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Robotic Telesurgery by Remote Surgeons 134

Roland Piquepaille writes "In a few years, telesurgery performed by multi-armed robots remotely controlled by real surgeons located hundreds or thousands of kilometers away will become commonplace. Today, Canadian doctors from the Centre for Minimal Access Surgery (CMAS) are developing the technology for NASA. Their goal is to build a portable robotic unit that would be used in space missions, war zones and remote areas within five years. So far, the experiments already done in Canada and for NASA are extremely encouraging. But read more for additional details and pictures of a real surgeon controlling such a robot."
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Robotic Telesurgery by Remote Surgeons

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  • Problems? (Score:3, Funny)

    by mr-mafoo ( 891779 ) on Friday May 19, 2006 @07:41PM (#15369721)

    "Oh no! The connection's lagging doctor!"

    "Reconfigure the upstream bandwidth, and re-route all traffic to the backup server!"

    • by IgLou ( 732042 )
      Better yet, make the robot surgeons web accessible.

      Nurse: "Doctor the robo-surgeon seems to have crashed."
      Doctor: "Look on the display it says, nothing for you to see? What's going on"
      In bursts the network admin exclaiming: "The surgeon he's been... slashdotted!"
    • Damn good job this demo isn't sponsored by Real.

      "As you can see, I make the incision here exposing the hear.....BUFFERING......
    • by Anonymous Coward
      I heard the UK is about to pass a law that outlaws this sort of thing...
    • "Oh no! The connection's lagging doctor!"

      "Reconfigure the upstream bandwidth, and re-route all traffic to the backup server!"

      That's a HUGE user interface problem, actually.

      The best round-trip time you'll get across the Atlantic is about 200ms. When you're expecting immediate feedback, it's an eternity. Not everyone learns how to deal with it very well.

      I'm the author of Unlagged [] for Quake 3 (which is currently the lag compensation technique used in Enemy Territory, if I'm understanding things correctly). It
      • You can do much better than 200ms across the atlantic.

        ~110ms between Sweden and New York right now for example. However it won't ever get much faster than that.
      • You can get a bit better than that.

        A quick check just now shows that I can, from western Norway, reach several servers in the US with ping-times of 100 -> 150 ms.

        Light moves 300.000 km/s and the distance from western Europe to eastern USA is on the order of 6000 km, so minimum physically possible pingtimes would be about 40ms.

        In practice, this means including the inevitable router-lag and the failure of network-cables to go in a straigth line, we're not likely to ever see much better ping-times tha

      • That's a HUGE user interface problem, actually. The best round-trip time you'll get across the Atlantic is about 200ms.

        What the they thinking of when they talk about doing this in OUTER SPACE for God's sake? Where would it be sensible to do this? In low-earth orbit they should be able to de-orbit in a few hours in an emergency. Further out, near the moon it's 3 seconds round trip. En-route to Mars; forget it.

        Wait till they can build a Known-Space-style autodoc.

    • This has really got nothing to do with NASA and space stations. Consider the potential for offshoring surgery. Indian/Chinese/whatever surgeons operating telepresence remote bots. All the hospitals will need are a few low-skill orderlies to strap the victims to the tables and give the bot a squirt of oil now and then. Should make for cheaper surgery and better profits for the health insurance companies.

      Sounds like whoring for a funny rating, but not so. There are millions to be saved in surgery bills $20/hr

      • If *I* was the one going into surgery, this is a hard sell to begin with. If I was told the doctor was physically located on the other half of the world, I would most likely run from the room crying.

        Most Indian and Chinese doctors I have met personally practice medicine in New York, and are just as competent as anyone else. I don't care WHO was on the other end, the very idea makes me nervous.

        Just thinking about this I picture the "select a mirror" page on surgeforce, and start scanning for the (missing

  • X-Bender: Fry: Stop being such a baby and chop my hands off!
  • by Ungrounded Lightning ( 62228 ) on Friday May 19, 2006 @07:48PM (#15369752) Journal
    ... QoS hooks are in and solid.

    This is a very strong argument for tiered bandwidth - so ISPs can guarantee that surgical waldo packets take priority over, say, downloads of the latest release of an OS or a new movie.

    It's one thing to hiccup when you're handling a VoIP packet. It's quite another when you're handling the content of a feedback loop including a video camera, a surgeon, a scalpel, and a vital organ.
    • Technically, it should be no different than driving the rovers on Mars.

      You take everything as a single indivisible step and don't rush until you know the outcome of the previous one.
      • Technically, it should be no different than driving the rovers on Mars.

        You take everything as a single indivisible step and don't rush until you know the outcome of the previous one.

        That doesn't work when you're doing surgery. The patient is under stresses that increase the damage to his body and the risk of unsatisfactory outcome (failure of the operation's goal, post-op infection, temporary or permanent impairment, or death) increase with every extra minute the operation takes.

