Telesurgery Research Articles

Evaluating the efficacy of telesurgery with dual console SSI Mantra Surgical Robotic System: experiment on animal model and clinical trials

The field of robotic surgery has grown exponentially over the past few decades. Surgical robots offer numerous benefits that enhance surgical precision, improve patient outcomes, and expand the capabilities of surgeons. Telesurgery, also known as a remote surgery, is a branch of telemedicine, which offers to perform surgical procedures requiring expertise of a surgeon located at a distance from a patient by using robotic systems and telecommunications technology. In a previous reported case, an animal experiment and clinical trial telesurgery using a dual console were performed. However, the mean latency time and data packet loss were considerably high. As a result, the performance of the telesurgery got severely impacted. This paper evaluates the feasibility, safety, and efficacy of remote telesurgery to precisely carryout predetermined surgical procedures using dual console SSI Mantra Surgical Robotic System. The trials were registered prospectively with trial registration number CTRI-2024-06-068361.

Emphasizing the innovation of urological robotic-assisted surgical instruments and technology driven by new quality productivity forces

New quality productivity force is an advanced form of productive force that is innovation-driven, characterized by high technology, high efficiency, and high quality. It aligns with the new development philosophy and represents an advanced state of productivity. Within the medical sphere, this concept is epitomized by the progressive evolution of surgical instruments and techniques. In recent years, the rapid development of new quality productivity forces in the medical field has generated significant anticipation for innovations in urological robotic surgery instruments and techniques. Advancements in domestically produced robotic surgery systems, remote robotic surgery, single-port robotic surgery, and pediatric-specific robotic surgery exemplify the critical application of new quality productivity forces in urology. The integration of artificial intelligence, haptic feedback technology, and sensory enhancement technologies has further enhanced the safety and precision of surgeries. Driven by these new quality productivity forces, the development of urological robotic surgery instruments and techniques has reached a new milestone, potentially setting a new gold standard for urological surgeries and providing patients with safer, more efficient, and personalized medical care. However, certain emerging technologies still face challenges in their application, necessitating further research and clinical validation.

Secure and lightweight key agreement protocol for remote surgery over tactile internet using physically unclonable functions

Secure and lightweight key agreement protocol for remote surgery over tactile internet using physically unclonable functions

New augmented reality remote for virtual guidance and education of fracture surgery: a retrospective, non-inferiority, multi-center cohort study.

The demand for telesurgery is rapidly increasing. Augmented reality (AR) remote surgery is a promising alternative, fulfilling a worldwide need in fracture surgery. However, previous AR endoscopic and Google Glass remotes remain unsuitable for fracture surgery, and the application of remote fracture surgery has not been reported. The authors aimed to evaluate the safety and clinical effectiveness of a new AR remote in fracture surgery. This retrospective non-inferiority cohort study was conducted at three centres. Between 1 January 2018 and 31 March 2022, 800 patients who underwent fracture surgery were eligible for participation. The study enroled 551 patients with fractures (132 patellae, 128 elbows, 126 tibial plateaus, and 165 ankles) divided into an AR group (specialists used AR to remotely guide junior doctors to perform surgeries) and a traditional non-remote group (specialists performed the surgery themselves). Among 364 patients (182 per group) matched by propensity score, seven (3.8%) in the AR group and six (3%) in the non-remote group developed complications. The 0.005 risk difference (95% CI: -0.033 to 0.044) was below the pre-defined non-inferiority margin of a 10% absolute increase. A similar distribution in the individual components of all complications was found between the groups. Hierarchical analysis following propensity score matching revealed no statistical difference between the two groups regarding functional results at 1-year follow-up, operative time, amount of bleeding, number of fluoroscopies, and injury surgery interval. A Likert scale questionnaire showed positive results (median scores: 4-5) for safety, efficiency, and education. This study is the first to report that AR remote surgery can be as safe and effective as that performed by a specialist in person for fracture surgery, even without the physical presence of a specialist, and is associated with improving the skills and increasing the confidence of junior surgeons. This technique is promising for remote fracture surgery and other open surgeries, offering a new strategy to address inadequate medical care in remote areas.

