Leveraging 5G technology for robotic surgery and cancer care

Feasibility of long-range telesurgical robotic radical gastrectomy in a live porcine model

BACKGROUND

Telesurgery has been made increasingly possible with the advancements in robotic surgical platforms and network connectivity. However, long-distance transnational complex robotic surgeries such as gastrectomy have yet to be attempted.

METHODS

Multiple transnational network connections by Science Innovation Network (SINET), Japan Gigabit Network (JGN), and Arterial Research and Education Network in Asia-Pacific (ARENA-PAC) were established and tested by multiple surgeons in a dry box model. Surgeons' perceptions of the different networks were recorded. Three robotic radical D2 gastrectomies in live porcine models were performed at a hospital in Toyoake, Japan, by a surgical team in a hospital in Singapore ~5000 km away, using the hinotori Surgical Robot System (Medicaroid Corporation).

RESULTS

The live porcine robotic gastrectomies were all completed in under 205 min with no intraoperative complications. From the different networks that were tested, the differences in latency ranged from 107 to 132 ms and did not translate to any significant differences in surgeon timings and perceptions.

CONCLUSIONS

Transnational telesurgical radical D2 gastrectomy is feasible in a porcine model. There is no appreciable difference between surgeon performance and perception with network latencies of 107-132 ms. Long-range telesurgery as clinical practice may become possible in the future.

Remote-Controlled and Teleoperated Systems: Taking Robotic Image Guided Interventions to the Next Stage

Remote-controlled and teleoperated robotic systems mark transformative advancements in interventional radiology (IR), with the potential to enhance precision, reduce radiation exposure, and expand access to care. By integrating robotic devices with imaging guidance, these systems enable precise instrument placement and navigation, thereby improving the efficacy and safety of minimally invasive procedures. Remote-controlled and teleoperated robotic systems-operated by clinicians using control interfaces from within or adjacent to the procedure room-are being adopted for both percutaneous and endovascular interventions. In contrast, although their application is still experimental, teleoperation over long distances hold promise for extending IR services to medically underserved areas by enabling remote procedures. This review details the definitions and components of remote-controlled and teleoperated robotic systems in IR, examines their clinical applications in percutaneous and endovascular interventions, and discusses relevant challenges and future directions for their incorporation into IR practices.

First impressions of Telesurgery robotic-assisted radical prostatectomy using the Edge medical robotic platform

PURPOSE

We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network.

MATERIAL AND METHODS

We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer.

RESULTS

We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days).

CONCLUSION

As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.

Intelligent medicine in focus: the 5 stages of evolution in robot-assisted surgery for prostate cancer in the past 20 years and future implications

Robot-assisted surgery has evolved into a crucial treatment for prostate cancer (PCa). However, from its appearance to today, brain-computer interface, virtual reality, and metaverse have revolutionized the field of robot-assisted surgery for PCa, presenting both opportunities and challenges. Especially in the context of contemporary big data and precision medicine, facing the heterogeneity of PCa and the complexity of clinical problems, it still needs to be continuously upgraded and improved. Keeping this in mind, this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa, encompassing the stages of emergence, promotion, development, maturity, and intelligence. Initially, safety concerns were paramount, but subsequent research and engineering advancements have focused on enhancing device efficacy, surgical technology, and achieving precise multi modal treatment. The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions. In the future, robot-assisted surgery for PCa will move towards intelligence, promising improved patient outcomes and personalized therapy, alongside formidable challenges. To guide future development, we propose 10 significant prospects spanning clinical, research, engineering, materials, social, and economic domains, envisioning a future era of artificial intelligence in the surgical treatment of PCa.

Smart Operating Room in Digestive Surgery: A Narrative Review

The introduction of new technologies in current digestive surgical practice is progressively reshaping the operating room, defining the fourth surgical revolution. The implementation of black boxes and control towers aims at streamlining workflow and reducing surgical error by early identification and analysis, while augmented reality and artificial intelligence augment surgeons' perceptual and technical skills by superimposing three-dimensional models to real-time surgical images. Moreover, the operating room architecture is transitioning toward an integrated digital environment to improve efficiency and, ultimately, patients' outcomes. This narrative review describes the most recent evidence regarding the role of these technologies in transforming the current digestive surgical practice, underlining their potential benefits and drawbacks in terms of efficiency and patients' outcomes, as an attempt to foresee the digestive surgical practice of tomorrow.

