How Tech is Enabling the Future of Surgery

Article By : John Koon

Robotics, AI, and 5G developers are handing surgeons and diagnosticians promising new tools for safer, lower-cost procedures.

Innovation and technology advancements are transforming medicine. Drugs are becoming safer and more effective, diagnoses are becoming timelier and more accurate, and minimally invasive or noninvasive procedures have been developed that minimize pain, risk of complications, recovery times, and cost compared with traditional surgery.

The Covid-19 pandemic has brought other challenges and priorities to light. Keeping in-person hospital visits to a minimum can prevent cross-infection among doctors and patients. Remote consultations, conducted with HD clarity, can reduce congestion in hospitals and medical offices while enabling doctors to consult with physicians in other locations, expanding the knowledge reservoir. As 5G and robotics enable remote surgeries, patients who are unable to travel will still be able to access care. And although noninvasive surgeries require greater precision, they reduce the risk of infection, including the risk that a patient will infect others during transport.

Robotic surgery

In 2010, a team in the U.S. demonstrated the da Vinci robotic surgical system by operating on a grape. Just over a decade later, surgeons and surgical teams have used robotic arms in thousands of operations and are using surgery simulators to plan and prepare for complex procedures in various specialties. According to a market research report by MarketsandMarkets, the global market for surgical robots will grow at a compound annual rate of 10.4% between 2018 and 2023, rising from US$3.9 billion to US$6.5 billion.

Recently, many surgical robotic systems have appeared alongside U.S.-based Intuitive’s pioneering da Vinci systems. For example, the University of Oxford’s Preceyes Surgical System has been tested on actual eye-surgery patients. The CorPath System from Corindus, a Siemens Healthineers company, uses virtual reality to help doctors get on-site training and prepare for remote surgery. With 3D modeling capability, the Mako SmartRobotics system from U.S.-based Stryker has been applied in knee and hip surgeries.

Designed and built in the U.K., CMR Surgical’s Versius system has obtained European health and safety approval and has completed approximately 1,000 operations.

Robotic surgery is expected to continue to gain momentum.

Mako SmartRobotics system from Stryker
The Mako SmartRobotics system from Stryker utilizes 3D CT-based planning technology for hip and knee replacement surgeries. (Source: Stryker)

Remote consultations in HD

Remote consultation will reduce the number of in-person consultations and the attendant risk of disease transmission. It will also enable doctors to consult with other physicians, increasing the pool of knowledge and experience. Moreover, 5G’s arrival will help improve video-streaming clarity and definition to enhance the quality of the consultation.

Artificial intelligence is an essential component of effective remote consultations. AI has already been applied to analyze medical images, genetic data, and patient data to diagnose or predict diseases. In April, the U.S. FDA authorized the first medical device using AI to help detect colon cancer. In 2020, the EU invested in AI to accelerate Covid-19 care, while the U.S. National Institutes of Health (NIH) started to harness AI for Covid-19 diagnosis, treatment, and monitoring.

In other efforts, a team at the University of Oxford has developed a rapid AI-driven Covid-19 triage method, Siemens is collaborating with partners to develop Covid-19 diagnostic tests, and Vocalis has obtained European approval for an AI-based voiceprint screener that analyzes the words spoken by patients to identify individuals with Covid-19. Given unlimited time, human pathologists make more accurate diagnoses than AI algorithms, but a scenario with no time constraints is not realistic. Thus, a hybrid model, in which the AI system assists doctors in making effective diagnoses, has been proposed. In the future, human-machine partnerships may produce optimal results.

Remote surgery over 5G

Remote surgery can make advanced procedures more accessible for patients who are too sick to travel.

And during an infectious-disease epidemic, remote surgery can help contain the spread of infection by minimizing the need for patient transport.

During remote operations, robotic arms and imaging equipment at one location are connected to the monitor in front of the surgeon at a separate location. The 4G network cannot sufficiently support real-time image or video streaming during remote surgery, so the faster and more stable 5G network will be a significant step forward for implementing such procedures. And the internet of things will help connect the physicians, virtual-reality tools, robotic arms, imaging equipment, image processors, data analytics software, and the patient. The result will be a 3D, immersive, and interactive experience for the physician that enables operations to proceed with more ease and precision.

Experiments with remote consultation and remote surgery in a 5G network are under way. In 2019, the Clinic Hospital in Barcelona, Spain, performed the first 5G-enabled remote surgery. Later that year, a surgical team at the Endoscopy Center at Japan’s Osaka Hospital collaborated graphically with the Digestive System Department of Spain’s Quirónsalud Málaga Hospital, sharing input on how an operation should proceed. Around the same time, a Chinese team performed three simultaneous orthopedic procedures using surgical robots and 5G.

A note of caution: Even though 5G is superfast, its reliability is an absolute requirement during the operation. Any IT or system errors will put the operation and the well-being of the patient in jeopardy.

Microsurgery

While minimally invasive surgeries are much more comfortable and safer for patients than traditional procedures generally are, they demand far greater precision. A surgeon has to work within a very limited field of vision and maneuver surgical tools and a 3D camera through a tiny opening and within a small space.

Microsurgeries of complex aneurysms, tiny blood vessels, nerves, and eye, ear, and vocal cord structures are applicable for biopsies, tumor eradication, and targeted drug delivery. Let us put it in perspective. An inch is 25,400 microns, and a human hair is about 70 microns. A human red blood cell is about 8 microns wide — one three-thousandths of an inch — and most of the capillary vessels are only as wide as a red blood cell. Therefore, surgeons have to operate with an even smaller field of vision and space during microsurgery.

Complex surgeries require a miniaturized, multi-backbone robotic system with micro-scale motion capabilities that is responsive to control. It must also be nimble and precise, like the system recently developed by a team at Vanderbilt University. Precision and a high degree of responsiveness also characterize a new microrobot system by Microsure, used by Maastricht UMC+, an academic hospital in the Netherlands, to perform a successful microsurgery on the sub-millimeter vessels in the arm of a lymphedema patient.

What’s next?

Even before the pandemic, medicine was trending toward remote continuous care for the growing number of patients with chronic illnesses. Covid-19 has accelerated this trend and extended it beyond outpatient care to surgery. In the future, such challenges as removing blood clots without surgery will be reality rather than the stuff of sci-fi novels. After a remote consultation with the patient, a physician could prescribe drugs to break up blood clots or might even perform catheter-directed thrombolysis — a minimally invasive treatment that dissolves abnormal blood clots in blood vessels — remotely.

However, multiple roadblocks exist on the way to executing more remote and advanced operations. One hurdle will be to meet the tremendous demand for 5G network bandwidth, latency, data security, and reliability. Also, the costs of robotic arms and operating room connectivity must come down. In addition, surgical training must keep up with the technology’s progress. Finally, further miniaturization of instruments and tools is required to enable more flexible and agile operating.

This article was originally published on EE Times Europe.

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