AdventHealth Team Successfully Tests Remote Robotic Surgery

April 19, 2019 - Roger Smith, PhD, and his team at Florida-based AdventHealth Nicholson Center recently conducted a successful Department of Defense (DoD)-funded trial on remote robotic surgery.

Smith, who is chief technology officer at the center, and his team used a dedicated fiber optic campus network to perform the remote robotic surgery.

“The Infrastructure we used for the trial was fiber optic cable. We didn't create a VPN [virtual private network] or something private for our traffic. We just went IP to IP with whatever traffic was on the network,” Smith told HITInfrastructure.com.

DoD funded the trial because the department is interested in developing robotics surgery to treat solders in war zones, he explained.

Smith explained that his team wanted to answer two questions in the robotic surgery trial:  What is the latency of the data between the two points of the system? And what level of latency can the surgeon tolerate and still do the procedure?

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The trial was conducted at the AdventHealth campus in the Orlando area, Smith noted.

“We streamed the robotic surgery data back and forth between two points within our system … We found out from our IT team as we were doing this that the network infrastructure for the campuses is in a protected and trusted environment. So, we didn't cross over into the public internet between our campuses,” he related.

During the trial, the data was arriving within 5 milliseconds. “We didn’t expect that and in fact, when they first gave us the data, w said that it’s got to be a mistake. Then, our IT team explained the situation about how things were wired. They said that between any of these campuses, you’re going to get about that number. And so as we did different combinations of the four campuses, sure enough, 5 milliseconds was pretty solid,” said Smith.

AventHealth Trial Used Da Vinci Robotic Surgical System

The team then took a simulator of the Da Vinci system, a robotic surgical system that enables complex surgery using a minimally invasive approach. The system is controlled by a surgeon from a console.

The team configured the simulator so that the amount of data latency could be adjusted. Smith and his team then recruited more than 100 surgeons to perform surgical tasks with vary levels of latency using the Da Vinci simulator.

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Smith explained that the team adjusted the latency upward to 100 milliseconds, 200 milliseconds, 300 milliseconds, 400 milliseconds, and all the way up to 1 full second.

Up to 200 milliseconds, most of the surgeons could not tell that there was any latency at all. “A few of them, at 200 milliseconds, could tell something wasn’t right. But they didn’t have the vocabulary to talk about it,” he said.

At 300 milliseconds, all the surgeons could see or feel the impact of the latency. Between 300 milliseconds and 500 millisecords, most of them could see the effect that the latency was having on their ability to perform surgery.

The surgeons would move their hand, but the instrument would not move right away. Many developed a technique where they would slow themselves down and think about the movement. They would move their hand and wait for the instrument to catch up.

“Then when we went over 500 milliseconds, most of the surgeons couldn't handle it. The slowing down and pausing technique was just more than they could mentally bear,” Smith related

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“They would stumble through the exercise and grab the needle, but they would grab it in mid-air where there was nothing. Or they'd go to put the needle into a piece of tissue and plunge it in like a spear rather than slip it in the way you're supposed to,” he said.

“It seems like a no brainer that, from a technical perspective, you could take robotic systems that exist now in a closed environment, and you could do telesurgery on the order of 20 miles without any problem,” Smith concluded.

The team also did tests with AdventHealth-owned hospitals in Tampa and Daytona Beach, Florida, as well as Denver and Fort Worth, using the internet in which the latencies were between 150 milliseconds and 200 milliseconds.

DoD Wants to Conduct Remote Surgery on the Battlefield

Smith explained that DoD would ultimately like to see remote robotic surgery deployed on the battlefield, but this would require wireless networks that are sufficiently robust to keep the latency to a manageable level.

Smith said that a 5G cellular network could possibly provide the bandwidth to conduct remote robotic surgery with acceptable latency.

Once the military successfully conducts remote robotic surgery in the field, then it is likely to gain more traction in the civilian marketplace.

“If that happens, then I think you would gather a lot of data and you would get a lot of experience and exposure for this idea. That would be essential for it to move beyond the military environment,” he said.

"I think proving it out in the military environment would really go a long way towards showing the rest of society whether remote robotic surgery was useful or not," Smith concluded.