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Biotech

Canadian Surgeons Perform Telerobotic Surgery 211

AndroidCat writes "While the equipment used isn't new, this operation was different because one of surgeons was 400km away. Dr. Mehran Anvari in Hamilton Ontario tele-operated instruments in North Bay General Hospital, supervised by Dr. Craig McKinley on site. The link was over a high priority routed Bell Canada connection. The patient, Ms. Fortier is doing quite well. Don't try this from home with a dialup connection."
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Canadian Surgeons Perform Telerobotic Surgery

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  • at least... (Score:4, Funny)

    by mirko ( 198274 ) on Wednesday March 05, 2003 @04:09AM (#5439059) Journal
    please : don't slashdot them while they are operating some people...
    • "We have reports that a bunch of nerds from the popular site Slashdot dot org has caused accedental deaths at various hopsitals around the country".


      Poor docs, now they'll have to carry Medical DoS Insurance...

    • the Blue screen of death will be the red screen of death after "where will you start today"
  • Good thing... (Score:1, Redundant)

    by Kalewa ( 561267 )
    Good thing they waited until after the operation to tell us about it. I'd hate for them to get Slashdotted in the middle of it.
  • Uh-Oh (Score:3, Funny)

    by gsharaf ( 654543 ) on Wednesday March 05, 2003 @04:11AM (#5439072)
    "Sir, we are getting a 404 from your heart."
  • hmm performance (Score:5, Interesting)

    by hfastedge ( 542013 ) on Wednesday March 05, 2003 @04:12AM (#5439076) Homepage Journal
    I wonder if any of the special IP priorities that rarely get used outside of LANS (or in) were used.

    Also, if any encryption was done, because id be concerned with achieving maximum latency possible.

    They said over a commercial network, so I'd have to assume encryption, possibly with special hardware for it.
    • i mean minimal latency and LAN's
    • Also, if any encryption was done, because id be concerned with achieving maximum latency possible. Yeah, it'd be a bitch to die from a little packet loss.
    • Re:hmm performance (Score:1, Interesting)

      by Anonymous Coward
      I would assume this would be done over a dedicated CBR or rt-VBR type point to point atm connection, to guarantee QOS. I doubt very much if this was done through IP over the WAN. I don't think it would be prudent to allow an operation to be subject to IP network problems

      As for encryption, I doubt this would be used as its not really needed on a point to point dedicated circuit.

      I simply cannot see the medical profession doing something of this seriousness over the internet or somesuchthing...
    • by Anonymous Coward
      >Also, any encryption was done

      Yeah.. because I can just picture what would happen if the ISP got their wires crossed and the medical implements ended up getting their commands from someone who was in the middle of a game of counterstrike.. %)

      (no I didn't RTFA. This is slashdot.. you don't need to RTFA to post an informed opinion, remember? :)
    • Yeah, and you'd hope they'd turn off the pr0n filter software too.

      I mean there isnt much that's pinker than someone's insides. That shit is sure to get blocked.
  • Dr. Nick (Score:5, Funny)

    by Anonymous Coward on Wednesday March 05, 2003 @04:14AM (#5439082)
    "The leg bone's connected to the hip bone,

    the hip bone's connected to the...red thing.
    The red thing's connected to my...wristwatch...uh oh."
  • by e8johan ( 605347 ) on Wednesday March 05, 2003 @04:15AM (#5439085) Homepage Journal
    Is this what you call a telephone operator?
  • by BWJones ( 18351 ) on Wednesday March 05, 2003 @04:17AM (#5439100) Homepage Journal
    Lots of folks complained about internet2, but this should be a prime example of why it is important.

    Just last week, we had a drop out of the Abilene node and most traffic from our lab was routed onto commodity routes where the performance degredation in terms of bandwidth and latency was pretty noticeable. I have become used to the gigabit ethernet performance in my dual G4 and degradation in performance with it due to Internet2 downtime is frustrating.
    • I don't want MS to be a part of it. Their prime aim seems to be to prevent anyone from truly innovating. I'd even suggest we pay MS to stay off Internet2 - say something like $10bn.
  • by joelparker ( 586428 ) <joel@school.net> on Wednesday March 05, 2003 @04:22AM (#5439112) Homepage
    Computer Motion is the company that built the ZEUS telesurgery system in the article. The company website has some pretty amazing advances here [computermotion.com]

    Cheers, Joel

  • by Anonymous Coward
    The surgeon just kicked your ass in Counter Strike with a 2ms ping.
  • Potential (Score:2, Insightful)

    by bjkoning ( 636780 )
    I think this has great potential. Some operations can only be done by a select group of surgeons, this technology makes it possible to perform operations that wouldn't normally be performed in a hospital. I think this is going the save lives on the long run. Let's just hope they don't run Windows, I wouldn't like a crash when I'm on the table.
  • by Anonymous Coward on Wednesday March 05, 2003 @04:29AM (#5439132)
    Sooner or later, an operation like this is going to fail. When questioned, the doctor will respond, "omfg!!!!! fucken lag!!!!!"
  • by Anonymous Coward
    ö SignOff Mehran: #operating-room (Ping timeout)
    <Craig> Oh shit!
  • Telerobotic Surgery for Dummies
  • by anubi ( 640541 ) on Wednesday March 05, 2003 @04:34AM (#5439142) Journal
    Being I work in robotics a lot, this technology is typical of what we are trying to do.