        If you lose packets RCing t
      • Oh yeah no difference at all.

        Mars rover: 40 minutes of lag between steps, and doing something as simple as rotating and rolling wheels based on camera feeback. Coarse grained movements generally okay.

        Surgery: Miniscule accurate movements. If something unexpected happens and the patient starts to bleed getting one thing even slightly wrong kills the patient.

        Only on /.

      • Mars doesn't move so much. Patients do. The heart beats, which makes EVERYTHING else pulsate. You know how on TV they open up the skull and the brain is just sitting there? Yeah, it doesn't do that.

        If you'd ever watched a surgeon you'd know how important instant feedback is. Surgeons operate by touch and sound as much as sight. "Okay, I'm feeling that I've cut through the dura and have reached brain... oops, that was a second and a half ago."
      • "OK, the cut went well. CLAMP!"

        "Uh, Doctor, blood pressure went to zero between the cut and the clamp."

    • Well, since the unit is being developed to perform surgery in space, as well, I imagine they'll be using dedicated video/data links. There's no real mention of what exactly they will be using, but I'd bet that "advanced telecommunications technology" doesn't mean internet.

      • The space application doesn't guarantee immunity from a big time lag--just the opposite. If NASA wants to use this for missions to the Moon or Mars, there will be a lag, and it will be quite noticible irregardless of how much they pay for their bandwidth.
        • The system would be totally impractical for earth-bound surgeons to use for Mars trips. Even the moon, with a second and half lag one way, would introduce some bad problems.

          But it seems obvious to me, at least, that this would only be usable with dedicated links, and not over the internet, which is what a lot of others seem to be saying here. I doubt very much that any of the engineers involved have even considered using the public internet (at least I hope they haven't! :-)

        • The space application doesn't guarantee immunity from a big time lag--just the opposite.

          The problem isn't just the lag.

          The problem is lag VARIABILITY and GAPS in data transmission.

          A space application has a fixed time lag and very low packet loss (through forward error correction - to an extreme degree if necessary). In the absense of jitter and the virtual absense of dropped packets, some degree of fixed lag can be taken into account.

          But removing jitter means enough buffering that your resulting fixed lag
      • There's no real mention of what exactly they will be using, but I'd bet that "advanced telecommunications technology" doesn't mean internet.

        A QoS-enabled Internet would work just fine. And it's coming - unless misguided "Net Neutrality" laws throw the baby out with the bathwater.

        There are two aspects to "neutrality" and tiered bandwidth.

        - One is using it to distinguish services that need different levels of support - giving them what they need (and perhaps charging extra if appropriate), but treati
    • Or they could just use Frame Relay.


    • And to think, when I read Waldo I though it would be one of those Sci-Fi concepts that would never come true.
    • QoS hooks aren't going to do much good if someone along your normal network path decides to upgrade a router, taking down your connection at least momentarily.

      I highly doubt that surgery would ever take place over the internet. It's just too unreliable to put someones life dependent on it. This kind of thing is far more likely to be used on dedicated point to point links.
  • Awesome. (Score:5, Insightful)

    by RoffleTheWaffle ( 916980 ) on Friday May 19, 2006 @07:49PM (#15369757) Journal
    Now we can outsource the medical field to India, too. *rimshot*
    • Actually, AFAIK that is being done already. I heard someone say that they went to, IIRC, taiwan to get some major dental work done because it was cheaper.
    • A lot of Americans go there(and Thailand) now. The prices are as low as one tenth of American prices. And the hospitals are more like five star hotels.
    • Now we can outsource the medical field to India, too.

      If they outsource my doctor, my automechanic, and my plumber to lower bills, THEN maybe I could start to compete with $4/hr. Indian programmers. Spread The "Love"!
      • They also have to whack building codes, universal education, social welfare programs, and military spending. Then you might have a chance.

        Let's call it what it is - we get cheap development and tech support, and therefore $29 wireless routers on the backs of villagers in India who are illiterate and don't have a clean supply of water, with a high infant mortality rate. I mean, it's either that or pay $80 for a wireless router, so the choice is clear.

        Americans can't stand not having a slave-like class, be
    • I had John McCarthy (LISP fame) as a prof for a quarter. He'd talk about all sorts of crazy stuff-- planes that land on perches outside your house, or skilled labor being outsourced to India and such via the use of remotely controlled robots. Well, sure, it didn't help that his example case was haircutting instead of surgery, but he was on the right track. :)
  • by The MAZZTer ( 911996 ) <<megazzt> <at> <>> on Friday May 19, 2006 @07:57PM (#15369797) Homepage
    Probably already been stated, but I can see it now...