Technologies Used for Telementoring in Open Surgery: A Scoping Review

Background: Telementoring technologies enable a remote mentor to guide a mentee in real-time during surgical procedures. This addresses challenges, such as lack of expertise and limited surgical training/education opportunities in remote locations. This review aims to provide a comprehensive account of these technologies tailored for open surgery. Methods: A comprehensive scoping review of the scientific literature was conducted using PubMed, ScienceDirect, ACM Digital Library, and IEEE Xplore databases. Broad and inclusive searches were done to identify articles reporting telementoring or teleguidance technologies in open surgery. Results: Screening of the search results yielded 43 articles describing surgical telementoring for open approach. The studies were categorized based on the type of open surgery (surgical specialty, surgical procedure, and stage of clinical trial), the telementoring technology used (information transferred between mentor and mentee, devices used for rendering the information), and assessment of the technology (experience level of mentor and mentee, study design, and assessment criteria). Majority of the telementoring technologies focused on trauma-related surgeries and mixed reality headsets were commonly used for rendering information (telestrations, surgical tools, or hand gestures) to the mentee. These technologies were primarily assessed on high-fidelity synthetic phantoms. Conclusions: Despite longer operative time, these telementoring technologies demonstrated clinical viability during open surgeries through improved performance and confidence of the mentee. In general, usage of immersive devices and annotations appears to be promising, although further clinical trials will be required to thoroughly assess its benefits.

Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges

The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.

Initial experience with robotic technology for thoracic surgery using the da Vinci Xi system in Tibet, China

Objective

Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report our experience concerning da Vinci Xi system in thoracic surgery and observe its practicability and surgical effect.

Methods

We retrospectively analyzed 26 patients who underwent robotic thoracic surgery including: twelve lung resection, two esophagectomies, ten mediastinal surgeries and two rib mass resection. The data of patient characteristics, operative time, perioperative complications were collected.

Results

Of the 26 patients, 22 cases were completed with da Vinci system successfully, including 7 segmentectomies, 4 lobectomies, 1 subsegmentectomy, 2 esophagectomies, 10 mediastinal surgeries (6 thymic resections, 3 posterior mediastinal tumor resection, 1 mediastinal cyst resection) and 2 rib mass resection. In which, 3 cases of lung resection begun with robotic technique were converted to thoracoscopic surgery (due to calcification of hilar lymph node), 1 case of bilobectomy was converted to thoracotomy due to thoracic adhesion. All the operations went well and no patients need blood transfusion. All patients had satisfactory postoperative recovery.

Conclusion

It is safe, reliable and effective to carry out robotic thoracic surgery on the plateau. On the premise of carefully and seriously discussing the indications of surgery, we should actively carry out the application of da Vinci robotic surgery system in Tibet Plateau.

Security Analysis for Smart Healthcare Systems

The healthcare industry went through reformation by integrating the Internet of Medical Things (IoMT) to enable data harnessing by transmission mediums from different devices, about patients to healthcare staff devices, for further analysis through cloud-based servers for proper diagnosis of patients, yielding efficient and accurate results. However, IoMT technology is accompanied by a set of drawbacks in terms of security risks and vulnerabilities, such as violating and exposing patients' sensitive and confidential data. Further, the network traffic data is prone to interception attacks caused by a wireless type of communication and alteration of data, which could cause unwanted outcomes. The advocated scheme provides insight into a robust Intrusion Detection System (IDS) for IoMT networks. It leverages a honeypot to divert attackers away from critical systems, reducing the attack surface. Additionally, the IDS employs an ensemble method combining Logistic Regression and K-Nearest Neighbor algorithms. This approach harnesses the strengths of both algorithms to improve attack detection accuracy and robustness. This work analyzes the impact, performance, accuracy, and precision outcomes of the used model on two IoMT-related datasets which contain multiple attack types such as Man-In-The-Middle (MITM), Data Injection, and Distributed Denial of Services (DDOS). The yielded results showed that the proposed ensemble method was effective in detecting intrusion attempts and classifying them as attacks or normal network traffic, with a high accuracy of 92.5% for the first dataset and 99.54% for the second dataset and a precision of 96.74% for the first dataset and 99.228% for the second dataset.

Evaluating the Effects of Pulsed Electrical Stimulation on the Mechanical Behavior and Microstructure of Medulla Oblongata Tissues

