Professor Prokar Dasgupta, Professor of Robotic Surgery and Urological Innovation King’s College, London, led a prostate surgery at Guy’s Hospital, London. While it is a common procedure, Professor Dasgupta was in an entirely different part of the building at the time of the surgery.
Present at the operating theatre itself was Malaysian urologist Dr. Warren Lo and an expert medical team. Dr. Lo operated on the patient using the state-of-the-art da Vinci robotic surgical system. He manipulated four modular and highly manoeuvrable robotic arms via a sophisticated, wired control unit.
Dasgupta observed the surgery in real time from his location and directed Dr. Lo via an extended reality (XR) interface that “projected” his hand gestures onto a high-resolution video feed that Dr. Warren and his team were looking at in the operating theatre.
But Dr. Lo, now a consultant urologist at Gleneagles Hospital, sees a future where not just the tele-mentoring portion of the surgery – but control over the robotic surgical system itself – is done remotely, wirelessly, and with near imperceptible delay over a 5G network.
“Consider the key elements that make up this remote, robotic surgical system. There is the high resolution, XR-enabled livestream capability between two locations and the control over the machine itself. There will come a point when I could be sitting in a room with a control unit, manipulating a robotic surgical system located in a different building, perhaps even in another city.
“Assuming both locations are covered by 5G networks and the surgical system is slaved to my control unit via a common software suite, remote robotic surgical applications could actually go mainstream.”
This, Dr. Lo says, would mitigate the problems of scarcity of robotic systems in general (there are fewer than 6,000 da Vinci machines in service globally), and a lack of medical specialists who are further qualified to safely handle these sophisticated machines for surgical applications. There may come a time when a cardiologist in Petaling Jaya “scrubs-in” and operates on a patient in Seremban.
NEXT-GEN MEDICAL TRAINING
This tele-mentoring aspect of the procedure has been replicated over a 5G network elsewhere in the world. In October 2019, Spanish telco operator Telefonica successfully livestreamed seven digestive endoscopy surgeries between Spain and Japan, over a 5G network. The procedures were conducted by a surgeon in Malaga under supervision and with advice from his Japanese counterpart all the way in Osaka, Japan. Telefonica’s 5G set up allowed the entire demonstration to be livestreamed in 4K ultra high-definition (UHD) and with near imperceptible delay despite the vast distance.
Tele-mentoring is uniquely suited to medical schools and teaching hospitals. A UHD and near instantaneous livestream would allow for large numbers of trainees to dial-in and remotely observe senior specialists in other states/countries.
This allows for a level of interactivity that does not exist with pre-recorded sessions. Trainees can ask questions, interact with the surgeon, and might even influence patient outcomes for the better.
“Such instantaneous knowledge transfer enables cardiologists in Malaysia to learn new techniques from their counterparts overseas,” says Chua Yong Howe, Chief Digital Officer of Edgenta Mediserve Sdn Bhd (Edgenta). The company provides various tech-enabled, cloud-based support services to over 300 hospitals in Asia.
Image quality and lag time are crucial considerations when livestreaming cardiac procedures. The video feeds typically employ a 3D-colour mapping system for greater detail and depth perception. In order for the service to be reliable, these videos must be livestreamed to the cardiologist at the other end without any loss of visual fidelity and in near real time. This enables the cardiologists remotely supervising procedures to identify areas of concern and accurately determine the location of the treatment.
It also allows trainees to view near real-time outputs of multiple monitoring equipment such as a point of view camera, a fluoroscopic navigation system, a 3D-heart mapping system, and the graphical displays of an electrocardiogram machine to better guide junior specialists performing surgical procedures.
Outside of training hospitals, tele-mentoring would help address the longstanding problem of a lack of specialists in the general population. A tele-mentoring service running over a reliable 5G network with sufficiently wide coverage would make specialists more accessible to rural areas of the country, be it for teaching or consulting with general practitioners.
“Tele-mentoring mainly caters to medical specialists and doctors by enabling and extending the reach of specialised training. It helps increase the pool of medical specialists which in turn enables greater patient access to specialist care, especially for patients in rural and semi-urban areas,” says Dr. Nik Fawaz Nik Abdul Aziz, Edgenta Managing Director.
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