Though it may still sound like science fiction, over the past 15 years, robotic-assisted surgeries have become practically commonplace. The vast majority of these operations are performed by the da Vinci surgical system, a four-armed, minimally invasive surgical robot controlled by a doctor sitting at a nearby console. In 2018, the da Vinci system was used in roughly 1 million surgeries. However, some experts see surgical robotics as just a stepping-stone to the next transformational surgery technology: telesurgery, or surgeries conducted by doctors located miles away from their patients.
Telesurgery procedures are still exceedingly rare, due in part to concerns around internet reliability and infrastructure. Controlling a surgery remotely is possible only if the data connection is broad and secure. But now, with the adoption of 5G communication networks, there’s reason to believe that mass-market telesurgeries are finally on the horizon. In fact, earlier this year, unconfirmed reports emerged that surgeons in China had conducted the world’s first 5G telesurgery on a human patient.
Remote surgery research in the United States dates back to the late 1990s, when the Defense Advanced Research Projects Agency (DARPA) began funding the development of surgical robotics. The first human telesurgery was performed in 2001, when doctors working in New York removed the gallbladder of a patient in France using the Zeus Robotic Surgical System. The operation was conducted and monitored by a team of 40 people, including surgeons, engineers from France Telecom, and representatives of Computer Motion, the company that created Zeus. The machine was rudimentary by today’s standards, with a 2D camera and pre-HD video quality. It also had just three surgical arms, as opposed to the da Vinci’s four. “It was really kind of an advanced version of traditional laparoscopy,” says Roger Smith, PhD, chief technology officer of the AdventHealth Nicholson Center.
5G’s ability to penetrate farther than current wireless networks could finally enable telesurgery, bringing necessary operations to those who need it more.
The 2001 surgery, known as the Lindbergh operation, relied on a hardwire internet connection tapping the highest-speed fiber optic service available at the time: 10 megabits per second. (By comparison, in 2018, the average home internet connection speed in the United States was 18.7 megabits per second.) At that speed, surgeons experienced a transmission delay of no more than 200 milliseconds — small enough to be considered safe. The proof of concept was a success. Since then, several more surgeries have been performed or assisted remotely, though most attempts have relied on a hardwire internet connection rather than a mobile one.
The Department of Defense funded Smith and his team to study telesurgery latency — the delay experienced by remote doctors — from 2011 to 2014. They found that telesurgery could be achieved with remarkably low latency over a hardwire internet connection, with delays as small as five milliseconds within a closed hospital network and usually no more than 100 to 200 milliseconds even over long distances. Smith says that most surgeons could not detect latency between 100 and 200 milliseconds. In simulations at 300 milliseconds, surgeons did notice a delay, but most were able to adapt. “Above 500 milliseconds, some surgeons could still perform pretty well,” Smith says. “But most of them had reached the edge of their tolerance.”
Populations in rural areas often lack access to specialized surgical procedures and, particularly in emergencies, miss out on life-saving care. Experts say that 5G’s ability to penetrate farther than current wireless networks could finally enable telesurgery, bringing necessary operations to those who need it more.
Though a few surgeries have been “tele-assisted” via wireless networks in recent years, the first fully wireless telesurgeries were reported to have taken place earlier this year. In January, stories in the Chinese press indicated that a surgeon there had removed the liver of a lab animal 30 miles away using da Vinci robots and wireless 5G internet. Then, in March, Dr. Ling Zhipei, of Beijing’s PLA General Hospital, reportedly performed brain surgery on a human patient more than 1,800 miles away—the first reported wireless human telesurgery.
Information on these operations is difficult to verify: All reports source Chinese state media, and Zhipei could not be reached for comment. Available reports do not clarify what kind of latency doctors experienced and how the medical team accounted for potential errors. Given China’s significant investment in both surgical robotics and 5G networks — Chinese tech giant Huawei in particular is emerging as an industry leader — the 5G telesurgery feat is credible, though there’s reason for skepticism.
