In ancient myths, the gods often swooped down from Mount Olympus to assist bumbling humanity. On Sept. 7, Zeus, king of the gods, along with his messenger, Hermes, helped surgeons in New York City perform a gallbladder operation on a woman 3,800 miles away in Strasbourg, France.
The achievement, executed by Dr. Jacques Marescaux of the Research Institute Against Cancers of the Digestive Tract in France and Dr. Michel Gagner of Mt. Sinai Hospital in New York, marked the world’s first successful transatlantic telesurgery operation.
The patient, a 68-year-old woman, had no complications and left the Strasbourg hospital 48 hours after the procedure.
During the transatlantic telesurgery, the surgeons sitting at a computer console in New York manipulated robotic surgical tools in an operating room miles away. Information flowed between the computer, code named Hermes, and the robot system, code named Zeus, using a high-speed communications link. A miniature voice-controlled camera inside the patient showed the surgeons what the robot was doing.
“The camera moves when the surgeon says ‘left, right, up or down,'” said David Quick, a clinical instructor at University Hospital who works with an identical Zeus system at UW-Madison. “At the remote site, the surgeon is connected to a video console monitor with instruments in his hands that are like joysticks, but much more complicated.”
The robot consists of three arms connected to the operating table. Two of the arms hold surgical instruments, and the third arm holds the camera. Through pencil-sized incisions, the robot inserts these tools into the patient, where they operate internally.
Previously, remote telesurgery was limited to a few hundred miles, because the time delay between the computer and the robot was too long. However, an optical-fiber network, which transmits information at the speed of light, helped overcome the time lag. During the gallbladder removal, the doctors in New York could see the robot’s movements within 150 milliseconds.
The short time delay made all the difference in the surgery’s success.
“When you’re sending messages, you want them to be rock-solid fast, because responsiveness is important,” UW engineering professor Nicola Ferrier said.
The concept of surgeons operating on patients across oceans could make highly qualified surgical expertise available worldwide. Furthermore, telesurgery could also be useful over smaller distances, eliminating expensive travel time to big-city hospitals.
“You can’t have experts everywhere,” Ferrier said. “In a state the size of Wisconsin, you can’t have a surgeon in every small little town.’
Additionally, robot-assisted surgery is less invasive than traditional surgery. For example, instead of slicing skin and spreading a heart-bypass patient’s ribs apart, the surgeon only needs tiny cuts. This “closed” surgery results in less pain and hospital time.
Although telesurgery does have advantages, its limitations are also apparent. Telecommunication links can be interrupted and power failures immobilize the robot for safety reasons.
“You don’t want the instruments to go shooting around inside the patient,” Quick said.
Also, another qualified surgeon has to be with the patient, ready to take over in case of an emergency.
However, the level of the transatlantic accomplishment does reach Mount Olympus-like heights.
“It’s a big step,” Quick said.
Military applications questionable
While medicine may have taken a giant leap forward, the jump falls short of doctors’ dreams.
“You could try to develop a [telesurgery] system where a doctor can work on soldiers on the battlefield with the surgeon behind the lines,” Quick said.
However, clinical assistant professor Steven Oreck, an expert in military combat surgery, said the technology is far from being sent with troops to Afghanistan, or anywhere else, any time soon.
“It’s one thing to be in a hard-wall hospital and another thing to be in a field facility,” he said. “It’s a whole other level of ruggedness you have to deal with.”
Oreck said the idea of battlefield telesurgery presents difficult logistical problems, including potential telecommunication interruption.
“The bad guys are always going to try to interrupt radio communication, either to find out what you’re doing or to jam the lines,” he said. “If you’re working on a guy with three gunshot wounds and all the sudden the bad guys turn on the jammer just as you were about to tie off a major bleeding artery?”
Furthermore, equipment delicacy presents another problem.
“If it’s tender, it’s trash,” Oreck said. “The equipment will get wet and muddy, be dropped six feet from a helicopter and be carried on trucks that bounce around on bad roads. It’s got to survive all that.”
Even if engineers can fashion tough technology, a qualified surgeon still needs to be with the patient in case the robot fails.
“If there has to be a surgeon standing by, it’s not doing anybody any good,” Oreck said. “What’s the point?”
The point is that, although telesurgery has triumphed recently, it needs to be adapted for useful military application.
“I think the concept of telesurgery is certainly something that needs to be researched,” Oreck said. “Right now it’s not even close for military use.”