Operating room technology
can never be sure that the speed of the communication will be the same, [and] under 200 milliseconds,” he says. “That is very important for your brain. You cannot have a delay that changes.” In 2020, doctors in China conducted four laparoscopic surgeries on pigs, from nearly 3,000 km away using a 5G wireless connection. The average network delay was reported as 264 milliseconds, yet the surgeons noted that the operations went “safely and smoothly”. Others have explored whether an internet connection would suffice. Between 2003 and 2005, surgeons in Hamilton, Canada, performed 22 operations from more than 350 km away using a high-performance virtual private network. Mostly, the time delay was 150-200 milliseconds, but sometimes it exceeded 250.
Thrombectomy is a complex surgery where a J-shaped wire like the one pictured is passed through the vascular system to reach and break up a clot.
the founder and president of surgical research and training institute IRCAD. “With 5G, we know that the majority of the time it is more,” he adds. But thanks to advances in surgical robotics and a wave of emerging solutions on the horizon, remote robotic surgery could become viable for more patients.
Minimally invasive surgery Doctors have been performing life-saving surgeries without robots for years – so it’s worth asking: Why use robotic arms in place of human ones? Well, robots can make smaller, more precise cuts and have a wider range of movement than a human hand, which makes minimally invasive procedures easier to perform, explains Marescaux: “The robot will amplify what you do…and it offers a lot of freedom.” For patients, this may lead to less scarring and a faster recovery.
“We still need to understand a little bit more about how those robots function when the commands from the robotic controls are being passed over the network.” Dr Ryan Madder
During operations, the robotic arms are controlled by the surgeon via a console, while a camera transmits real-time imagery of the patient to a screen in front of them. This technology is already being used in hospitals, but the surgeon is usually in the same building – often, they’re in the same room. With a strong enough network, these procedures could be done from another city or even continent – in theory, at least. Some research has suggested that 5G could do the trick, but unless you have a dedicated line and perfect connection, relying on 5G for complex surgery between, say, two continents, is unrealistic, says Marescaux. From point A to B, “you
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Robots are currently used for a range of surgeries across urology, cardiology, gynaecology, head and neck, and more. And thanks to their enhanced movement range and precision, they enable certain operations which are traditionally done via open surgery to be performed using keyhole techniques, such as prostate removal and surgery for stomach cancer. Were these procedures available remotely, there’s no doubt they would increase access to care – patients may otherwise need to travel to a specialist centre for gastrectomy, for example – while giving more people less invasive options for surgery.
Treating stroke When treating stroke, it’s crucial to act within 60 minutes, known as the “golden hour”, to reduce the chance of long-term brain damage. Yet, reaching a neurovascular surgeon in time, most of whom are based in big city hospitals, is a major challenge. Then, there’s the thrombectomy procedure itself, which can also be a complex and drawn-out process. The surgeon needs to manipulate a J-shaped wire through to the stroke site by rotating it outside of the body – but if it can’t navigate the sharp twists and turns of the vascular system, it needs to be taken out and replaced.
“It can take a very long time,” says Xuanhe Zhao, professor of Mechanical Engineering at MIT. “So we saw an opportunity to apply our intravascular robotic system to stroke treatment.”
The system uses a straight guidewire with magnetic particles inside, whose movement is manipulated by a magnet that’s controlled by a surgeon via a joystick. This allows for precise control over the wire’s movement once inserted, so it can be led straight to the clot, Zhao explains. “It’s just like playing a video game,” he quips.
While one robotic arm holds the magnet in place, another captures real-time, X-ray imagery of the procedure that the surgeon sees on a screen. At the
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