    We already use micro-manipulators to do things so fine that we humans find it hard to control our own hands to do. There are many things a machine just does much better than we can.. things like zoom vision, ability to see from angles where we can not get our heads to, and doing precision tasks. Ever tried to make stitches as precise as a sewing machine?

    The business end of the machines can be much smaller than our fingers, and tools on the machine are designed expressly for needed things. None of this "hand me the scapel, nurse" stuff. The machine can have as many arms and tools as the designers deem necessary.

    And the machines can be made absolutely sterile. It is really hard to sterilize a human, and still have us functional.

    It is really a tiny, very tiny, step from going to having a surgeon sitting next to a patient doing the surgery, to having one on the other side of the world doing it... ( the main problem is latency ).

    The biggest advantage to the patient is that his need of surgical services may happen at any time - what it means is there is a world-wide pool of surgeons available to help - right now. They do not need to get scrubbed. If they are a critical care surgeon, by golly, they may have their end right in their den at their personal residence. Even if the surgeon was in a most unsanitary condition at the time of need, that would not be a factor. Time is. And that is what this technology gives us. Who is best equipped to meet the need... NOW.

    This is what dreams are made of. This is why we go to work. To make things like this.

    This is why we need technology.

    • by Evil Adrian ( 253301 ) on Wednesday March 05, 2003 @04:58AM (#5439186) Homepage
      I don't mind this kind of stuff being done over a LAN, but over the Internet? Packet loss, DDoS, a critical routing point decides to crap out in the middle of surgery...

      Halfway across the world seems retarded to me. In the same room using robotics seems absolutely delightful.

      Speaking of long-distance stuff, though, it's a shame the FuFme [fufme.com] site is no longer running... :-)
      • Adrian:

        As you indicated, the main problem is indeed latency.

        I note many corporations use live video teleconferencing over the net... so the idea of streaming video back to the surgeon does not seem all that off. Motor control has much less need of bandwidth than video. Packet loss can be handled by redundant packet technologies. I am very confident that suitable compression/encryption/data integrity assurance can be implemented to mitigate disruption or eavesdropping of the surgical procedures. I am afraid nothing can be done about DDoS or critical router failures, but consider the alternatives are no help at all.

        In a time of need, I am willing to grab for any help I can find. Consider how reliable the net is and how little it is really crippled from technical issues such as this.. its something I am willing to bet my life on, given what the alternative is.

        Thanks for the reply.

      • by vidarh ( 309115 ) <vidar@hokstad.com> on Wednesday March 05, 2003 @06:35AM (#5439378) Homepage Journal
        Bell's "national IP infrastructure" is as close to the internet as the phone network is - it is a private IP network where they can enforce as much redundancy and quality of service as they like, which means guaranteeing bandwidth and latency is not a problem. Unless their system is badly flawed, packet loss, DDoS or intermittent hardware failures should not be a problem.

        This is hardly the public internet.

      • One of the main reasons why the large distance matters has to do with military applications. The military dosent want to send in valuable(sp) human medics, when it can send in a Medivan with the robotic setup inside it. Surgeons woulnt have to endanger there lives on the battle field, and some say might perform better as they are not under any physical threat.

        So one day training to be a medic might not involve any form of combat training.

        And if the medics play their cards right, they might even be able to VPN into work (yea ok i pushed it to far on this one).

    • They do not need to get scrubbed. If they are a critical care surgeon, by golly, they may have their end right in their den at their personal residence. Even if the surgeon was in a most unsanitary condition at the time of need, that would not be a factor.

      for some odd reason this reminded me of a scene in Swordfish where a certain person had to do certain tasks in a most unfavorable (erm, favorable?) position.

      medical profession do have it the best eh? being able to save somebody's life and be get some lovin' all at the same time - and get paid alot. For other professions it's just not logistically possible. Maybe except porn actors, but I'd hardly qualify that as "saving lives."

    • Anubi! How many times do I have to tell you not browse /. on the computer doing the surgery?
      Leave it alone, it's busy!
      And back to work!
    • The plus side, to me, was that the surgery was light enough on the patient that she's doing very well. And that, minus all the techno tricks, is what counts right?

      Go gettem tiger! Snag those dreams!

  • Well okay... (Score:2, Interesting)

    by dotgain ( 630123 )
    ..but when it's my life (or anybody elses, for that matter) in question, was there any good reason for doing it remotely, other than the fact that he can?

