ELECTRONIC ASSIGNMENT COVERSHEET

Research Report : ICT612 Assignment 1

Title: Tele-Operative Surgery

INTRODUCTION

Human factors in technology could be seen with the innovation of new technologies having an integration model to interact and operate with people. One such promising technology includes Tele-operative surgery, which contributes to medical and healthcare domains. Approximately 70 percent of scientific procedures were performed through the concept of telesurgery with the help of robotic elements in the year 2008 at US da Vinci healthcare units [1]. Therefore, automatic tele-operations are adopted by the medical field supported by human factor concept. However, it is important to understand the standard definition of concept. Tele-operative surgery is made up of two concepts, i.e., tele-operations and tele surgery. Whereas, the term is used interchangeably with remote surgery or telesurgery in existing literature.  “Tele-operation” refers to an operation of system accomplished from certain amount of distance similar to remote control through robotics. While, “remote or telesurgery” is defined as the ability with which medical representative performs surgery from a remote location though a master controller and sensory system that offers feedback to users [2]. Thus, a surgery performed by automatic operation from a remote location is make it easy to perform health aid to patients effectively. Furthermore, telesurgery systems have several components including slave robots, master station, nurses’ cart and communication mean followed by computer enhanced connectivity.

The major users of Tele-operative surgery system are surgeons who are present from distant location, patients who are operated, as well as surgical care units in which medical help and healthcare is required [3]. The medical professionals and healthcare domain are mainly the users who have invested into such automatic systems so that best surgeries are obtained. In addition to that, purpose of this system to offer medical care due to issues such as shortage of surgeons, lack of geographical access to surgeons, complications, financial responsibilities and long-distance travelling problems [4]. The sort of tasks performed by telesurgery systems include dissection and suturing within a simulated platform as per study conducted previously [5]. Therefore, tele-operative surgery offers doctors to perform different types of surgical procedures for patients with help of automated system.

Tele-operative surgery uses three important technologies which support this system to work effectively. One of the important technology supports is robotics through which automation for surgical tools could be performed. Second support is from communication devices that connects the system for performing through a higher speed connectivity mechanism with wireless networking. Lastly, concept of management information system is also implemented to manage data present into systems. Whereas, a video monitoring tool is also used to check and see live feeds of operation for surgeon at remote location. Therefore, technologies which are mainly supported are communication, information technology as well as management information systems.

Therefore, purpose of this report to understand the concept of tele-operative surgery and its implications for being human factor connected with IT technology. Furthermore, this report strategically explains previous background research on topic, working and operation of system, advantages and limitations of device to research as well as summary for future scope for tele-operative surgery or telesurgery or remote surgery.

BACKGROUND RESEARCH

The advancement in the medical and health showcase reflection for expansion in the field of information and communication technologies. As per existing literature, several types of teleoperations are explored for healthcare domain. Teleoperations include telemedicine, tele surgery, and robotic surgery are used interchangeably. While, robotic and telesurgery comes under tele-operative surgery domain, telemedicine is a well-defined approach which supplies medical care to patient situated at distance that does not have well-experienced doctors or nurses’ staff.

Healthcare professionals are adopting telemedicine and telesurgery for diagnosis, treatment plans as well as disease prevention for patient well-being [6]. Tele-surgery is being promoted due to its ability and capability for performing surgeries through modern instruments and technique from different miles to reduce time and delay for patient health. As per accomplished studies, surgeons who are not present physically could observe and manipulate surgical instruments in operation theatre with help of new electronic interfaces [7-8]. Further, tele-surgery provides a specialist surgeon to perform surgeries for heart or kidney by being present through a virtual platform beside patient in critical conditions such as remote and rural areas, accident scenes, battlefield where military officials are injured as well as long distance situations where medical care is not present. Telemedicine services are offered like distance counselling, telesurgery and teleradiology for patients [9]. Therefore, a wide scope of telemedicine is adopted by application of features like ICT technologies for healthcare service. In other words, teleoperations include a variety of ranges from simple telephone connection for a service to application of intelligent agents through vital signs, medical images and robotic operations [10].

However, the inclusion of such diverse technology-based systems also brings issues in context to technicalities, and lack of knowledge for medical professionals. Whereas, security and legal frameworks also required for tracking mistakes when performing surgery through telemedicine. As per existing literature several issues are discussed related to tele-operative surgery. Technical threshold is one of the problems in which network latency is disturb for frequent distance due to communication discomfort [11]. It is extremely important for surgeons to have a minimal degradation for picture, latency, quality of data in higher rate as well as strong communication and information technology [12]. Another issue described is surgical robots with lack of feedback management that cuts of information source for doctors to operate properly on patients [13]. Additionally, another sort of challenges discussed are lack of planning, no discussion prior to robotic surgeries, language barriers due to international remote locations involved and confusion over technical specifications in between 2D/3D views [14].