Feasibility and safety evaluation of ultra-remote robot-assisted laparoscopic hysterectomy

ObjectiveTo assess the safety and feasibility of ultra-remote robot-assisted laparoscopic hysterectomy using the Edge Multi-Port Endoscopic Surgical Robot MP1000 (Shenzhen Edge Medical Co., Ltd., Shenzhen, China) combined with 5G communication technology. MethodsA case of remote robot-assisted laparoscopic hysterectomy was successfully completed on May 2024 by using the Edge Multi-Port Endoscopic Surgical Robot MP1000 at Zhongnan Hospital of Wuhan University and the People's Liberation Army General Hospital, approximately 1, 200 ​km apart. The procedure was simultaneously broadcast during the 36th Annual Meeting of the International Society for Gynecologic Endoscopy in Conjuction with the Peking University Gynecologic Oncology Summit Forum. ResultsA 49-year-old female was hospitalized in the Department of Gynecology of Zhongnan Hospital of Wuhan University for frequent urination for half a year and increased menstrual flow for over a month. The patient was diagnosed with abnormal uterine bleeding caused by multiple uterine leiomyoma and endometrial polyps, combined with moderate anemia. There were no contraindications for surgery, and the patient had surgical indications. On May 2024, the patient underwent a 5G remote robot-assisted laparoscopic hysterectomy and bilateral salpingectomy under general anesthesia. The procedure was successful, with no surgical complications and no interruptions during the live broadcast. The intraoperative blood loss was approximately 20 ​mL, and the surgery lasted about 70 ​min. The bidirectional latency during the operation was around 19 ​ms, with no adverse events related to the robot or the network. The patient recovered well postoperatively and was discharged on the fourth day with no postoperative complications. ConclusionPreliminary findings indicate that ultra-remote robot-assisted laparoscopic hysterectomy is safe and feasible with the support of 5G communication technology. This surgery represents the first globally broadcast remote procedure in the field of gynecology, marking a new milestone in the stability and safety of China's remote medical technology. Remote robotic surgery is expected to be widely promoted in the future, providing services to patients in areas with limited medical resources.

The New Dimension of Surgery: Telesurgery and Surgical Nursing

In the recent COVID-19 pandemic, it has been observed that surgical patients have turned more towards telemedicine applications to meet their health care needs due to the fact that they cannot apply to hospitals unless they are mandatory and even the majority of non-urgent medical activities, including elective surgeries, are paused. Telesurgery, one of the telehealth concepts in the provision of health services, has emerged as a promising application known as remote surgery, which provides remote surgical care to patients. Today, telesurgical interventions performed away from patients using surgical robots, virtual reality applications, advanced computer and network technologies have become a rising trend in the field of surgery. It is obvious that telesurgery applications, which aim to provide high quality remote surgery with worldwide expertise, have some obstacles due to the fact that it is a very new technology. However, despite the obstacles, it is witnessed that telesurgical interventions are being successfully applied day by day thanks to different application methods. It is predicted that telesurgery, which is expected to reach and serve more patients in the future, will be more widely applied and developed with its high-speed advanced network connection, lower cost rates and reaching all over the world, even to space and the depths of the sea. When we look at the nursing practices in telesurgery, which is a new application area in the field of surgery, it is stated that positive results have been achieved, but the number of studies is still insufficient. Depending on the telesurgery technology, which is expected to develop rapidly in the coming years, it is thought that there will be a rapid increase in the number of studies on telesurgery in the field of surgical nursing. Therefore, in this review, it was aimed to clarify telesurgical interventions, which have been started to be applied by surgeons as a new trend in recent years and which is a very new and highly developed application area for nurses, and to examine the surgical nursing interventions applied in this field.

The revolution of metaverse in surgery: a mini-review with video.

The virtual reality (VR) is an application in which people can interact each other with their own avatars. Metaverse has already been tested in numerous medical fields and health care as telemedicine, second opinion and remote discussion, but in surgery some fundamental concepts are not yet very widespread. In this study, we want to show our surgery and workshop experiences in the Metaverse to demonstrate the safety and efficiency of this new technology in surgery, in particular for telementoring and remote surgery, combining artificial intelligence (AI), augmented reality (AR) and VR.