    No link, no matter how fast or secure, will let a physician monitor the status of his patient nearly as much as actually being there. I could do my job from remote at home, but my boss prefers I actually come in to work, in case something goes wrong I can be there first hand to see what's going wrong.

    It's not like 400km is a great divide. Drive it. fly it. Okay, the operation was a success, but say it wasn't. The first question that's going to be asked is, "and you decided to perform the operation from beside your swimming pool watching it on your 14" TFT why?"

    I'm not surprised this is possible, nor would I bother with the risk. What do we need airplane pilots or taxi drivers for, if these jobs can ben done by someone sitting behind a console or in a cafe. Hell, someone could fly two planes at once.

    Get my drift?

    • Okay, the operation was a success, but say it wasn't. The first question that's going to be asked is, "and you decided to perform the operation from beside your swimming pool watching it on your 14" TFT why?"

      ...no doubt asked by a manager of some description working form home beside THEIR pool...
    • C'mon... (Score:5, Insightful)

      by WebCowboy ( 196209 ) on Wednesday March 05, 2003 @05:28AM (#5439242)
      Wait a minute...it's not like there was a lady on an operating table, being prodded by a robot and no-one around save perhaps a pimply-faced computer geek to make sure everything was going well. There WAS a doctor overseeing events at the site. Conversely, it's not like the doctor on the other end was lounging by the pool, tweaking the trackpoint of his IBM ThinkPad. This technology wouldn't be used on a person unless it was proven safe and the benefits for outweighed possible risks (also, remember they weren't doing brain surgery on their maiden voyage--it was surgery to correct an acid-reflux problem, so if there were problems the risk of death would be quite low).

      You're right--400 km isn't exactly a cross-continent trek, but keep in mind that a round trip by car would eat up eight hours of a skilled surgeon's time (and time is money), and even flying would take a few hours. Also, remember the surgery was in North Bay and performed by a doctor in Hamilton. North Bay isn't exacly a metropolitan hub--there's maybe what...50,000 people there? I don't think there are gonna be direct flights leaving hourly from Hamilton. Besides, do you know what the weather has been like in Ontario lately? Cold and horrible! Flight schedules aren't going to be reliable, and driving 400 km through a blizzard would be quite treacherous!

      The next step is to start using this technology in places like Yellowknife. Yellowknife! Not exactly the kind of place that's teeming with specialised surgeons, and a doctor in Toronto can't easily hop a train, plane or taxi there, nor can the patient be safely relocated to Toronto without great expense and risk. You'd have to hop a 727 in Toronto to Edmonton, a lear jet to Ft. McMurray and a turboprop to Yellowknife (at best you might be able to avoid the stopover in Ft. McMurray)--or else spend a great deal of taxpayer's money in an already strained socialised haelthcare system on a special private direct flight.

      Yup, telesurgery starts to look pretty appealing if you've been suffering on a long waiting list typical of the healthcare system in Canada, and it offers you the chance to get it done not only properly, but much sooner as well.

      And if we put a taxi driver out of a job who the hell cares--he's probably an immigrant with 10 years of medical training and a long history of performing surgery in Pakistan, scaping out a living until all the immigration bullshit has been shoveled and he can get certified to work as a doctor in Canada. Maybe the money saved with this technology can make that process go faster so he can "do surgery by the pool" with Dr. Anvari. That old farmer in Cowcrap, Saskatchewan who needs his hernia fixed might appreciate the resulting shorter waiting time too...
      • ..it's not like there was a lady on an operating table, being prodded by a robot and no-one around save perhaps a pimply-faced computer geek to make sure everything was going well. There WAS a doctor overseeing events at the site. Conversely, it's not like the doctor on the other end was lounging by the pool, tweaking the trackpoint of his IBM ThinkPad.

        Yeah, okay, I might have gone a bit overboard there.

        Also, remember the surgery was in North Bay and performed by a doctor in Hamilton. North Bay isn't exacly a metropolitan hub--there's maybe what...50,000 people there? I don't think there are gonna be direct flights leaving hourly from Hamilton. Besides, do you know what the weather has been like in Ontario lately? Cold and horrible!

        Accepted. Since I'm a New Zealander, I'm not all that familiar with the Geography there. You make some good points, which I wish I had the benefit of when I posted. About the trip, I was thinking more of the patient being driven to the more capable surgeon, rather than the other way around. Of course, this isn't always possible, depending on the stability of the patient.

        Thanks for your points.

        • It is so rare for someone on Slashdot to accept criticism, and acknowledge it, and admit that he was not absolutely correct. In other words, to behave like an adult seeking truth.

          Thank you for raising the level of discourse.