“They would have had to make significant alterations to the current da Vinci platform to use it over 5G,” says telesurgery pioneer Dr. Mehran Anvari, who has routinely performed telerobotic operations since 2003 and continues to work on the development of new surgical robotics. And as the editor in chief of the International Journal of Medical Robotics and Computer Assisted Surgery, Anvari says he would expect to have heard about the coming publication of any articles regarding the surgery. He has not.
A representative from Intuitive Surgical would not deny or confirm the use of the da Vinci system in the Chinese 5G operation, though they pointed out that the machine is not designed for telesurgeries. “Our systems are not telesurgery systems — they are robotic-assisted surgical systems, which are under full surgeon control at a console in the OR with the patient and surgical team,” they said.
Regardless, Anvari is excited about the prospect of 5G telesurgery. 5G networks are able to move more data, much farther, far more quickly and reliably than existing 4G networks by operating at significantly higher frequencies — anywhere from 30 GHz to 300 GHz, compared to 4G’s 6 GHz. With more frequency bands available, the network is also far less likely to be interrupted. In the United States, 5G is only available in home service and mobile hotspots in a few cities, with a wider rollout not expected until 2020. China, Japan, and South Korea have all outpaced the United States in building 5G infrastructure.
Today’s surgical robots are large and heavy because they require great computational power to process graphics, vision from the robot’s cameras, and movement. In addition to enabling telesurgery, 5G technology could also enable smaller, nimbler surgical robots, which could greatly expand a remote surgeon’s capabilities.
“With a 5G wireless connection, you can do those things not on the robot, but somewhere else, in the cloud,” says Ludovic Righetti, who leads the Machines in Motion Laboratory at NYU’s Tandon School of Engineering and works with 5G in the NYU Wireless lab. “With 5G, we can transmit a lot of data, and we can do all the processing as fast as we receive it.” Righetti says that 5G’s ultra-low latency could even allow surgical robotics to incorporate haptic — or tactile — feedback, so that surgeons could actually feel what their instruments are doing.
Remote robotic capabilities could allow one surgeon in a central location to perform interventional procedures on patients across an entire network of hospitals.
Among U.S. surgical robotics companies, Corindus Vascular Robotics is leading the way in 5G testing. The company’s CorPath GRX is an interventional vascular robot that assists physicians in placing stents and is already in use around the world for coronary and peripheral vascular interventions. The company recently began the process of seeking FDA approval for stroke intervention.
In 2018, the CorPath was used for remote procedures in humans for the first time. Dr. Tejas Patel, of the Apex Heart Institute in Ahmedabad, India, successfully performed remote procedures on five patients from a distance of about 20 miles away. The telesurgeries relied on a hardwire internet connection with a guaranteed speed of 100 megabits per second. Doctors were on the scene with the patients, ready to take over in the event of any problems.
For the past six months, Corindus has been testing its technology in 5G. In late April, the company conducted its first 5G surgical simulations. From the Verizon Innovation Center in Waltham, Massachusetts, Dr. Ryan Madder operated a machine located about six miles away at another Verizon center in Cambridge, Massachusetts, completing between 12 and 15 simulated surgical cases using a combination of 5G and hardwire internet. In the second half of the year, Corindus plans to expand this testing into a multiple-city, cross-country pilot.
Doug Teany, chief operating officer at Corindus, says the company sees two medical conditions as candidates for remote intervention: heart attack and stroke. In rural areas, valuable time is often lost while transporting a patient to a facility where they can relieve specialized care. The more quickly patients receive treatment, the more likely they are to make a full recovery and less likely to need long-term care. Remote robotic capabilities could allow one surgeon in a central location to perform interventional procedures on patients across an entire network of hospitals.
In addition to 5G’s ability to reach rural areas, Teany points out that network “slicing”— a unique 5G capability that lets users create dedicated end-to-end networks for a specific function — could make telesurgery more secure.
In the future, Corindus is also interested in using 5G to create augmented reality. “It becomes feasible on ultra-high-speed connections to give more information to a remote physician about what’s in the room and what’s happening. The clinical goal is to create a sense of immersion so it looks and feels like they’re in the room,” he says. “The more advanced features we can layer in, [the more we can] reduce risk to the patient.”