Another set of studies conclude that infrastructure of medical services could offer best results if they cooperate. For example, lack of difficulties to adopt the application of remote procedures are resistance from physicians, care providers and patients due to lack of health policies and worldwide availability of resources making technology adoption much stronger and effective [15-16]. As per development history, first tele operative surgery was accomplished in from New York surgeon in the year 2001 at France location using asynchronous transfer mode fibre optic communication link with no packet loss and 155m latency [17]. Whereas, first tele-robotic remote surgical system was developed in the year 2003 across St. Joseph’s Hospital in Hamilton and North Bay General Hospital with using 15 Mbps of bandwidth network with 400 kilometres apart distance [17]. Thus, both systems performed more than 20 surgeries which were extremely successful. Even though such successful scenario, it is not widely accepted due three challenges including extreme communication cost, no trust assurance for networks, as well as higher latency. Therefore, before using telesurgery system, healthcare must consider all these implications so that they could employ unique opportunities for medical domain.

Hence, adoption of new technologies integrated with tele-operative surgery like software-defined network, Internet of things perception, software-defined network, Internet of things perception, machine learning, data analysis, cloud computing, Fog computing and hardware virtualization will offer future opportunities.

How it works

The proposed system works under a master slave system which consist of a master side console, robotic arms provided on side of patient as well as a visualizing system [18]. In addition, master side manipulators who serve as the computer interface for surgeon to operate tools from remote location. Whereas, a 3D display system is also connected on master side console so that records could be obtained on camera as well as video for feedback of live surgical systems.

There are four major components of the remote surgical system which combines to final system.

·         Slave Robots

In the diagram below, slave robots represent symbol 1 in which components are again divided into sub-compartments. 1a is the positioning stage which will offer robot placement and orientation to the patient. In context to that, the system structure contains a vertical sliding axis as well as three vertical pivot joints [19]. As a result, robot weight for patient operation will have proper adjustments. Further, second and third stage represent 1b which is external robot structure and 1c instrument. 1b and 1c will provide instrument to move from operating side to internal wrist for tool tip rotation axes. In addition, 1c again has more four parts including interface containing robots, long shaft from trocar, internal wrist rotation for tool around any axis and tool. Further, 1d endoscope will perform functions included with other three components.

·         Master Station

The robot control takes place at master station symbol 2 where surgeon operates the surgery virtually. 2a is input device from which control and displacement occurs so that robot could replicate the performance. In context to that, for allowing stable movements, an armrest 2b will be attached so that closed input devices handle properly. Furthermore, surgeon could also offer to provide different commands from 2c including foot pedals, switches and button which are connected on the device armrest effectively [18]. The component 2d will offer controlling through electric scalpels as well as 2d will provide video display and visual feedback.

·         Nurses cart

The symbol 3 represents additional cabinet so that robots could be carried from one place to another. As well as 3a controllers offer medical equipment placements and 3b is external video display [18]. Whereas, the cabinet will also provide nurses, professionals, and surgeons to check visualization of surgical procedures.

·         Communications means

Finally, communication means are also implemented to reduce communication delay so that efficiency could be improved. In addition to that, force feedback is generated so that proper working and stability could be obtained.

Figure 2. Components and Work structure of Telesurgery System Source [18]

Types of Tele-operative surgery systems

In the supervisory controlled robotic system, the surgeon will plan the surgery into offline mode from a computer terminal model for the pateint with different forms of surgeries. Furthermore, surgeon will then dowload the surgical plans into a surgical robot who will have understanding what to conduct in sugery operation. Lastly, now robot will execute the surgery as per designed and preplanned operation. However, surgeon will supervise the operations of robotic movement. In the robotic telesurgical system, surgeon will control the robot in the real time by using haptic interface through which feedback will go into surgical instrument. Whereas, robots will with complete trust replicate the motions of surgeon connected to the interface. In addition to that, master slave surgeon will get feedback in real time by help of camera recording as well feedback through instruments.

Figure 3: Types of Telesurgery Systems Source [19]

BENEFITS AND RISKS

Benefits:

There are several benefits of using the tele-operative surgery system which exist currently. One of the important aspects of system is improvisation in dexterity, accuracy, lack of tremor, and 3D stereo vision as well as capability to monitor and operate in broad scope of countries and cities [20]. Therefore, a system that offers accuracy in operational functions will do less mistakes in complex surgeries. Whereas, if surgeons have well and capable infrastructure, they could perform operations from any corner across world and with utmost simplicity. Furthermore, video monitor capture live feeds for patient every minute making surgery less complex or complicated. Thus, improvisation is in basic operational features and functionality will also propagate usage of system in near future.

Another benefit includes higher quality surgery procedure into locations that are extremely complex such as rural areas, spacecraft and military battlefields overseas [4]. For example, virtual interactive presence is implemented for such extreme conditions by implementing local and remote workstation, video capture device, video displays as well as connected them with global point to point communication [21]. Therefore, it is beneficial to perform telesurgery in underdeveloped areas, military services, and space.