      • Re:C'mon... (Score:5, Insightful)

        by RobinH ( 124750 ) on Wednesday March 05, 2003 @08:22AM (#5439642) Homepage
        Yup, telesurgery starts to look pretty appealing if you've been suffering on a long waiting list typical of the healthcare system in Canada

        I'd just like to point out that there are long waiting lists in the U.S. too; it's just that you are allowed to jump ahead in line if you have more money. If don't have enough money, you're not allowed to get in line. I'll take the Canadian system any day.
    • No link, no matter how fast or secure, will let a physician monitor the status of his patient nearly as much as actually being there.

      The point is that the physician can not always be there on time.
      Sure it's better to have the doctor there than the robot, but it's also better to have the robot there than have the doctor sitting on a plane.
    • It was 400km this time. Canada is a HUGE country. We've got people who are thousands of km from the nearest surgeon. Telesurgery has the capacity to make someone in Inuktitut life much easier.
  • by peatbakke ( 52079 ) <peat@peat.oGINSBERGrg minus poet> on Wednesday March 05, 2003 @04:39AM (#5439155) Homepage
    ... if we can perform surgery via telerobotics, why wouldn't we be able to perform, say, guided experiments in space?

    Given the inherent safety issues with routine space travel, how difficult would it be to create a remotely manned orbiter to carry out space based experiments?

    It seems like there would be a tremendous number of benefits -- no direct risk to human life, smaller shuttle / more room for payloads, 24/7 operation (split shifts behind the controls), etc. ... of course, we'd have to deal with staying in contact with the shuttle while it orbited the Earth, and the lag associated with such distances ... and it wouldn't be quite so exciting ...

    Just a thought. Any ideas?
    • Well the latency would, of course, be much higher. Probably something on the order of 300-400ms (I'm probably way off on this...). And we STILL don't have robots that can perfectly duplicate everything humans can do in orbit. Maybe someday but right now it is just easier to send humans up... probably. I mean you cannot build robots that could repair the Hubble for instance, and I would hate to try.

      An interesting footnote, the Soviets launched their space shuttle,Buran completely automated into orbit and back again with no problems [astronautix.com]. To Quote:

      The software problem was rectified and the next attempt was set for 15 November at 06:00 (03:00 GMT). Came the morning, the weather was snow flurries with 20 m/s winds. Launch abort criteria were 15 m/s. The launch director decided to press ahead anyway. After 12 years of development everything went perfectly. Buran, with a mass of 79.4 tonnes, separated from the Block Ts core and entered a temporary orbit with a perigee of -11.2 km and apogee of 154.2 km. At apogee Burn executed a 66.6 m/s manoeuvre and entered a 251 km x 263 km orbit of the earth. In the payload bay was the 7150 kg module 37KB s/n 37071. 140 minutes into the flight retrofire was accomplished with a total delta-v of 175 m/s. 206 minutes after launch, accompanied by Igor Volk in a MiG-25 chase plane, Buran touched down at 260 km/hr in a 17 m/s crosswind at the Jubilee runway, with a 1620 m landing rollout. The completely automatic launch, orbital manoeuvre, deorbit, and precision landing of an airliner-sized spaceplane on its very first flight was an unprecedented accomplishment of which the Soviets were justifiably proud. It completely vindicated the years of exhaustive ground and flight test that had debugged the systems before they flew.
    • Well, the moon is about 1.4 light seconds away, so even in the best case latency you'd have more than 1.4 second delay. It is pretty hard to do things when you have to wait 3 seconds for each move (1.4 to do it, and 1.4 to find out if it happened right). Delicate work would be impossible. And then, if you are thinking of something like to mars, you're dealing with a lag time of 5-22 minutes (depending on if it is close or far from us in its orbit), so that is basically out for anything useful. Plus if there is any packet loss, then you have to make the round trip several times before you know if it worked. Of course, they'd probably transmit each packet a few dozen times just to safe, but even then if you are doing things without waiting to see the results you can really mess things up.

      Besides, if you are trying to think ahead, (and presumably scientists are) then you realize that going up and playing around at the space station and on the moon is really just something we have to do before we could even consider something as far away as Mars. If we can't make it to orbit and back safely (and I think we can, I don't consider two accidents out of so many years to really be unsafe) then we'd have no hope of going farther.
  • by A Rabid Tibetan Yak ( 525649 ) on Wednesday March 05, 2003 @04:39AM (#5439156)
    From the article:

    Using telerobotics will enable patients living in remote locations to be able to undergo procedures they would normally have to travel to city locations to receive, Dr. McKinley said. Telerobotic surgery will also assist with medical training, enabling experienced surgeons to assist from a distance those who are still learning.

    This is probably the killer app. Being a med student myself (and having just watched Scrubs) I think the ability to have someone watching over your shoulder during an important operation would greatly assist confidence during learning surgical procedures -- especially during unusual times of the morning when the hospital is understaffed etc., and you're the house surgeon lumped with everyone walking in the door.

