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Science Technology

Video Over IP Permits South Pole Surgery 125

Henry Malmgren writes "Last week at the South Pole research station, we successfully completed knee surgery using a video over IP link back to the United States. The article is light on technical details, but what we did was to use a Polycom VTC unit to send a video signal to Raytheon Polar Services HQ in Colorado. Our signal went primarily over a Marisat satellite at T1 speeds, and then HQ redistributed the video to Boston via a dedicated ISDN line. We had signal problems several times during the transmission with Marisat, so we had to switch to a NASA TDRS satellite towards the end of the surgery. We also used an Iridium phone as a voice backup for the times when we couldn't get decent quality over either bird. During the surgery there were three cameras that we used to send back video to the states. One was the built in camera on the VTC unit, a second was a handheld Sony 8mm unit, and a third was a black and white "Doc Cam". This was a head mounted camera with a LED light unit that was built on station by our Senior Communications Technican, Jon Berry. This allowed the transmission of video from the Doctor's perspective. Unfortunately, while the Doc cam worked great locally, and we got great recordings of the surgery from it, it didn't work well over the satellite link. The camera view jumped around so much that it didn't compress well over the satellite link. The best video was obtained by putting the hand held camera on a tall tripod which was able to look directly into the surgical wound."
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Video Over IP Permits South Pole Surgery

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  • Breast Cancer (Score:3, Insightful)

    by dextr0us ( 565556 ) <dextr0us&spl,at> on Thursday July 18, 2002 @02:54AM (#3907026) Homepage Journal
    I cannot remember the particulars, but this is quite an innovation since the last major medical emergency in the south pole. A scientist had breast cancer, and she ended up performing self chemo on herself. Imagine if they had this technology a few years sooner! Usually on slashdot all we hear is the typical Linux yaddyaddayadda (not that i dont appreciate that), but it is nice to hear such a great use of technology
    • Re:Breast Cancer (Score:2, Interesting)

      by ianaverage ( 168691 )
      Some of the story can be found here [about.com]. There is more here [about.com].
    • Re:Breast Cancer (Score:4, Informative)

      by Anonymous Coward on Thursday July 18, 2002 @09:04AM (#3907821)
      Wrong. The last one wasn't breast cancer. It was a heart attack. I know, I was there.

      Dr. Ron was airlifted out in the dark. That's a first - it's never, ever been done before.

      We had a satellite link with Swedish Medical at the time. Streamed ultrasound images to them and talked via Iridium. I know this, 'cause I set it up.

      It got zip media coverage as compared to the "breast cancer" story (which stinks to high heaven).
  • by MikeyO ( 99577 ) on Thursday July 18, 2002 @03:01AM (#3907045) Homepage
    So they had a wireless T1 link at the south pole and The best they could do in Boston was ISDN??? Maybe i should move to the Sou1th Pole, if the wireless offerings are that good!!
    • Re:ISDN vs T1?? (Score:2, Informative)

      by reduced ( 589510 )
      but its over satellite. good luck with the lag.
      • but its over satellite. good luck with the lag

        Do you actually know about this kind of thing, or are you just talking trash?

        *DISCLAIMER* I don't really know about this. I'm just askin'

        It seems like the lag would be less over a satellite assuming quality setup. You have a speed of light shot to the satellite. Satellite processing time, which is similar qualitatively to one hop through a router, followed by one speed of light shot to the ground. Now, if the satellite is high enough, one hop could get you from the south pole to the north pole. The physics of the situation might require one, two tops more hops. So someone traceroute me a path that only takes three hops on a ground based network from the south pole to the north.
        Now, I did say that a satellite hop was *qualitatively* the same as a router hop. Can anyone quantify this? Is one satellite hop time-equivalent to 1, 2 ,999 router hops?
        • at the speed of light something can travel around the earth in about 2 seconds or so. half way around would be about 1 second, thats gonna make for a hell of a ping.
        • Re:ISDN vs T1?? (Score:2, Informative)

