latest advance in a field which doctors claim
someday may allow a surgeon on earth to operate on astronauts in space.
Dr.
W. Randolph Chitwood, Jr., head of the cardiac team at East Carolina University
in Greenville, North Carolina, already consulted with NASA about potential
earth-to-space operations. His team has completed the first robotic mistral
valve cardiac surgery trials with the da Vinci Surgical System. While witnessing
the Telesurgical demonstration in Chicago, Dr. Chitwood stated that a robot
performing the bulk of an operation is perhaps less than a decade away.
Astronauts with a medical emergency in space need months to travel back to
earth. With use of telerobotic technology, surgeons may be able to direct
surgery over millions of miles by telemanipulation, according to Dr. Chitwood.
One obstacle to overcome would be the time delay that has to be bridged at very long distances for the robot to respond. Parallel studies by Dr. Kavoussi have proven that the effect of time delay on physician performance may not exceed 700 ms because this would result in a significant deterioration in the remote specialist's efficacy. This data is crucial in tailoring the requirements for telecommunication between two sites based on distance, bandwidth, and cost. At present, long-distance surgery between remote sites on earth alone is still experimental. Dr. Jarrett explained that patients therefore have been billed only for costs associated with procedures done on-site. Up till now, private funding has paid for all the long-distance costs, including the remote surgeon’s fees.
Telecollaborative
Surgery
SANTA
BARBARA, Calif. -- Computer Motion Inc. (NASDAQ: RBOT), the leader and pioneer
in medical robotics, announced that a London Health Sciences Center (LHSC) team of surgeons in London,
Ontario, Canada performed the world's first series of Telecollaborative
surgeries using Computer Motion's SOCRATES™ Telecollaborative System.
To
date a total of six robotically assisted procedures have been completed with the
surgical mentor telecollaborating from the University Campus and the operative
surgeon performing the procedure at the Westminster Campus, some 15 miles away:
- Drs. Douglas Boyd, Alan Menkis and Reiza
Rayman completed a mitral valve repair and two heart bypass surgeries;
- Drs. Brian Taylor and Winston Hewitt
performed an appendectomy procedure; and
- Drs. Richard Inculet and Richard Malthaner
completed a lung biopsy and a lung resection procedure.
The
medical community agrees that one of the most effective ways for surgeons to
learn new procedures is directly from another surgeon. As a result, surgeon
champions are routinely called upon to lend their clinical expertise and
direction to surgeons who are still gaining expertise in advanced or complex
procedures. Often, there are travel costs and scheduling challenges associated
with this method.
There
has been a growing interest in finding a better way to economically and
effectively augment minimally invasive and conventional "open"
surgical training. Standard teleconferencing systems are proving to be
inadequate to the task of transmitting a clear, steady, non-pixilated operative
image for the remote surgeon.
The
Computer Motion SOCRATES system eliminates these and other problems. SOCRATES
provides the remote surgeon access to a precise and stable image via Computer
Motion's AESOP(R) Endoscope Positioned plus much more.
Yulun
Wang, Ph.D., founder and chief technical officer of Computer Motion, commented,
"Computer Motion has taken telecommunications one important step further by
developing the SOCRATES system to eliminate the distance barrier for physical
interaction, enabling a new class of training and education required for the
advancement of open and endoscopic surgical techniques. In the late 1980s and
early 1990s when the medical community realized the full significance of
laparopscopy for patients, thousands of surgeons had to learn new surgical
techniques. This situation is repeating itself as emerging technology is
enabling new advanced surgical procedures that yield improved patient outcomes
across a broad range of surgical disciplines. We now sit on the threshold of
another training and education opportunity, and Computer Motion is uniquely
positioned to facilitate the necessary transfer of knowledge with our SOCRATES,
AESOP and HERMES technologies."
"SOCRATES
is a huge step beyond just sharing audio and video feedback via
teleconference," said Dr. Ken Harris, chief of surgery at LHSC. "For
the first time, the mentoring surgeon is able to actively participate in a
`hands-on' manner from a remote location. This translates to a very economical
and effective method to shorten the learning curve for surgeons applying new
surgical techniques to their practice. SOCRATES also facilitates the expansion
of minimally invasive surgery into areas that may not currently have access to
or the budget for surgical experts. This is something that patients around the
world will benefit from."
LHSC
is comprised of three separate sites across the city of London, Ontario.
"This is a splendid example of the innovative spirit at this
hospital," said Tony Dagnone, president and CEO of LHSC. "The positive
impacts to patient care delivery as a result of the telementoring approach are
astounding. We believe the SOCRATES technology will someday mean patients will
be able to access the care they need closer to home in their community
hospitals. Beyond our region, this technology will also allow us to share with
and learn from other world-class healthcare providers. LHSC is committed to
pursuing robotically assisted surgeries because we believe it is in the best
interest of patients for improved outcomes and quality of life," Dagnone
added.
Early
development work on Computer Motion's telerobotic systems began in 1996 when
Johns Hopkins University, under the direction of Dr. Louis Kavoussi, pioneered
the development of telerobotics with Computer Motion's first telerobotic system,
the AESOP(R) 1000 TS. Johns Hopkins was the first institution to use Computer
Motion's telerobotic system in multi-center U.S. and transcontinental clinical
trials. Dr. Kavoussi and a number of notable surgeons, including Dr. Peter
Schulam of University of California, Los Angeles Medical Center, published their
initial telerobotic experience and continue to work with the technology today.
Several
other world-class institutes, including the Medical College of Virginia and the
Medical University of South Carolina, have partnered with Computer Motion in the
development and testing of SOCRATES. The new system is currently under FDA
regulatory review.