    However, allowing dangerous operations to be undertaken in remote locations is probably not a great idea... without qualified staff physically on hand, I don't think you'd want to trust someone's life to an IP connection; otherwise, the next time some DDoS or Outlook worm strikes, servers aren't the only thing we lose.
    • huh? (Score:5, Funny)

      by djupedal ( 584558 ) on Wednesday March 05, 2003 @04:51AM (#5439175)
      killer app? Excuse me? They're teaching med students to kill, these days, are they?

      Man, no wonder malpractice is out of hand.

      And being rabid is no excuse.
    • by anubi ( 640541 ) on Wednesday March 05, 2003 @05:01AM (#5439192) Journal
      From Yak's comment:
      "However, allowing dangerous operations to be undertaken in remote locations is probably not a great idea... without qualified staff physically on hand, I don't think you'd want to trust someone's life to an IP connection; otherwise, the next time some DDoS or Outlook worm strikes, servers aren't the only thing we lose. "

      Good consideration and caution. Nicest to err on the side of safety if at all possible.

      Consider I am driving down some back woods road and have my accident. I am tore up bad. They run me into the hospital. No-body there is really up to doing open-heart surgery to fix where the steering column tore into me. But they do have a robot in the OR. I am bleeding to death NOW. Sure, I would love to have qualified staff on hand standing by to see to it my needs are met, but that is just not an option here. Inside of two minutes, they can probably connect to somebody in some time zone somewhere in the world who knows what to do. Wheel me in and let the guy over in Australia fix me up while I lay bleeding to death in Kansas at 2AM. If the system goes down while I am under the knife, I am really still no worse off than if I did not have the option of telesurgical care in the first place. There is maybe a 0.1% chance of system failure, but there is 99.9% chance there won't be technical problems. Its that probability I am betting my life on.

      And, as noted, the whole operation, being digitized, is a movie record of what happened so it can be later reviewed for doing it better next time and training students.

      Can't you imagine the simulation software we can come up with so students can run simulations until they feel comfortable with the real thing? Kinda like flight simulators for pilots, so you can crash a few times without getting all the next of kin on your tail.

      • "There is maybe a 0.1% chance of system failure, but there is 99.9% chance there won't be technical problems."
        Not if you use the Internet. There'll be a minimum one second lag, coupled with the potential for a route to go down at any time, resulting in a pause while the IP packets are re-routed.

        "We've got a bleeder! ... ... ... damn, he bled to death. Too bad we had to operate on him just when the Matrix 3 DVD hit the internet. Damn slashdot-hippie-induced-lag."
        • B3ryllium notes:
          "Not if you use the Internet. There'll be a minimum one second lag, coupled with the potential for a route to go down at any time, resulting in a pause while the IP packets are re-routed."
          Yeh.. latency... Thats the kicker. I am confident though that there will be some way to set the protocol streams up so that this can be optimized for this sort of stream transfer much like the corporate videoconferencing. But exactly as you say, it *is* a problem.. and sorely needs our attention. The internet itself is pretty darned reliable though - I just hope these latest worms teach us not to code things in "untrustworthy" ways.

        • What do you mean a minimum one second lag? With a decent connection (read: not dialup or ADSL etc.) and decent equipment getting down to a couple of hundred milliseconds round trips for transatlantic connections isn't a problem.

          But still, using the internet as opposed to hiring a dedicated channel for an application like this would be stupid.

      • thats great that they can do that remotely, but who is going to cough up the money for these macines. secondly, in these 'remote' areas, we have issues getting high speed internet, it wold take an act of a supernatural being to get a reliable connection. in the neantime, we'll just sit here and watch the batient bleed to death while the 2 remote ends synch up.
        • Consider how much we pay to train and equip ambulances and paramedics to try to buy a few minutes.

          Please consider I am not referring to elective or "convenience" surgery - there is no way I would want to go under a telesurgical knife for that. That is something I could travel in person and be in the immediate presence of my caregiver for.

          I think we are talking about that hope when there was no hope. A telesurgical robot can begin work immediately during a crisis situation. The blood and life fluids are draining from the patient every second that care is delayed. Its not the best care in the world, but its the best care that can be provided under the circumstances. I do not see these machines as really being astronomical in cost once they are standardized and mass produced.. Note they will have to be standardized and mass produced if you expect interoperability amongst teams of surgeons. Kinda like a piano keyboard is going to have to be a standard if pianists worldwide are going to be able to play it.

        • Noone sane would use the public internet for an application like this - you would use a guaranteed quality of service link set up for the purpose, and that can easily be provided nearly anywhere. Your phone calls are typically allocated a fixed bandwidth digital channel from your local exchange onwards, for instance. If you're worried about redundancy, setting up a VPN with a redundant connection through a physically separate line should be no problem for any telco. Yes, you would pay lots more than for your home internet connection, but then it would still be peanuts compared to the cost of a long operation anyway.
      • Consider I am driving down some back woods road and have my accident...