          by Lokni ( 531043 )
          I believe the latency to a Geostationary satellite is 250ms round trip. I do data transfers daily across the Magnastar radiotelephone systems and Inmarsat Satcom systems for aircraft and can vouch that the bandwidth sucks. I have had to drop data speeds to about 2400 bps just to get a reliable link. Lucky bastardos in the government though have nice Satellite T1 links to play with. At least they have link problems too.
        • I have Starband. Pings range from 600ms to 1200ms generally. I think the best ping in theory is something like 400ms, with geostationary satellites.
  • The technology is very neat but, I dont quite understand why it was needed. Was it really neccesary for the physician in the pole to be talked through the operation. I am truely curious about this and would like to know more.
    • Well, it says that the available medical facilities aren't really designed for surgury. They considered evacuation, but decided it would be too dangerous to the aircrew.

      I'd say that Dr. Pollard, while a Surgeon, isn't qualified on this knee surgury, so they had Dr. Zarins (in Boston), a qualified specialist, watch over to help with any problems. The live feed was the best 'overwatch' they had.
      • Yeah, it would have been nice if the article actually told us what happened.

        It must have simply been a consultation, albeit by unusual and way-cool means. I'm sure that the local medical team did the surgery, and the remote team gave advice as needed on very specialized issues peculiar to joint surgery. But the article doesn't actually *say* so. Maybe news writers need a satellite link to someone who knows how to tell a story. :-(

        Anyway, given the quality of the link, I hope that the use of teleoperators would not even be considered unless the condition were an immediate threat to life. (See Clarke's "A Meeting with Medusa" for a really good story which shows some of the problems with teleoperation.)

        I was reminded of the story about the DEC support center guy who got a call via satellite from the crew of a battle tank in the middle of maneuvers, wanting help getting their ruggedized MicroVAX back in operation.

    • For the same reason that there are orthopaedic surgeons, cardiologists, general surgeons, general physicians, endocrinologists, rheumatologists, haematologists, respiratory physicians (for some reason they are called pulmonologists in the US, though that is the worst mangling of words since "respirator". It is a ventilator here (UK). You don't respirate, you ventilate. How stupid is that?)

      The in-house doc will be some sort of generalist, probably with a special interest in "winter medicine" (i.e. altered physiology in cold conditions, and illnesses particular to such conditions).

      They all have basic grounding in all areas of medicine, but could never safely practise on their own outside their specialty. Just the same as I couldn't take apart a car engine on my own, but with a video link a mechanic could talk me through it because I know how to use basic tools. It really is that simple.

      • You don't respirate, you ventilate. How stupid is that?

        Not very stupid. I, myself, respire several times a minute.

        respire: 1. To breathe in and out; inhale and exhale. 2. To undergo the metabolic process of respiration. 3. To breathe easily again, as after a period of exertion or trouble.
        etymology : Middle English respiren, to breathe again, from Latin respirare, to breathe.

        • Exactly. You respire. You don't respirate. Such a word does not exist. Hence a respirator is a stupid word, whereas you do ventilate, and hence a ventilator makes sense.

          As usual, every other country in the world calls it one thing, and the US calls it something else. Why is that?

    • What? Doesn't "surgical wound." accurately describe the situation for ya?

    • The technology is very neat but, I dont quite understand why it was needed. Was it really neccesary for the physician in the pole to be talked through the operation. I am truely curious about this and would like to know more.
      It is necessary because in Antarctica in winter there is usually one doctor per station, and that guy is a general doctor, not a surgeon. There is on average one surgery every 3 winter over, except at the Australian stations that seem to have an appendectomy a year.

      When I wintered over at Dumont d'Urville in '93 we broke all records with 7 surgeries, including one appendicitis. I have more info on how we coped with it and pictures as well on my site [gdargaud.net].

      At the time all the doctor could rely on was a satellite voice link and a motley crew to assist him. Still much better than what the pioneers had to rely on. In Port-Martin in 1951 they did an appendicitis with sharpened kitchen knives and there's a great story about it but the link seems to be gone.

      A russian doctor had to take out his own appendix in Antarctica in 1961.