Strategic connectivity in 5G and 6G and remote surgery: The case of Germany

This article addresses the topic of 5G and 6G as a Technological Innovation System (TIS) along with the industrial application of Remote Surgery as an empirical case, exploring three main contributions. Firstly, this research contributes to the connection of the Technological Innovation Systems perspective and 5G and 6G networks in a quantitative viewpoint at national and international levels. Secondly, it contributes to Knowledge Production (F2) and Diffusion (F3) studies through Bibliometrics and software uses. Third, it contributes to the studies of a connection in 5G and 6G networks in the Remote Surgery empirical case application on TIS analytical background. Methodologically, the research problem of this study is to explore the R&D capacity in 5G and 6G TIS concerning the applicability of Remote Surgery worldwide and, consequently, in Germany. The general objective is to improve the industrial relevance of Remote Surgery through quantifying publications and patents and the collaborative networks in these domains. According to publications and patent data, the results reveal a crucial R&D map of Germany until 2021.

Industry Status and Future Development Trend of Da Vinci Surgical Robot

In this paper, we analyze the current industry status of the Da Vinci surgical robot in the medical field and its future development trend. As an advanced minimally invasive surgical tool, the Da Vinci surgical robot has been widely used in many types of surgery, including urology, gynecology, cardiothoracic surgery and general surgery, by providing high-precision surgical operations, three-dimensional high-definition views and greater surgical flexibility. First of all, we analyze the application status of Da Vinci surgical robot in the world. In addition, we explore the major challenges and limitations of Da Vinci surgical robotics. Subsequently, the key factors driving the development of the Da Vinci surgical robot are also analyzed. In terms of future development trends, we predict that the integration of artificial intelligence and surgical robotics, the development of remote surgery and the emergence of more personalized surgical solutions will further promote the progress of Da Vinci surgical robotics and the expansion of the surgical field.

SP-DG: A programmable packet-level scheduling for queuing delay guarantees in time-critical networks

Time-critical applications, such as remote surgery, virtual reality, and automatic driving, impose stringent requirements for minimizing delay and jitter. The queuing delay at forwarding nodes significantly affects application traffic. To tackle this challenge, Time-Sensitive Networking (TSN) techniques have been proposed to ensure deterministic queuing delay. However, existing deterministic solutions, including the Time-Aware Shaper (TAS) and the Cyclic Queuing and Forwarding (CQF) model, encounter limitations due to their reliance on precise synchronization and dedicated forwarding plane devices. In this paper, we present a novel solution: the Strict Priority queuing model with a queuing Delay Guarantees (SP-DG), specifically designed for programmable forwarding planes. This model introduces an upper bound on the queuing delay for packets at each switch, effectively characterizing their distinct queuing delay requirements. By utilizing exponential smoothing to predict traffic intensity, packets are intelligently scheduled to appropriate queues based on their upper-bound queuing delay requirements. Our Netbench simulation and P4 software switch experiments demonstrate that the proposed SP-DG algorithm, compared to the state-of-the-art SP-based queue scheduling algorithms, achieves superior performance in delay-bounded queue scheduling.

Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges.

The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.

IPFS-blockchain-based delegation model for internet of medical robotics things telesurgery system

The concept of the Internet of Medical Robotics Things (IoMRT) is where intelligent robots assess surrounding events, combine information from their sensors, use both local and dispersed intelligence to determine the best course of action, and move or command objects. Telesurgery is one application of IoMRT (TS). With 5G-enabled Tactile Internet (TI) enabling telesurgery (TS), there is ample opportunity to provide exceptional, accurate, ultra-responsive, and real-time virtual surgical procedures. The potential for accurate surgical diagnosis involving the exchange of patient electronic medical records (EMR) with several doctors using an assistant robot (AR) could be greatly useful in the medical field. As a part of this, permission delegation has emerged as a novel approach for data sharing in TI. Robust control of access guidelines combined with a configurable permission scheme promise secure EMR exchange. The present research proposes a multi-hop permission delegation strategy for EMR exchange based on blockchain technology and with configurable delegation depth. Furthermore, the original EMRs are stored on the interplanetary file system (IPFS). Permission delegation uses smart contracts and proxy re-encryption technology. Attribute-based encryption, which offers fine-grained management of access, is used to guarantee data security. Blockchain is also utilized to accomplish immutability and traceability. Delegators may regulate the depth of delegation by using smart contracts. The suggested approach satisfies the intended aims, according to analysis of the protocol. Lastly, the Ethereum test chain is used to assess and put the suggested method into practice. The outcomes of the conducted experiments demonstrate that the suggested protocol operates better than the competitors.