        You're right. In an A&E situation like that, with no other option to save you from an almost certain death, it would be irresponsible not to use a robotic surgeon if available - the principle of non maleficence ("first, do no harm").

        However, my earlier post was with regard to more routine 9 till 5 procedures -- for example, it would be better to ship an otherwise healthy transplant patient who has been on a waiting list for months, to another hospital to undergo the procedure, rather than go for robotics to save the journey. Sure, it might even be more expensive, but again ethical principles would caution against taking unnecessary risks.

        One thing I considered before was borderline cases like the scientist in Antarctica who got breast cancer, and had to have an airdrop of supplies before being evac'd when the weather changed. While not strictly applicable, in a borderline case would you want to hold out for transport or go for a robot? You can't really answer that generally, only on a case by case basis, but I think that this robotic tech is good if only it gives healthcare staff more options in cases where there were previously one or none (A&E for example).

        And as for usage in training, I can't see it. The only real theoretical advantage over a regular videotaped operation would be the interactivity of a simulator, at which point you might as well use a model/cadaver/etc anyway. And why would you need to run a simulation over a WAN? A regular computer with a decent 3D card and whatever special input device they're using would be fine.
        • "The only real theoretical advantage over a regular videotaped operation would be the interactivity of a simulator, at which point you might as well use a model/cadaver/etc anyway."
          I agree with you... I don't think videotapes could teach surgery near as good as doing the surgery itself.. whether simulated or on real cadavers. No more than watching videotapes of others doing analog design is going to make me a good designer.

          I get the idea nothing is going to replace the genuine cadaver ( once you get over the smell ). We have one over at our college, and when I saw it and got a whiff, I got a whole new respect for the class of pre-med students. I don't recall having a thing in my engineering training that smelled quite like that.

          I would think the simulator would mostly be for training how to apply the surgical knowledge through the telesurgical robot. There would be advantages and disadvantages to using the bot. Having an assortment of tools all ready to go, with macros in place so that repetitive things such as stitching could be automated, but there is also the drawbacks of latency and use of unfamiliar tools. I noted in another post how important I feel it is to standardize the interface if we expect surgeons worldwide to be able to use it. Hopefully, as we engineers and robotocists hone our skills to produce better products, doctors hopefully will find these products more useful in the OR. The idea being to make a surgical assistant that contains all the tools a surgeon needs and can perform under the direction of the surgeon what has to be done. Hopefully, the idea is that the surgeon will find the robots to be a useful aid in the OR so that the surgeons will be comfortable working through them. When the surgeons can see through the robot's eyes and work through the robot's hands, the distance between surgeon and robot falls out of the equation. And if the robots are standardized - then it does not make any difference which robot the surgeon works through, just as I have several identical tools I use, it does not make any difference which oscilloscope I get, they all work the same. Same concept - just extended.

          Because the robot is not as constrained as we humans are, I get the idea a lot of work may be done out the end of catheter-style tools so we can minimize invasive surgery. Advances in miniaturization of cameras, optics, light sources, and actuators could make for some dandy tiny yet powerful operating tools.

          But then, if we have telesurgical robots, it only follows that interactive simulation would be the only way to go. Kinda like a videogame. It would make videotapes obsolete , as nobody wants to learn how to play a videogame by watching instructional tapes!

          For review though, the images and the action taken by the surgeon could be stored so it could be reviewed and used for demonstration, it would probably become part of the patient record. Hopefully it would replace that long essay my surgeon had to prepare when I had surgery once. Surgeons should not have to spend their time messing with all that paper.

          I definitely side with you about elective and convenience surgeries. I feel as you about the bot being primarily for when time is of the essence. I do not think we are quite there yet, and I'll hold off for the Doctor's opinion on what they feel right with. I would expect no less.

  • by djupedal ( 584558 ) on Wednesday March 05, 2003 @04:47AM (#5439166)
    By David Orenstein, December 2001 Issue [business2.com]

    Earlier this fall, 68-year-old Madeleine Schaal volunteered to make medical history by allowing Jacques Marescaux and Michel Gagner to remove her gall bladder. What's so unusual about that? Only that she lay on an operating table in her hometown of Strasbourg, France, while the two doctors performing the surgery were in New York.
    • This is still impressive, much as the second landing on the moon was just about as impressive as the first.

      I would imagine that they start off with low-risk operations now, as a form of practicing, as it were. No doubt they also have a backup team of surgeons ready to intervene if something threatens to go wrong. Besides, I do not expect that they will be remotely doing life-or-death or really invasive surgery for a long time, if ever.

      There is also the matter of using robots and remote-controlled scalpels and the like for brain surgery; in these cases I am quite sure this is controlled by the surgeon located right there with the patient.

