Early days of remote surgery over broadband

Funding to see the development of wide-scale robotic surgery over broadband connections in Canada is still a very distant reality, but the monitoring of both patients and healthcare professionals over the Internet is on the horizon. As the cost of robots becomes more affordable, remote centres equipped with them that can assist in high-tech surgery may dot the landscape, and that is in addition to the presence of robots based at academic hospitals, says Christopher Schlachta, medical director of Canadian Surgical Technologies & Advanced Robotics (CSTAR), a program of the Lawson Health Research Institute and London Health Sciences Centre (LHSC). He is also an associate professor of surgery at the Schulich School of Medicine and Dentistry at the University of Western Ontario.But bringing remote robotic survey, greater online patient monitoring and physician training is still going to require the presence of broadband connections. Telerobotic surgery for example requires an IP VPN over an MPLS network, underpinning the absolute requirement for high-quality broadband connections. Electronic medical records, teleconsultations and telementoring are currently being practiced in Canada, but telemonitoring and telerobotic surgery are still in experimental stages. The Ontario Telemedicine Network partners with CSTAR surgeons at LHSC in providing teleconsultations and telementoring, notes CSTAR director Schlachta. The current use of robots in Canada sees surgeons 10 or 20 feet away from the patient, but future paradigms, with increasing use of digital technology, may mean the robots can perform surgery in remote regions of Canada, guided by specialists in university-affiliated hospitals."Right now, I sit at a console and move instruments with my hands and there are cables that reach to the operating table," says Schlachta. "If there is a dedicated connection or satellite connection, with high bandwidth from your hospital to Thunder Bay, for example, then what I do will be performed by the robot in the remote centre."But with the current price tag of the technology that vision is still "a long way off." Schlachta predicts that computer-assisted robotic surgery will evolve as a fusion of imaging and mechatronic technologies. "At the current cost of $5 million per da Vinci robot, they cannot be found in every hospital in Canada," he says. "We don't have a robotic system that is inexpensive enough to populate remote hospitals. We are waiting for the costs of robots to come down and for more robots to come into the marketplace."Schlachta envisions other potential scenarios, such as having a surgeon or even family physician provide pre-operative and post-operative care for a patient while the robot performs a highly technical surgery. Some of the concerns that arise with expanded use of robots are possible time lags that can occur over broadband or satellite connections, notes Schlachta. "It will become a concern in terms of how far away the patient is," he says. "When it is a local distance, a delay of a half second may not be meaningful. However, if the patient is on a spaceship, that delay is significant."But, perhaps, one day the use of telerobotic survey will be common place as the positive impacts on the Canadian healthcare system can be great. Not only can this technology allow for more effective surgeries, it can reduce the recovery time for patients, which in turn means shorter hospital stays. Schlachta sees the evolution of telerobotic surgery beginning the top of a pyramid that has the electronic medical record as its foundation. The EMR makes possible teleconsultation, the second layer of the telehealth pyramid, over a secure, encrypted and high-speed connection. The third layer is telementoring, which involves training surgeons in remote areas, or even community hospitals located an hour away, using videoconferencing technology and secure network connections, so surgeons learn skill sets to perform specialized procedures that aren't commonly performed in Canada. The fourth layer is telemonitoring which means patients at remote sites can be continuously monitored and physicians at these remote locations can check in with more experienced healthcare professionals about making any changes in care.

Early days of remote surgery over broadband

News | 06/19/2007 1:25 pm EDT

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