  • I'm glad to see some competent technology used in a complicated and potentially dangerous situation. After seeing the Volvo & Windows98 topic, I was afraid this one could've been Surgery & AOL. The one thing someone dosn't want to here during surgery is "You've got mail!!!", or pop-up add might not be good either. I've been wondering for years when we would get to see these amazing network infrastructures around the world put to some advanced use. What the future holds?... we will see.
  • by tlambert ( 566799 ) on Thursday July 18, 2002 @03:06AM (#3907065)
    I'm actually surprised that there hasn't been more telesurgery experiments; I find the whole idea fascinating, and that the process can be made to work at all really amazing and impressive.

    But I think that the referenced article had a better take on it than this posting, whose "additional technical details" are, at best, unintentionally misleading.

    The implication of "video over IP" is that you did this over the public IP network, which in fact is not the case.

    The fact that you did this over what was effectively a dedicated point-to-point link means that the use of the IP transport was irrelevant (worse; it added unnecessary overhead, subtracting from the total data rate).

    I understand not wanting to risk someone's knee on a link succeptible to a DOS (or only succeptible as a result of a substantial investment of effort on the part of the attacker). But your posting implies that this is something which took place over the public Internet, or *could* take place over the public Internet, when it's not.

    -- Terry
    • Your point about IP is valid. I have no idea why, on a private network, they would use IP as a network protocal when there are better ways to send real time data.

      Still, I think it is relevant. As time goes on, people are making IP do more and more. That this has been done over IP means that maybe when Internet2 is for everyone this will be possible (over VPN I hope ;).

      • IP works fine for real-time data as long as you have control over who has access to the network and what applications they run. You can use UDP for time critical data. The reason why IP is so popular is the widespread availability of cheap and off-the-shelf software and hardware.
    • I would imagine the main reason there haven't been more experiments is simply due to the risk to a patient's health if something goes wrong, especially in today's litigous society. Given the choice, would you rather fly a patient (or surgeon) to the right place at a cost of say £5,000 or would you rather risk the £1m settlement if it all goes horribly wrong over a videolink?

      However, I do believe there is a lot to be said for these kinds of ideas, and they are gradually taking off but I reckon it'll be a while before they achieve enough credibility to become the norm rather than the occassional events like this.

    • IP != Internet (Score:3, Insightful)

      by Cato ( 8296 )
      IP doesn't imply the Internet, of course.

      IP was probably chosen because you could get an end to end link (most likely Ethernet at both ends of the satellite link). Satellite networks do clever things with TCP to make it work better on their high-latency links. Most video apps will be IP based these days, or require a single layer 2 (such as ISDN) end to end, which is restrictive.
    • I expect the main reason to do this over IP was that they had IP links and equipment available. The great benefit of IP is in flexibility and versatility - IP is the swiss-army-knife of network protocols. Sure there are more efficient solutions, but they require dedicated (often application-specific) network hardware.

      - Fzz

    • As a bit more information, the satellite link we used to communicate with the doctors stateside is the exact same link we use for all our day to day internet access. I suppose it all depends on how far down a pipe you're willing to to extend your defination of "Internet" to. We did shut down HTTP and FTP traffic in order to have maximum bandwidth available to the operation. Changing the protocol from IP to anything else would have been technically impossible in the time we had available to us.

      We did try to use a basic 'net connection to the doctors in Boston at first, but found the delay and quality was unacceptable, thus the conversion to ISDN on that link.
  • we told him to watch his step. the driveway was covered in ice.
  • Ahhhhhh (Score:4, Funny)

    by gvonk ( 107719 ) <slashdot AT garrettvonk DOT com> on Thursday July 18, 2002 @03:11AM (#3907082) Homepage
    You had me at "T1 over satellite."
  • What I'd like to see is a web cast of this sort of thing.

    • They're doing an unfamiliar procedure by video. Any kind of "oops" prolly wouldn't look to good to the viewing public ;-)
  • by Darby ( 84953 ) on Thursday July 18, 2002 @03:26AM (#3907119)
    This was a head mounted camera with a LED light unit that was built on station by our Senior Communications Technican, Jon Berry.