  • Latency (Score:2, Insightful)

    by ashkar ( 319969 )
    I don't think latency would be such a big deal. It would be rather simple to write some sync code. That way the surgery might lag, but at least the surgeon's movements would never be ahead of the operation itself. His commands could be ignored until the two ends were in sync again.
    • Re:Latency (Score:3, Insightful)

      His commands could be ignored until the two ends were in sync again.

      Read that line again...very carefully. Don't you think there could be some problems there?

  • Best/Worst (Score:2, Insightful)

    by Evil Adrian ( 253301 )
    Best case: surgery is fine, patient recovers.
    Worst case: link gets disrupted, surgery machine goes Max Headroom on the patient -- "sl-sl-sl-sl-slice!!"
    • Why is this modded "insightful"? Grow up!

      If you know only a small bit about systems design, you know that in case of any mechanical/electrical/other failure the system must fall back into a safe state. In this case the machine will retract so that the patient will not be harmed.

      This is nothing knew. It has been done even in mechanical systems like train signals in the 19th century. If the cable breaks, the signal will fall and the train must stop.
  • by Geaty ( 654469 )
    Could you imagine what would happen if there were security issues with something like this? The implications would keep me out from under the remote-controlled knife. One could conceivably go in to get your tonsils removed, and some kid could take over the connection and carve their initials on your forehead or something. Albeit my understanding of network security is almost non-existent, but I think this is still something somebody should think about.

    Obligitory bad joke: "So would all operations be done calling collect?"

  • Yay! (Score:2, Troll)

    by Evil Adrian ( 253301 )
    The cool thing about the Canadian health care system is that ANY citizen can get free Internet surgery!
  • Lets just hope these surgeons don't play counterstrike, I can just see one of them screwing up an operation and instinctively shouting "LAG!!!"

  • Murder (Score:2, Interesting)

    by pyrote ( 151588 )
    with this perverse investment in technology it brings to light the possibility of murder by Virus.

    Hack a machine being prepared for the surgery and have it send a horizontal slice 30 minutes into Mr. Gates open heart surgery.

    There is no stopping this kind of crime unless the computers involved are Bios flashed, loaded from ROM media(from a locked and certified source), and tested immediately before the procedure. quite like putting all your physical devices in an autoclave.

    I like tech, but I'll stick to live docs for a while, or get it done quickly before this type of crime comes to surface.
  • Ya, my grandpa is doing this right now as we speak. you can monitor it realtime as he gets his new heart. here's his URL: http://grandpasheartmonitor.com

    Grandpa? GRANDPA???? *BEEEEEEEEEEEEEEEEEEEEE........
  • Hardly a first... (Score:2, Interesting)

    by Renaud ( 6194 )
    400km is nice, but how about New York to Strasbourg, France, 2 years ago, using the same Zeus robot ?

    Unfortunately it was drowned under the 9/11 news at the time.

    Google for "Operation Lindbergh" [google.com]
    • I believe their qualification of this as a first was that they were using a standard Internet connection (abet with hipri routing and a backup connection). I think the article mentions this, or possibly the CBC radio news bit where I first heard it. (I should have included a link to CBC Radio [cbc.ca] but between submission 5pm and publication 3am, it probably dropped off the news queue.)
  • Oddly enough, this got little or no press at all about this, until the actual procedure occured. Sadly, it wasn't even the big news story on our LOCAL news channel...they didn't even play it first during our local news. This is a groundbreaking operation which could lead to people gaining access to skilled surgeons around the world.
  • i wouldn't do it (Score:4, Interesting)

    by frankmu ( 68782 ) on Wednesday March 05, 2003 @06:08AM (#5439326) Homepage
    as a surgeon, i have my misgivings about these types of surgery. the easy surguries a 4th year medical student can do. the hard ones are what we get paid for. laparoscopic surgery can have severe complications, like poking a big vessel called the AORTA. you need someone who can open up a patient and stop the bleeding RIGHT AWAY. there are times when you just can't use laparoscopy also, and you need actual feel. cost-wise, it may be cheaper buy a bus ticket for the patient to get the consultation 400 km away, than for every hospital in the country to have these robots in the OR.
  • I guess this is what is meant by having putting someone's Life on the LINE.
  • by kfg ( 145172 ) on Wednesday March 05, 2003 @06:31AM (#5439372)
    In his classic 1946 novel "City" Clifford Simak predicted the fall of the city as the focal point of human life and interaction. Telecomunications and globally networked computers were going allow people to live anywhere, and work from wherever that was, over the network, creating a dispersed culture with minimal "face time" in people's lives.

    Independant robots with artificial intelligence were, of course, a major part of that invisioned future, taking over the tasks of housemaid and gardener, thus further reducing the overall level of interhuman interaction. ( Can you say automatic vacuum cleaner? I knew you could)

    Truely visionary. In 1946 the American suburb and "planned community", as we know it, was still a gleam in the Levitt's eyes. Computers themselves were the crude and expensive dinosaurs of geek myth and networks didn't exist, let alone anything on the scale of the internet.