Next advantage is reduction of travel oriented financial problems for surgeons and patients both to appear as well as dangers [22]. For instance, several medical care’s require surgeons to frequently visit them for follow up care in rural areas making finance an issue. Thus, nurses as well as doctors monitor and interpret the operations that are crucial from remote location saving expenses.

Additionally, telesurgery offers a 3-D dimensional display system so that surgeons and medical units could get feedback for operational activities through visual representation. Furthermore, with 3-D display device such as autostereoscopic display surgical information with life surgery video is offered to several surgeons from on same operation same time so that cooperation and efficiency for patient could be achieved [23].

There are several other advantages of telesurgery which had made it accepted among masses. Some of them include, surgical collaboration in real time, improvement in surgical accuracy by making health tissue safety methods thereby improving patient recovery [4]. As per new advance technology such as virtual reality simulator dv-trainer provides training to new and experienced surgeons so that they learn surgical operations by guiding untrained for performing operations through a live videoconferencing [24]. Therefore, tele-operative surgery is a very effective way to offer medical and healthcare in improving surgical operations through technology-oriented systems.

Risks/Technological Limitations:

One of the crucial risks and primary difficulty with tele-operative surgery comes due more distance resulting in lower quality network issue within infrastructure implemented making communication much lagging [25]. The internet problems could bring network issues making tele surgical treatment complex and could also risk patient’s life. Another risk is latency variation that will decrease performance of operator in robotic telesurgery with disturb performance into operations [26]. Thus, latency or speed is considered one of the risks which will make surgical inaccuracies by making delay for communication lines or coding-decoding of video signals [27].

Cyber-attack is another risk which could threaten patient’s safety, security and data privacy due to sensitive information present on computer network and information technology. Furthermore, as per this issue, telesurgeries are not accepted widely due to single Tele surgical protocol that determine security requirements however, lacks issues for authentication, confidentiality, security policies over national and international environments [28]. Thus, the potential risk could deliver confidential information to cyber criminals who will alter or block communication due to lack of backup systems for data storage.

Implementation cost is another risk which could disturb the propagation of telesurgery instruments and systems. For instance, developing countries could not afford robotic systems or higher quality communication network on longer geographic locations [29]. Thus, cost is concern because of much more scale level cost budgets it is extremely difficult to adopt telesurgery system into underserved locations. Whereas, legal and ethical concerns are another sort of issues which could stop surgeons to practise medicine. The lack of regulations and licensure requirements for different countries with legal requirements to complete geographical surgery through remote locations could stop doctors to perform surgeries [29]. While, some technical failure occurs and a patient’s life is at risk then full responsibility and measures must be adhered. Thus, all such risks while developing a tele-operative surgery system should be taken into consideration before imitating project proposal.

CONCLUSION

To summarize, tele-operative surgery is a very innovative technology which will offer medical field with a very broader perspective to operate and cure patients with complex diseases. Although several types of concepts are included, some of them proposed were telesurgery, remote surgery, tele-operations and robotic surgical systems which follows same idea to operate from remote location on patient with help of automatic robots. Furthermore, major users of such systems include novice and experienced surgeons, patients and healthcare units which will receive better infrastructure to public. There were several types of tele-operative surgery systems which makes it extremely different in operations. For example, the supervisory controlled robotic system and the supervisory controlled robotic system differs due to their offline and live conditions to monitor.

As per review, several issues and barriers were identified for the system including communication and network latency, video feedback problems, 2D-3D dimensions, lack of planning, no discussion prior to robotic surgeries, language barriers due to international remote locations involved and confusion over technical specifications in between 2D/3D views. Furthermore, security and data confidentiality are another concern due to which personal information becomes threat. However, several policies to include security and legal parameter were also considered in studies. Additionally, medical services coordination from doctors as well as patient is another concern which make it extremely difficult to implement new technologies. Thus, all such issues were concerns to adoption new human aided technologies into medical domain expansion.

Whereas, several possible advantages were also found into the telesurgery systems effectively. Some of them included in dexterity, accuracy, lack of tremor, and 3D stereo vision as well as capability to monitor and operate in broad scope. These benefits will make it possible for healthcare organization to promote and accept newer innovative technologies. On the other hand, cyber threat and other technological issues could also occur which will reduce opportunity for worldwide acceptance. Lastly, financial cost implementation also become barrier to adopt the functionality and features.

Finally, there are several opportunities which will make improvements to represent remote surgical systems in between perspective. Presently, telesurgery is only done within closeness of patient though wireless commands. Therefore, distance between surgeon and patient should be reduced between communication and network bandwidth. Furthermore, several robotic systems are operated without any training sessions. Thus, a basic training plan should be discussed and given to healthcare providers making them well prepared in telesurgery operations. Furthermore, a possible future scope for system is integration for voice commands which will operate different functions. On the contrary, teleoperative surgery systems must have integrated diagnostic testing equipment. Thus, another scenario includes for future to make robotic small and through sensor, cameras and new integral instruments. Furthermore, if such developments are implemented in future then more adoption systems could be propagated.

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