Telesurgery may soon be a practical option in Japan

May 23, 2022

FUKUOKA — Telesurgery, where, for example, surgeons in urban areas operate remotely on patients in rural areas, is moving towards practical use in Japan.

Behind this are advances in telecommunications technology, which have made it safer to operate surgical robots remotely.

The innovative medical procedure holds particular promise for rural residents as it will enable advanced surgeries to be performed even in areas where there are few surgeons.

There are still issues with ensuring patient safety, however, so the Japan Surgical Society aims to publish guidelines for performing telesurgery by the end of this year.

In March, Kyushu University conducted a telesurgery demonstration by connecting its affiliated hospital in Fukuoka City to another affiliated hospital in Beppu, Oita Prefecture, about 100 kilometers away.

At Kyushu University’s Beppu Hospital, a monitor showed an animal placed on an operating table at Fukuoka Hospital. The animal was used to create a situation similar to human surgery.

“I will make the incision in this area,” said a Beppu surgeon as he grabbed both hands to manipulate a surgical robot in Fukuoka.

On the operating table, the scalpel attached to the end of the robotic arm moved delicately as Beppu’s surgeon moved his hands. A Fukuoka surgeon also took turns operating the robot, and a kidney was removed from the animal in about an hour.

Operating the robot from Beppu, the university’s associate professor, Junichi Inokuchi, said: “It didn’t seem distant. It was smooth.

Last year, Kyushu University conducted a test to control a medical robot remotely by connecting with Hokkaido University and Sapporo Medical University. Hirosaki University in Aomori Prefecture is also engaged in similar telesurgery trials.

Broadband communications
Universities are beginning to focus their research on telesurgery since the Department of Health, Labor and Welfare revised guidelines for online medical care in 2019. The guidelines set a policy for putting telesurgery into practice .

The current situation has been brought about by the development of communication technologies. Although the technology has been researched for about 20 years, the problems of communication delays have not been completely solved because large amounts of data have to be exchanged. Communication delays could lead to life and death issues, for example, in the event of sudden bleeding, if there is a significant lag between the manipulation of the surgeon and the movements of the robot, it could lead to massive blood loss .

Kyushu University received cooperation from NTT West Corp. to provide a high-speed communication line for its tests, confirming that the time lag between the operating room and the robot console was around 5 milliseconds, even over a distance of around 100 kilometers.

Surgical robots are becoming popular especially in laparoscopic cancer surgery. In addition to US-made da Vinci surgical systems, locally produced surgical robots have also appeared in recent years. Kyushu University used in its March test a robot being developed by Riverfield Inc., a Tokyo-based startup launched by the Tokyo Institute of Technology.

Assistance to the attending physician
In case of problems such as interruption of communications, surgery can be continued locally.

“There is always a attending physician next to the patient,” said Eiji Oki, an associate professor at Kyushu University. “The experienced specialist surgeon remotely assists the attending physician in carrying out the operation.”

He explained that even telesurgery requires a GP and other medical staff on site who have the skills to perform the surgery.

The Japan Surgical Society is working with telecommunications operators and lawyers to create telesurgery guidelines, which will specify the requirements of the telecommunications environment, detailed explanations of benefits and risks for patients, and how to treat problems that may arise. Once the company releases the guidelines, telesurgery will enter the clinical use phase for human patients, primarily in teaching hospitals.

“It is important that staff at the surgery site and remote surgeons communicate with each other and prepare for the various issues that may arise,” said Satoshi Hirano, a professor at Hokkaido University involved in compiling the data. guidelines. “Tele-surgery will also provide rural surgeons with the opportunity to learn advanced techniques from their mentors at teaching hospitals and other institutions.”

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