    What makes all of this relevant to the article is that Simak predicted one of the side effects of this would be an increasing social isolation of humanity, to the point where we were actually unable to deal with each other face to face, or even leave our homes with any comfort. To an extent the evidence suggests that there is a certain truth to this and all of us here are well familiar with the stereotype of the net connected and sophisticated geek huddling in some dark hole somewhere (like his mother's basement) but essentially inept at face to face confrontation.

    To illustrate this he chose to tell the story of a supremely gifted surgeon who allowed a friend to die, a friend with the answer to life, the universe and everything ( as yet unrevealed to the public), simply because his isolationist produced agoraphobia didn't allow him to travel to perform the needed surgery.

    Simak's prescience in this novel is absolutely stunning in scope ( and the story is masterful as well, read it), but the one thing he did not forsee was that even *surgery* would one day be performed from our isolated aeries in the Himalayas ( well, to be fair, he did actually take this partially into account by placing the surgeon on Earth and the patient on Mars, thus net lag was a significant factor in the requirement that the surgeon actually be *present* on Mars, but we can already forsee ways around this problem).

    Perhaps only our geometrically increasing numbers stand between us and his vision of an isolated future lived over the net.

    KFG
  • Too many people think something is going to go wrong. As long as it's not done on windows, fine by me. Though it would take BSOD to a new level.
  • So these are the people that also brought you Naked News [nakednews.com] and this [barelycooking.com]?

    The only logical combination would be remote-sex and telerobotic masturbation...

    Actually, on the point of telerobotic-sex. How about telerobotic cooking? so maybe my mom can cook me an omlete that I can't get so often, since I live some 8000 miles away? Or have famous french chefs cook you some *real* french dinner? Or, heck, have the shit on Iron Chef telerobotically cooked in your local telerobotic restaurant / community food-center, so we can taste, and not just dool over, the fine ass dishes they make on the show? I'd pay some serious cash for the food network to be broadcasting such kinds of data. I wouldn't think it's difficult to record it and have the same meal prepared when you need that exotic whatever to save your life (say, when you get the munchies, or your pregnant wife gets the cravings, etc). Still have to buy the ingredients though...

  • A recent report in German magazin DER SPIEGEL [spiegel.de] indicates that hip bone operations performed by "robodoc" surgeons still have a high rate of failure.

    Robodoc is only an example, the report's main focus is that US regulations for medical procedures require more safety testing than German regulations. As a result, German clinics are a testbed for new, untested technology from abroad, sometimes with chilling results.

    German clinics already use Robodoc for hip bone operations on a quasi-regular basis (the report estimates 10000 operations in Germany so far) while the same procedure still hasn't been in approved in the US by the FDA since 1993.

    The report quotes critics who see a blind faith in technology, patients are told that Robodoc is far more exact than any human operator, while there are still a number of embarassing failures.
  • I believe it could be feasible ... especially for near-orbit operations, like ISS and satellite maintenance.

    Ok, I know that one of the main goals of ISS is to learn how to create a life-supporting space abitat ... but maybe is time to rethink about it.

  • Dr. Mehran Anvari in Hamilton Ontario tele-operated instruments in North Bay General Hospital,

    You'd think that Dr.Anvari would take whatever chance he could get to get out of Hamilton. People here know it as the armpit of Canada.
  • I can see it now - insurance companies are going to push operations to offshore, Doctors in Bangalore are going to be operating on American patients using telesurgery.

  • Yeah, you gotta have *at least* a 256K DSL line. Otherwise DIY home robotic surgery could be problematic.
  • Tactile feedback and 3D vision.
    If the surgeon can not feel when the instrument touches the organ or encounters an obstruction, how can he operate at all?
    3D vision is important, too. Or, even better, an ability to move the camera, controlled by his head movements - ability to look at the field from different angles. Then the surgeon's brain can restore the 3D picture of the field.
  • Indeed, read Clarke's "A Meeting with Medusa" to see why.
  • by AndroidCat ( 229562 ) on Wednesday March 05, 2003 @01:33PM (#5441494) Homepage
    CBC radio will be (is) having a short bit on the operation. (12:32 est Probably it can be time-surfed at CBC Radio [cbc.ca]
  • Sterelizing instruments is relatively easy, as they're small individual pieces. But how would they sterelize the whole robot, or at least its hands?

    Are there some kind of latex gloves it is first covered with, before the operation?

  • The USA doesn't need Canada's help in making the ISS a total piece of crap--but thanks anyway for that worthless thing. I hope you have different people working on the robotic arms that do surgery.

  • Hand-eye coordination is a 100-500 millisecond feedback loop.

    This waldo probably added all of 40 ms to that, if they had a clean link.

Waste not, get your budget cut next year.

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