ABSTRACT
BACKGROUND: In North America, the urological community has embraced surgical robotic technology in the performance of complex laparoscopic surgery. The performance of complex long-distance telesurgery requires further investigation prior to clinical application. METHODS: The feasibility of laparoscopic robot-assisted pyeloplasty in a porcine model was assessed using the Zeus robot and the internet protocol virtual private network (IP-VPNe) and satellite links. Eighteen pyeloplasty procedures were performed, using real-time, IP-VPNe and satellite network connection (six of each). Network and objective operative data were collected. RESULTS: Despite network delays and jitter, it was feasible to perform the pyeloplasty procedure without significant detriment in operative time or surgical results compared with real-time surgery. CONCLUSION: The completion of complex tasks such as robotic pyeloplasty is feasible using both land-line and satellite telesurgery. However, the clinical relevance of telesurgery requires further assessment.
Subject(s)
Internet , Laparoscopy/methods , Robotics/methods , Spacecraft , Surgery, Computer-Assisted/methods , Telemedicine/methods , Urologic Surgical Procedures/methods , Animals , Canada , Feasibility Studies , Laparoscopes , Man-Machine Systems , Robotics/instrumentation , Surgery, Computer-Assisted/instrumentation , Swine , Telemedicine/instrumentation , Urologic Surgical Procedures/instrumentation , User-Computer InterfaceABSTRACT
BACKGROUND: Telesurgery was performed with ground vs. satellite networks, and differing satellite bandwidths. METHODS: The networks were compared during internal mammary artery (LIMA) dissection in pigs (n = 8). Length of LIMA dissected and surgical quality (five-point scale) were recorded. Also, satellite bandwidth was decreased (n = 7) to determine a limit for telesurgery. RESULTS: No significant differences existed in LIMA dissection during the ground (4.3 +/- 0.5 cm) and satellite phases (5.4 +/- 1.1 cm; p > 0.05) or in quality of surgery, although latency on satellite was 10 times greater (55 vs. 600 ms). With decreasing satellite bandwidth, surgery was not possible below 3 Mb/s, and quality of surgery was significantly decreased comparing 9 Mb/s (4.38 +/- 0.66/5) to 3 Mb/s (4.10 +/- 0.80/5; p < 0.05). CONCLUSIONS: Satellite communication is a viable telesurgical modality. Satellite bandwidth should be above 5 Mb/s during telesurgery if used primarily or as back-up.
Subject(s)
Internet , Minimally Invasive Surgical Procedures/methods , Robotics , Satellite Communications , Telemedicine , Animals , Computer Communication Networks , Dissection/methods , Mammary Arteries/surgery , SwineABSTRACT
BACKGROUND: Basic telesurgical manoeuvres were conducted with signal delays. METHODS: Eight test subjects conducted four manoeuvres. Time delays of 0-1000 ms were investigated. Time to task completion and error rate were recorded in sequential delays of 0-600 ms. Additionally, blinded random delays of 0-1000 ms were studied. RESULTS: In the sequential trials (0-600 ms), there were no significant differences in average task time compared to zero latency. The error rate remained low despite increasing time delay, and was significantly less at 500 ms (p < 0.05). In the random trials, task time was significantly greater at delays of 500, 600, 800 and 1000 ms (p < 0.05). There were no significant differences in error rates (p = 0.252). CONCLUSIONS: Operators are capable of performing surgical exercises at significant delays. Latent video feedback is difficult for telesurgery. Visual or virtual reality cues should be implemented to aid the operator in a high-cadence telesurgery environment.
