Tech & Innovation in Healthcare

Who assumes the liability if there are complications?

Imagine this — a patient is laying on an operating table ready for a complicated surgery, but the doctor is not present. Instead, the physician is connecting to a video call to perform the surgery from their office without scrubbing in. Sound like science fiction? Don’t be so sure!

Learn how telesurgery can help train future surgeons and offer high-quality care to patients, and understand the current technological challenges.

Realize the Potential of Remote Surgeries

“Telesurgery is still very much in its infancy as to how people are trying to engage. This interest has been around for a long time on how people can share knowledge and experience,” says Samuel R. Browd, MD, PhD, FANS, FAANS, FAAP, professor of neurological surgery at the University of Washington, attending pediatric neurosurgeon at Seattle Children’s Hospital, and co-founder and CMO of Proprio Inc. in Seattle, Washington.

Is telesurgery the same as connecting to a surgical robot remotely to perform procedures? In part. Telesurgery is an overarching concept that incorporates connecting to a surgical robot remotely as well as a surgeon being in the operating room (OR) virtually via a video connection. When a surgeon has a telepresence, they’re able to come in and provide oversight and guidance, or perform the procedure by way of a remote connection. “Telesurgery could be the same, where I’m beaming in, if you will, to some other location to provide guidance and maybe shine a laser through the system on particular anatomy of the patient. Then there are end effectors, which is sort of the ultimate downstream implementation of telesurgery,” Dr. Browd says.

The latter of which could involve the surgeon sitting in their office while operating on a patient located halfway across the world. By using a virtual reality (VR) headset or another modality to see the patient on the table, the surgeon can then operate the surgical robot to perform the surgery.

Telesurgery offers several benefits for providers and patients, including:

• Delivering care in remote or difficult-to-access areas
• Providing care in high-risk zones, such as areas of military conflict
• Performing procedures with increased accuracy
• Performing less invasive procedures, depending on the modality

Train the Next Generation of Surgeons

Throughout the pandemic, telehealth proved to be a welcome and beneficial tool for both providers and patients. Similarly, telesurgery has shown that it can be just as useful in healthcare. Physicians can use telesurgery to collaborate with other surgeons and provide training to students throughout the world.

“Folks who may not have access to either the best facilities or best teachers, now have access to those folks. You don’t have to plan a trip to Africa and only spend a week there — you could mentor somebody on an ongoing basis anywhere around the world,” Dr. Browd says. By breaking down the barriers to surgical training, telesurgery can help level the playing field as to where and how people receive training and mentorship.

At the same time, patients can receive higher levels and quality of surgical care. If the patient lives in a distant location where their access to care is limited, they may be able to visit a nearby medical center or hospital where a surgeon can receive guidance from an expert via telesurgery or that same expert could perform the procedure via a robotic system and a high-speed network connection.

“It’s going to be an interesting opportunity to democratize surgery, both in terms of training and in terms of access to expert care,” Dr. Browd adds.

Tackle Technological Concerns

One challenge facing telesurgery is data latency, or how fast is the signal coming across from the other location. Most of us have experienced a lag in the signal during a video call, which can be frustrating when you’re trying to make a point in a meeting. Now, apply that to a medical procedure where the OR surgeon may be awaiting the next instruction from the surgeon on the video call, or if a surgeon is using a robot to perform a delicate procedure. A 2015 study on robotic endonasal telesurgery found that video and control latency of < 100 ms produced a near real-time transmission. This low latency helps keep the connection quick and reliable when a provider is delivering critical information.

However, the amount of data being transferred will become a factor when attempting to ensure a clear, reliable connection. “Most operating rooms were never developed as technology platforms, so it’s a real issue as to how you are moving significant amounts of data from one spot to someplace on the other side of the world because combining latency and surgery is obviously dangerous,” Dr. Browd says.

Data security is another concern telesurgery faces. Regardless of whether surgeons are collaborating over a video call or one surgeon is remotely porting into a surgical robot, securing the connection and data is crucial to ensuring the privacy and safety of the patient. “If somebody hacks into a robot or does something to change the inputs so that what you said you wanted the robot to do and it does something different, that could be potentially fatal or catastrophic in some way,” Dr. Browd adds.

As telesurgery advances, stronger security protocols and high-end data security will be critical to ensuring the safety of the patient while they’re on the operating table.

Who’s Liable if a Procedure Goes Wrong?

Before the start of 2020, Dr. Browd taught a selective dorsal rhizotomy (SDR) to a surgical colleague in Australia. SDR is performed to treat pediatric patients with cerebral palsy, and during the procedure, the surgeon carefully cuts specific nerves to help the patient walk better. However, due to COVID, Dr. Browd’s surgical colleague was unable to fly to the U.S. to learn the technique and Dr. Browd was unable to fly to Australia to teach the technique.

As a result, the two connected over a video call from the operating room. On one screen, the operative’s surgical video was livestreamed, while another screen displayed the electrophysiology that Dr. Browd used to decide which nerves to cut.