Fiber-optics IoT healthcare system based on deep reinforcement learning combinatorial constraint scheduling for hybrid telemedicine applications

Telemedicine is an emerging development in the healthcare domain, where the Internet of Things (IoT) fiber optics technology assists telemedicine applications to improve overall digital healthcare performances for society. Telemedicine applications are bowel disease monitoring based on fiber optics laser endoscopy, gastrointestinal disease fiber optics lights, remote doctor-patient communication, and remote surgeries. However, many existing systems are not effective and their approaches based on deep reinforcement learning have not obtained optimal results. This paper presents the fiber optics IoT healthcare system based on deep reinforcement learning combinatorial constraint scheduling for hybrid telemedicine applications. In the proposed system, we propose the adaptive security deep q-learning network (ASDQN) algorithm methodology to execute all telemedicine applications under their given quality of services (deadline, latency, security, and resources) constraints. For the problem solution, we have exploited different fiber optics endoscopy datasets with images, video, and numeric data for telemedicine applications. The objective is to minimize the overall latency of telemedicine applications (e.g., local, communication, and edge nodes) and maximize the overall rewards during offloading and scheduling on different nodes. The simulation results show that ASDQN outperforms all telemedicine applications with their QoS and objectives compared to existing state action reward state (SARSA) and deep q-learning network (DQN) policy during execution and scheduling on different nodes.

갑상선 절제술 후 흉터 관리

The cosmetic outcomes following thyroid surgery are a priority for patients as the surgical scar is in a visible area of the anterior neck. This concern has sparked widespread interest among surgeons in minimizing scarring or various remote access surgeries. Hypertrophic scars and keloids, primarily forming in the dermis, are benign hyperproliferative conditions influenced by numerous factors, including TGF-ß1, PDGF, MMPs, genetic factors (more prevalent in colored races), age, and the tension state of the skin and scar. Anti-scar methods including skin tension-bearing methods and devices, topical anti-scar agents, local injections, and laser or phototherapies, that target these scar formation factors have been developed. The currently adopted early postoperative strategies for thyroidectomy scar reduction will be reviewed.

Transforming surgical landscapes: obstacles in the integration of robotic surgery in Pakistan -is cost the only limiting factor?

The advantages of Robotic Assisted Surgery (RAS) over laparoscopic surgery encompass enhanced precision, improved ergonomics, shorter learning curves, versatility in complex procedures, and the potential for remote surgery. These benefits contribute to improved patient outcomes which have led to a paradigm shift in robotic surgery worldwide and it is now being hailed as the future of surgery. Robotic surgery was introduced in Pakistan in 2011, but widespread adoption has been limited. The future of RAS in Pakistan demands a strategic and comprehensive plan due to the substantial investment in installation and maintenance costs. Considering Pakistan's status as a low to middle-income country, a well-designed economic model compatible with the existing health system is imperative. The debate over high investments in robotic surgery amid unmet basic surgical needs underscores the complex dynamics of healthcare challenges in the country. In this review, we discuss the potential benefits of robotics over other surgical techniques, where robotic surgery stands in Pakistan and the possible hurdles and barriers limiting its use along with solutions to overcome this in the future.

Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk.

To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. Retrospective cohort. Academic medical center. Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hybrid Wi-Fi and PLC network for efficient e-health communication in hospitals: a prototype

E-health is being adapted in modern hospitals as a significant addition to the existing healthcare services. To this end, modern hospitals urgently require a mobile, high-capacity, secure, and cost-effective communication infrastructure. In this paper, we explore potential applications of a hybrid broadband power line communication (PLC) and Wi-Fi in an indoor hospital scenario. It utilizes the existing power line cables and Wi-Fi plug-and-play devices for indoor broadband communication. Broadband power line (BPL) adaptors with Wi-Fi outputs are used to build an access network in hospitals, particularly in areas where the wireless router signal is poor. The Tenda PH10 AV1,000 AC Wi-Fi power line adapter is a set of BPL adapters that offer operational bandwidth of up to 1,000 Mbps. These adapters are based on the HomePlug AV2 protocol and can provide a data rate up to 200 Mbps on the physical layer. An experiment using the PLC Wi-Fi kit is carried out to show that a Wi-Fi and PLC hybrid network is the best candidate to provide wide range of practical applications in a hospital including, but not limited to, telemedicine, electronic medical records, early-stage disease diagnosis, health management, real-time monitoring, and remote surgeries.