    Now this is a Capital G Geek in the best of all possible meanings.
    "You wanna what? OK, I got some LEDs and shit...(madly digging through toolbox).Some wires hmmm.. soldering iron over here. Right on surgical lamp, heh. One of these days you'll come up with a challenge for me. Hey, when you're done with the surgery, can we keep the T1 satellite link up for a few. I have some .... uh... important stuff to frag^H^H^H^H do.

    Seriously, there's a guy who actually earned the "Senior" in his title.

    • Actually, I used a SuperCircuits PC70XS camera attached to a Black Diamond Moonlight headlamp. The camera was powered by a radio shack +12VDC power supply. Total cost: about $100. Total fun: plenty, and still accumulating. Of course, there are commercial models of the same basic concept already available. (just not available to south pole winter-overs after the last flight in February)
  • Because of its location high on the Polar Plateau and at the Earth's axis, Amundsen-Scott is a world-class astrophysical observatory. It also has some of the world's cleanest air... The 51 people spending the austral winter (February through November) at the station are unable to leave because extreme cold and darkness prevents aircraft landings.
    It's good to know that people are still doing cool things with technology on the frontier. After a hard day of commenting on academic trolls trying to discredit Orwell [slashdot.org] and a MacWorld Expo that announced virtually nothing [slashdot.org], this is truly a ray of sunsh^H^H^H^H^H^H^H^H^H^H^H^Hbreath of fresh air.
    • Just to be a troll...

      So you consider ZeroConf ipV6 tech 'virtually nothing'? How about full OpenGL Operating System level hardware display acceleration? Bluetooth multi-device portable and peripheral Synchronization?

      You must have been watching/reading about it from the lowest level of ignorance possible.

      anyways... enough trolling.

      This is definitely a good story to see on /. though there have been thousands of others in the past.

      • The technologies in Jaguar are great and all, but Apple announced them earlier, they weren't announced today. Apple just confirmed the date it will be available, which we had narrowed down to the month. I wasn't bashing them. I was simply pointing out that previous MacWorlds offered more of that "WOW" factor Jobs likes to spring on us.

        I'm a bit surprised to see the moderation my post got: Insightful=1, Overrated=1, Underrated=1. I was really aiming for "Funny."

        1. "doing cool things with technology on the frontier" -- cool is an understatement for the Antarctic winter
        2. I made a show of deleting "ray of sunshine" because, as the quoted segment of the article points out, there is no sunshine in Antarctica right now.
        3. I replaced my sunshine comment with "breath of fresh air" because the article says "It also has some of the world's cleanest air"
        As I typed it all just fit, so I figured "what the heck." Of course, now that I've explained that no insight was intended in my comment, I'll be modded down: "Stupid=1" :o)
  • What about the lag? (Score:2, Interesting)

    by millette ( 56354 )
    I don't mean the story happening on July 5th, I mean in the transmission. I'd hate to be the surgeon cutting, like, even 100ms before I see what I'm cutting. I Take that back. I'd really hate to be the patient, being a surgeon can't be a bad thing, anyway you look at it. Seriously, anybody has numbers on this, or is it just something you get used too? Like if you had real long arms, impecceble vision, and had to operate 30,000km away..?
  • Anyone else remembered this one?
    Luckily, Spock himself is able to provide some assistance in the procedure after McCoy manages to re-connect his vocal chords.
    Not the recursive part, that's just silly, but where Bones is just the arms and eyes, like the robot in this story. Yeah, that's a quote from Eric W. Weisstein: http://www.ericweisstein.com/fun/startrek/SpocksBr ain.html
  • So do you suppose there were any penguins involved...? :)
  • by manseman ( 582150 ) on Thursday July 18, 2002 @04:58AM (#3907286)
    Now the surgeon can scratch his ass as much as he likes during surgery without having to wash his hands and change gloves.
    • bleh and THAT is why i dont want to go into medicine
      i am a very itchy person, its not so much scratching your ass is scratching your head, cant just back into a table or something and scratch your ass but your head... that one takes some trickery.
  • by Pedrito ( 94783 ) on Thursday July 18, 2002 @06:39AM (#3907427)
    And so, this is the second time they've needed remote medical help because the doctor there wasn't capable of handling the job themselves. Seems to me that this will necessarily lead to the creation of the EMH (Emergency Medical Hologram). These South Pole people really need to talk to the Star Trek people and get to work.
  • Umm... What exactly are they doing to folks down there that causes their knees to blow out?
    • I blew mine out skiing. My uncle however blew his out on an icy sidewalk. The right twist and tension will take out a tendon preaty good. Plus remember these guys are more than scientists down there, they have to more or less run a city by themselves. Catch the Discovery Channel special sometime on the Doc that got breast cancer down there.
    • Intramural penguin football. Dar Gibson was a star punter. (Do you have any idea how hard it is to get a 65-pound Emperor between the uprights?)
  • Maybe three years ago one of the Smithsonian ComputerWorld awards went to a company that was working on heart surgeries like this.