    Doctor [Scalpel] Patient
    Doctor: WTF LAG
  • Trouble (Score:4, Funny)

    by tocs ( 866673 ) on Friday May 19, 2006 @08:03PM (#15369826)
    Oh no, I thought the scalpel was moving away from the patient!!!
    • I suppose I'll answer my own question. I could have sworn I saw this thing on a news program working over a long distance. But according to their website:

      Q. Is this telesurgery? Can you operate over long distances?
      A. The da Vinci Surgical System can theoretically be used to operate over long distances. This capability, however, is not the primary focus of the company and thus is not available with the current da Vinci Surgical System.

      • September 7, 2001 - ZEUS robotic system developed by Computer Motion was used in the trans-Atlantic operation. A doctor in New York removed the diseased gallbladder of a 68-year-old patient in Strasbourg, France.

        Apparently these guys are. I believe this [] is the story you heard...
    • The robot used for this mission was developed by SRI International, a non-profit research firm; one of whose spinoffs is Intuitive Surgical. This two-armed robot was developed initially for open trauma surgery for the military, and was upgraded before the NEEMO 9 mission as a deployable system. Here's a link with some information (note that the pictures are rather old; the surgeon side of the system looks different now): []

      You can read more about the mi
  • As a med student and sysadmin I just wondered over a couple of potentially isues

    What the maximum allowed network latency and thereby the maximum allowed operation distance be? Could somebody come with an answer?
    will it do for spacetravel?
    I mean they had to make the marsrovers autonomously, due to transmitting time.

    They say they will take it to the battlefield. Come on it is monstreus piece of equipment, with a weight of approx a ton. For what reason wil they take it to the battlefield.
    Not enough surgeons available at the frontline military service?
    They will still need staff at operation ward, nurses anesthesiologist and so on.

    We have a few of these robots at the university hospitals. Normally we have a group of surgens stading by just in case things goes wrong. We do not trust the machine totally.

    I really do hope they are hackerproff. What and opportunity to blackmail people.
    "Pay me or your husbend will end up without his left kneecap. Your VISA number please"

    Regards Rune
    • What the maximum allowed network latency and thereby the maximum allowed operation distance be? Could somebody come with an answer?

      I wonder if it would depend on the doctor. Network FPS games seem to be a decent analogue to this with regards to latency. Some players adapt just fine, and others never really get it.

      It's not such a big deal now that all of them implement client-side prediction (which a surgical system might be able to do), but back in the days of Quake 1, it was a huge differentiator.
    • There is development currently underway (called TraumaPod) of a robotic telesurgery platform that will be deployable and can get to soldiers almost immediately after being wounded. These systems would provide trauma-mitigation care during transport to a facility where more advanced care can be given.

      For now, telesurgical systems are focused on expanding the surgeon's "reach" to those who don't have access to surgical care (on the very front lines of a battlefield, in space, remote locations, etc).

  • by Kelz ( 611260 ) on Friday May 19, 2006 @08:39PM (#15369985)
    I'm paying my doctor too much already to allow HIM to telecommute.
  • by kcbrown ( 7426 ) <> on Friday May 19, 2006 @08:39PM (#15369992)
    Advantages: robotics can be extremely precise. If programmed properly, it can compensate for any twitchiness on the part of the operator.

    But the disadvantages are significant: the feel isn't the same as performing the surgery for real. Now, for certain types of surgery that problem isn't a problem, but the human hand is actually quite sensitive to pressures and other types of feedback that I'm sure are quite invaluable to a surgeon (IANAS, however). A machine can provide some of that feedback through the link but the amount of feedback will be limited by the sensory capability of the machine.

    So, like many things, I can see this being useful for a relatively limited set of surgical operations, while for others "being there" will remain necessary.

    That said, if I have to choose between having this and having nothing at all (a battlefield comes to mind for such a situation), I'd rather have this and I'll take my chances with the limitations...

    • The problem of "feel" is being solved simultaneously to this remote manipulation technology, though the article may not mention it. Haptic [] interfaces give mechanical feedback to the controls to convey sensations like texture and viscosity. Using a tool like this [] I have virtually stirred syrup and cut open a human kidney. The former I can vouch as feeling almost indistinguishable from reality; you might have to find a more educated or psychotic person than myself to vouch for the latter.
  • What will Bones think when he's replaced by a hologram []?!
  • alien probes are scary []...
  • and robotic arms? Are there secret Mech bases out there in the tundra or something? Well I for one welcome our remotely controlling, Molson dispensing overlords, eh.
  • da vinci system (Score:3, Informative)

    by VoidEngineer ( 633446 ) on Friday May 19, 2006 @09:23PM (#15370151)
    For more information on telerobotic surgery systems (they're a few years old now): [] [] Retrieve&db=pubmed&dopt=Abstract&list_uids=1471286 6 []

  • Voice: forceps please ...

    Background: blip blip blip

    Voice: Good ...