Improving the latency for 5G/B5G based smart healthcare connectivity in rural area

Smart hospitals are poised to greatly enhance life quality by offering persistent health monitoring capabilities. Remote healthcare and surgery, which are highly dependent on low latency, have seen a transformative improvement with the advent of 5G technology. This has facilitated a new breed of healthcare services, including monitoring and remote surgical procedures. The enhanced features of 5G, such as Enhanced Mobile Broadband (eMBB) and Ultra-Reliable Low Latency Communications (URLLC), have enabled the development of advanced healthcare systems. These systems reduce the need for direct patient contact in hospitals, which is especially pertinent as 5G becomes more widespread. This research presents novel hybrid detection algorithms, specifically QR decomposition with M-algorithm maximum likelihood-minimum mean square error (QRM-MLD-MMSE) and QRM-MLD-ZF (zero forcing), for use in Massive MIMO (M-MIMO) technology. These methods aim to decrease the latency in MIMO-based Non-Orthogonal Multiple Access (NOMA) waveforms while ensuring optimal bit error rate (BER) performance. We conducted simulations to evaluate parameters like BER and power spectral density (PSD) over Rician and Rayleigh channels using both the proposed hybrid and standard algorithms. The study concludes that our hybrid algorithms significantly enhance BER and PSD with lower complexity, marking a substantial improvement in 5G communication for smart healthcare applications.

Strengthening IoT Network Protocols: A Model Resilient Against Cyber Attacks

The pervasive Internet of Things (IoT) integration has revolutionized industries such as medicine, environmental care, and urban development. The synergy between IoT devices and 5G cellular networks has further accelerated this transformation, providing ultra-high data rates and ultra-low latency. This connectivity enables various applications, including remote surgery, autonomous driving, virtual reality gaming, and AI-driven smart manufacturing. However, IoT devices’ real-time and high-volume messaging nature exposes them to potential malicious attacks. The implementation of encryption in such networks is challenging due to the constraints of IoT devices, including limited memory, storage, and processing bandwidth. In a previous work [1], we proposed an ongoing key construction process, introducing a pivotal pool to enhance network security. The protocol is designed with a probability analysis to ensure the existence of a shared key between any pair of IoT devices, with the predefined probability set by the system designer. However, our earlier model faced vulnerabilities such as the “parking lot attack” and physical attacks on devices, as highlighted in the conclusion section. We present a complementary solution to address these issues, fortifying our previous protocol against cyber threats. Our approach involves the implementation of an internal Certification Authority (CA) that issues certificates for each IoT device before joining the network. Furthermore, all encryption keys are distributed by the primary IoT device using the Unix OS ‘passwd’ mechanism. If a device “disappears,” all encryption keys are promptly replaced, ensuring continuous resilience against potential security breaches. This enhanced protocol establishes a robust security framework for IoT networks, safeguarding against internal and external threats.

Technological development of robot-assisted radical prostatectomy

The surgical outcomes of robot-assisted radical prostatectomy have shown remarkable improvement over the last two decades since its advent, due to advances in surgical concepts, techniques, and equipment. Today, ongoing research aims to compare the benefits and drawbacks of various surgical approaches, such as anterior, posterior, lateral, transvesical, and transperineal approaches, in terms of tumor control, functional recovery, and complication reduction in order to achieve the goal of pentafecta (no postoperative complications and negative surgical margins in addition to trifecta) to the maximum extent. It is imperative to explore and integrate novel technologies such as 5G remote surgery and artificial intelligence into the clinical practice of robot-assisted radical prostatectomy while ensuring patient safety, which has immense potential for substantial benefits to patients with prostate cancer.