    And no, nobody was exactly volunteering to be the first high-risk surgery attempt. It seems right that we'd try knee surgeries in a situation like this first; both the isolated patient and the lack of really bad potential outcomes make this a decent first choice.

    The people with the remote heart surgery systems saw them as a training tool, for one example, first. They had some specific ideas about the steps that'd happen before the technology could be adapted for real surgery, anyway.

  • Let me say up front that this is way cool.

    But reading the summary, I kept expecting to hear how you ID'd the limo from the vanity plate. [imdb.com]

    Party on!
  • Ah... Early morning... Coffee... Let's see what's on Slashdot...

    OPEN KNEE SURGERY!!!

    Ug... Not an image I want in the morning...

    Why not have a Jon Katz article on Kurt Cobain's counter-society life, complete with vaporized head?
  • Is this really going to become reality for remote operations? Given how unrealiable the network is for absolutely secure, realtime video I hope this is limited to only minor non-critical surgery. But then again, if it's non-critical and can wait, it's best to go into the hospital.

    I really wonder how practical remote surgery besides distance learning.

  • If we could leverage the impressive amount of cpu power currently to be found for relatively low price to replace current compression techniques with hybrid realtime 3D + Video.

    For instance, easy prediction models (like the arms/smocks of the doctors, scalpels, hemostats, suction tubes) could with signatures and then compress the difficult to predict stuff (patient's entrails) with compressed video. Contrast in most operating environments means that this shouldn't be too hard to do. Then at the video destination build real-time 3D models of the cut objects to fill in the video. This should dramatically cut down on the ammount of video which needs to be compressed and transmitted.
  • According to the article, the lab was staffed with medical doctors, but they had no facilities that were set up for surgery.

    So, the have people capable, but no facilities for it, how is a satellite connection with an experienced doctor in Boston going to help?

  • here... [wired.com]
    Internet on south pole is tricky... not many sattelites going there.
  • Sounds like the time the hospital said that they were going to operate on my grandmother with the main surgeon 'consulting' on the surgery. It turns out that he was in his car with a cell phone. Ah, telemedicine.

    (Always ask lots of questions - even if it pisses people off. If you don't like the setup (as in our situation) refuse to go along. In our case we told them to wait for the surgeon to arrive and be physically present in the operating room during the surgery. Who knows if he was mentally present, though.)

  • These were probably the most expensive surgeries ever. Why would someone go all the way to the south pole for knee surgery? I'm sure there are plenty of docs in highly populated areas where those needing the surgery live.
  • ...for penguins, I guess.
  • by MeerCat ( 5914 ) on Thursday July 18, 2002 @05:29PM (#3911992) Homepage
    If you want to know more about life in antarctica, and the realities of being a doctor, a friend of mine resigned a top surgeon's job to spend a year in antartica as medical officer (plus dentist, plus hairdresser).

    Great diary, the real issues of life at the south pole, great photos... have a read of Ingrid On Ice [abc.net.au]

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