    Background: blip blip blip


    Background: bleeeeeeeeeeeeeeeeeeeeeeeeeep

  • by shoolz ( 752000 ) on Friday May 19, 2006 @10:21PM (#15370347) Homepage
    Wouldn't simply Robotic Telesurgery be an appropriate title? Wouldn't simply Robotic Telesurgery be an appropriate title?
  • I'm sure this has the potential to save lives, but the thought of being operated on by an actual doctor freaks me out, so the thought of someone doing that with a machine over a network just...ugh. Very discomforting.
    • AMEN! I've been able to avoid major surgery my whole life, and I can just picture all the things that can go wrong during a live operation, much less during a "teleoperation." And think of the liability issues. You think it's hard getting service for your computer ("It's the software!" "No, it's the hardware!" etc. etc) just imagine having to sue the hospitals at both ends, the doctor(s), the hardware manufacturers, the network admins, the ISPs, etc., none of whom admit to any error on their part.

      • Local staff (anesthesiologist, nurses, etc), equipment that's not the main cutbot, the cutbot, the cutbot's software, the connection, the medium that holds the connection...and all that on the other side. Those are too many variables for something as serious and delicate (or brutal) as surgery can be.
    • Too right - and with the ping times we get in New Zealand you would bleed to death before the surgeon at the other end even knew he had knicked an artery.
    • Yoky Matsuoka, a roboticist from Carnegie Mellon University agrees with you (the network part at least), as stated in May 2006 'Ping' in Wired Magazine: 'I am not ready to undergo a serious remote procedure. The best surgeons are known for their superb dexterity and their ability to handle unusual complications. These abilities are significantly affected by network delay and the lack of realistic tactile feedback that soft tissue provides. As a robotics expert, I've seen too many half-working prototypes
  • I wouldn't want to get that done on me if I worked for Blue Security. Imagine a Russian spammer getting tip off from a buddy. A DDoS and surgeons will see "Buffering..please wait.."
  • The doctor will be in a call center in some low-wage country, of course.
  • "Physician, route thyself."
  • One huge advantage of such a system is that one could write a human surgery simulator much easier than one could construct a robust, responsive physical simultation of a human under surgery. Doctors can have done 100 surgeries almost exactly like the real thing (and have watched "virtuoso" recordings of past surgeries) before ever putting a patient's life on the line.
  • h@ck3d (Score:3, Funny)

    by Tablizer ( 95088 ) on Saturday May 20, 2006 @12:56AM (#15370736) Journal
    All your spleen are belong to us
  • ...DDOSing spammers may finally be charged with murder, and sentenced to death.

    On second thought I'm not sure that first part is really a good thing.

  • I can't think of any other reason the surgeon in the linked photo (who is described as being far away from his patients) in the additional details and pictures link [] is wearing scrubs and a hairnet.
  • Will they be using this [] as the interface software?
  • waldos can be good (Score:2, Insightful)

    by hogghogg ( 791053 )
    I didn't RTFA, but a thorassic surgeon I know told me that using a waldo in lung surgery can be very useful, because the machinery can scale down your motions, making it possible to perform extremely precise, tiny cuts and stitches, etc; for some operations a waldo is indispensible, apparently. I have to admit that this doesn't have much to say about the idea of remote operation, but I, for one, will welcome our scalpel-wielding aluminum overlords when I need some surgery.
  • What are we going to do when we've outsourced *everything*?

    Okay, kids aren't getting CS degrees because there are no jobs to be had, they've all been shipped to India (or China, or whatever other shithole^H^H^H^H^H^H^H^H"low-wage country".) Eventually, we'll stop training our own programmers. Now, India doesn't like the fact that we're not going to let them nuke Pakistan back into the stone age, so what do they do? They cut us off. Now what? We saw something similar in the '70s with OPEC. Similarly, w
    • It's even worse than that.

      why did the south lose the war, class?

      It's because they did not have the centers of manufacturing that the north possessed

      when you are faced with a national emergency, whether natural disaster, disease, war, or any other calamity, you have to retool your factories to meet the demand of that emergency. If you do not have the factories to begin with, you lose.
  • This week, a long-distance heart operation [] has been carried out. The operation was initiated and monitored in Boston, the surgery took place in Milan, Italy.
  • "Robotic Telesurgery done by remote surgeons" seems a bit redundant. If the surgeons weren't remote it wouldn't be "tele". I.E. Telecommunications is communications between people who are remote from each other.
  • I heard there were no respawn points......
  • I don't think that robotic telesurgery will every be practical or utilized outside of extreme situations such as those encountered with deep space travel. There are just too many variables and too much else involved in patient care to make this something that will ever be utilized, for example, in the Canadian North (I thought it was laughable that this was a venue that was suggested as one where robotic telesurgery could be widely utilized to help cut down on dollars spent transporting patients South for

The human mind ordinarily operates at only ten percent of its capacity -- the rest is overhead for the operating system.