Feb 04 2021

What Does the Future Hold for Robotic Surgery?

Remote surgery has the potential to revolutionize healthcare, but what’s necessary to make it a reality?

A healthcare staffing gap is looming on the horizon, according to the Association of American Medical Colleges. By 2033, AAMC predicts that an aging population and accompanying retirements will conspire to create a significant shortfall of anywhere from 54,100 to 139,000 physicians.

One development that could mitigate the gap, however, is the expanding role of autonomous surgical robots. Increasing adoption of 5G networks, combined with advancements in autonomous and artificial intelligence solutions and the secondary effects of pandemic-driven telemedicine mandates, has created a unique opportunity for healthcare agencies. Robotic surgery tools capable of assisting doctors in lifesaving efforts at a distance — or completing less complex tasks with minimal oversight — may serve to augment human professionals in a variety of roles.

Surgical Robots are Evolving to Support New Use Cases

As noted by News Medical, medical robotics have been in use for more than three decades. While initial efforts — such as the 1990s-era Automated Endoscopic System for Optimal Positioning (AESOP) — focused on functions such as voice-activated camera control, it wasn’t long before the technology advanced. The next iteration of robots had multiple, articulated arms that surgeons could control from a computer console.

Despite rapid advancement in minimally invasive, remote operations, challenges in form and feedback remained: Larger form factors bounded by processor and part sizes constricted the number of potential use cases, while the lack of touch and force sensations made it difficult for doctors to create precision cuts and identify potential areas of concern.

Advancements in both robotic construction and network connection, however, have spurred new types of robotic surgery. In March 2019, a doctor in Sanya, China, used remote surgery tools to implant a stimulation device into the brain of a Parkinson’s patient who was in a hospital 1,900 miles away.

Robotic Surgery Includes Assistive and Fully Automated Support

Although individual applications vary based on the tools and technology available to medical professionals, two broad types of robotic surgery exist: assistive and fully automated.

Assistive tools are directly controlled by doctors to make small incisions, ensure accurate placement of medical devices and close up patients after surgery. Fully automated tools are capable of end-to-end surgical tasks without the need for human intervention. As noted by the IEEE, work on fully autonomous surgical robots is underway. In 2016, the Smart Tissue Autonomous Robot (STAR) was able to independently complete repairs on a pig’s intestine — notably, with greater accuracy than a human surgeon.

Although these fully featured tools show promise, they’re far from ready for general use, and surgeons aren’t worried about being replaced. “Even though we surgeons take pride in our craft at doing procedures,” Dr. Peter Kim said after the STAR success, “to have a machine that works with us to improve outcomes and safety would be a tremendous benefit.”

RELATED: Nonsurgical robots have a role to play in healthcare too.

5G Networks Improve Level of Care

So how does robotic surgery work in practice? The first thing surgeons need is fit-for-purpose technologies designed to deliver specific outcomes. As noted by the Mayo Clinic, for example, it’s now possible for physicians to use a combination of remote-controlled robotic arms and miniature cameras to perform minimally invasive robotic heart surgery for conditions such as mitral, tricuspid or aortic valve replacement.

Network connections are critical. Although doctors can easily operate robotic tools with no latency when they’re in the same room, increasing pandemic pressures combined with looming physician shortages may create conditions that see hospitals equipped with cutting-edge surgical equipment but lacking skilled operators. That means they may need to partner with operators in other locations.

As a result, emerging 5G connections are critical. According to Ramsés Gallego, international CTO for cybersecurity at Micro Focus and ambassador for ISACA’s Barcelona chapter, new 5G networks “offer a massive benefit for near real-time technologies and velocities of data transfer.”

“The promise is 10 times the bandwidth compared with 4G,” says Gallego. “If 4G gives you a peak of 1 gigabyte per second, 5G gives you a theoretical peak of 10GBps.”

As 5G networks expand, Gallego believes some hospitals will connect directly to orbiting satellites rather than using traditional routers and ISPs. Stable 5G connections also offer the promise of significantly reduced latency: from almost 2 seconds using current networks to around 2 milliseconds to relay information between devices.

Autonomous Robots Empower Healthcare Transformation

For Gallego, the move to autonomous surgical robots represents more than digital transformation. “It should rather be viewed through the lens of radical innovation, because healthcare is about people — and saving people’s lives,” he says.

He points to the increasing use of machine learning (ML) algorithms to help improve intelligent medical device applications. In particular, he sees promise in unsupervised machine learning and reinforcement learning.

While unsupervised ML algorithms make it possible to discover patterns of behavior and improve patient outcomes, reinforcement-based tools “can learn from their mistakes, such as false positives with treatments or diagnostics,” Gallego says. Both types allow healthcare professionals to “start detecting patterns of behavior and distill multiple sources into a single source of truth.”

Gallego puts it simply: “This type of radical innovation amplifies the reach of and enhances the skills of people.”

RELATED: Robotic process automation has potential as it matures.

Security and Network Stability for Robotic Surgery

Of course, no substantial solution shift is without potential obstacles.

First is network stability. For 5G robotic surgery to deliver consistent patient outcomes, networks must be rock-solid and free of potential interruptions. This speaks to Gallego’s point about satellite connections; for many hospitals, it may make more sense to bypass traditional internet suppliers and instead rely on direct access alternatives.

Data reliability is also critical.

“Healthcare organizations need to ensure there is data integrity in place,” says Gallego. “Data coming from the emergency room, intensive care unit or surgical suite cannot be altered.”

That becomes more complex when surgery occurs at a distance. If attackers are able to compromise and modify data in transit, they could incorrectly report patient vital signs or current device status and put the entire operation in jeopardy. Another concern is what Gallego describes as “DDoS [distributed denial of service] from a physical standpoint.” That is, if attackers can convince medical professionals that something has gone seriously wrong with remote surgeries, they could be pulled off other tasks to solve the supposed problem, thus reducing the amount of resources available for other priorities.

For Gallego, the journey to 5G-enabled remote surgery requires a new approach to cybersecurity that instead focuses on cyber resilience. Instead of the familiar “identify, detect, prevent, respond and recover” framework, he suggests that hospitals should “anticipate, withstand, recover and evolve.”

As remote surgery continues to mature to address both front-end applications and back-end IT support, it holds promise to not only alleviate staffing shortages, but also expand access to certain types of care. From assistive robotic solutions to fully automated robotic surgery, 5G-enabled medical devices are paving the way for doctors at a distance to deliver superior care anytime, anywhere.

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