Tele-Robotic Surgery for Combat Casualty Care
Tasha Merchant, Francesco Bianco, MAJ Christopher Dyke, Gerald Gantt, Ernest Lockrow, Marko Rojnica, Valentina Valle, Dennis Fowler, Kate Petty, Yulun Wang, Shane Farritor, Piet Hinoul, Dmitry Oleynikov, Eric Elster, Enrico Benedetti, CAPT Matthew Bradley, Stephen T. BartlettObjective:
These experiments test the feasibility of tele-robotic surgery for the shipboard care of combat casualties.
Summary Background Data:
Limited research on the effects of telecommunications latency on tele-robotics has been a consistent concern in the growth of tele-robotic surgery. These experiments are designed to provide well-controlled real-world data on robotic surgical performance with electronically added latency that simulates combat-relevant, satellite-based tele-robotic communication.
Methods:
Surgeons at 2 university hospitals separated by 1096 km bi-directionally performed remote cholecystectomy (Ch) and right colectomy (Co) dissections on cadaver subjects. Varying latency between 0 and 300 ms was electronically added. Network performance, OR time, Global Performance (GP), and Surgery Task Load Index (TLX) were determined. Statistical analysis: simple linear regression.
Results:
Network latency was 28 ms, jitter 0.03 ms, with zero packet loss. Including robotic intrinsic latency of 50 ms, total latency (TOT) varied from 78 to 378 ms. 12 Ch and 14 Co were performed by 4 surgeons. Co OR time unexpectedly decreased with TOT (
Conclusions:
Experienced robotic surgeons rapidly develop cognitive and motor adaptation to tele-robotic latency. Satellite-based tele-robotic surgery in combat environments may add greater latency than fiber-optic-connected civilian applications. Our data indicate a significantly greater tolerance for latency than previously reported. Development of telerobotic surgery for combat casualties is highly feasible.