The impact of latency on surgical precision and task completion during robotic-assisted remote telepresence surgery.

OBJECTIVE: It has been suggested that robotic-assisted remote telepresence surgery with a signal transmission latency of greater than 300 ms may not be possible. METHODS: We evaluated the impact of four different latencies of up to 500 ms on task completion and error rate in five surgeons after completion of three different surgical tasks. RESULTS: The surgeons were able to complete all tasks with a latency of 500 ms. However, higher latency was associated with higher error rates and task completion time (TCT). There were significant variations between surgeons and different tasks. CONCLUSION: Surgeons are able to complete tasks with a signal transmission latency of up to 500 ms. The clinical impact of slower TCT and increased error rates encountered at higher latency needs to be established.

Establishment of the world's first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community.

OBJECTIVE: To establish a telerobotic surgical service between a teaching hospital and a rural hospital for provision of telerobotic surgery and assistance to aid rural surgeons in providing a variety of advanced laparoscopic surgery to their community patients. SUMMARY BACKGROUND DATA: The above service was established between St. Joseph's Hospital in Hamilton and North Bay General Hospital 400 km north of Hamilton on February 28, 2003. The service uses an IP-VPN (15 Mbps of bandwidth) commercially available network to connect the robotic console in Hamilton with 3 arms of the Zeus-TS surgical system in North Bay. RESULTS: To date, 21 telerobotic laparoscopic surgeries have taken place between North Bay and Hamilton, including 13 fundoplications, 3 sigmoid resections, 2 right hemicolectomies, 1 anterior resection, and 2 inguinal hernia repairs. The 2 surgeons were able to operate together using the same surgical footprint and interchange roles seamlessly when desired. There have been no serious intraoperative complications and no cases have had to be converted to open surgeries. The mean hospital stays were equivalent to mean laparoscopic LOS in the tertiary institution. CONCLUSIONS: Telerobotic remote surgery is now in routine use, providing high-quality laparoscopic surgical services to patients in a rural community and providing a superior degree of collaboration between surgeons in teaching hospitals and rural hospitals. Further refinement of the robotic and telecommunication technology should ensure its wider application in the near future.