The development of remote surgery hinges on comprehending the mechanical properties of the tissue at the surgical site. Understanding the mechanical behavior of the medulla oblongata tissue is instrumental for precisely determining the remote surgery implementation site. Additionally, exploring this tissue's response under electric fields can inform the creation of electrical stimulation therapy regimens. This could potentially reduce the extent of medulla oblongata tissue damage from mechanical compression. Various types of pulsed electric fields were integrated into a custom-built indentation device for this study. Experimental findings suggested that applying pulsed electric fields amplified the shear modulus of the medulla oblongata tissue. In the electric field, the elasticity and viscosity of the tissue increased. The most significant influence was noted from the low-frequency pulsed electric field, while the burst pulsed electric field had a minimal impact. At the microstructural scale, the application of an electric field led to the concentration of myelin in areas distant from the surface layer in the medulla oblongata, and the orderly structure of proteoglycans became disordered. The alterations observed in the myelin and proteoglycans under an electric field were considered to be the fundamental causes of the changes in the mechanical behavior of the medulla oblongata tissue. Moreover, cell polarization and extracellular matrix cavitation were observed, with transmission electron microscopy results pointing to laminar separation within the myelin at the ultrastructure scale. This study thoroughly explored the impact of electric field application on the mechanical behavior and microstructure of the medulla oblongata tissue, delving into the underlying mechanisms. This investigation delved into the changes and mechanisms in the mechanical behavior and microstructure of medulla oblongata tissue under the influence of electric fields. Furthermore, this study could serve as a reference for the development of electrical stimulation regimens in the central nervous system. The acquired mechanical behavior data could provide valuable baseline information to aid in the evolution of remote surgery techniques involving the medulla oblongata tissue.

Development of a master-slave 3D printed robotic surgical finger with haptic feedback

Robotic surgery started nearly 30 years ago. It has achieved telepresence and the performance of repetitive, precise, and accurate tasks. The "master-slave" robotic system allows control of manipulators by surgeon at distant site. Robotic surgical fingers were developed to allow surgeons to move them with accuracy through sensors fixed on surgeon's hand. Also, haptic sensors were developed to allow transmission of sensation from robotic finger to surgeon's finger. A complete system of a, 3D printed by a stereolithography (SLA) 3D printer, robotic surgical finger with haptic feedback system is proposed. The developed system includes a master glove that controls the motion of a 3DOF robotic slave finger while getting haptic feedback of force/pressure exerted on it. The precise control of the slave robotic finger was achieved by applying a Proportional Integral and Derivative (PID), fast and robust, control algorithm using an Arduino based hardware and software module. The individual joint angles, metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP), and wrist were measured using rotatory and inertial sensors respectively. The degree of movement for MCP, PIP, and Wrist joints were measured to be 0-86°, 0-71°, and 0-89° respectively. Motion to the robotic finger is mimicked by a glove motion requiring minimal learning curve for the device. The collected data for the slave motion is in good agreement with the master-glove motion data. The vibro-tactile haptic feedback system was developed to distinguish between three different materials to mimic human flesh, tumor, and bone. The master-slave system using robotic surgical finger with good simultaneous movement to surgeon's finger and good haptic sensation will provide the surgeon with the opportunity to perform finger dissection in laparoscopic and robotic surgery, as it used to be in open surgery. 3D bio printing will make this process even cheaper with the added advantage of making surgical tools locally according to the need of the surgery. An ongoing work is to develop silicone based 8 mm robotic surgical finger with multiple type haptic feedback.

Advancements in robotic surgery: innovations, challenges and future prospects

The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.

Exploring the Risks, Benefits, Advances, and Challenges in Internet Integration in Medicine With the Advent of 5G Technology: A Comprehensive Review

The integration of 5G technology in the healthcare sector is poised to bring about transformative changes, offering numerous advantages such as enhanced telemedicine services, expedited data transfer for medical records, improved remote surgery capabilities, real-time monitoring and diagnostics, advancements in wearable medical devices, and the potential for precision medicine. However, this technological shift is not without its concerns, including potential health implications related to 5G radiation exposure, heightened cybersecurity risks for medical devices and data systems, potential system failures due to technology dependence, and privacy issues linked to data breaches in healthcare. We are striking a balance between harnessing these benefits and addressing the associated risks. Achieving this equilibrium requires the establishment of a robust regulatory framework, ongoing research into the health impacts of 5G radiation, the implementation of stringent cybersecurity measures, education and training for healthcare professionals, and the development of ethical standards. The future of 5G in the medical field holds immense promise, but success depends on our ability to navigate this evolving landscape while prioritizing patient safety, privacy, and ethical practice.

Role of 5G Networks in Healthcare Management System

The present-day healthcare system operates on a 4G network, where the data rate needed for many IoT devices is impossible. Also, the latency involved in the network does not support the use of many devices in the network. The 5G-based cellular technology promises an effective healthcare management system with high speed and low latency. The 5G communication technology will replace the 4G technology to satisfy the increasing demand for high data rates. It incorporates higher frequency bands of around 100 MHz using millimetre waves and broadband modulation schemes. It is aimed at providing low latency while supporting real-time machine-to-machine communication. It requires a more significant number of antennas, with an average base station density three times higher than 4G. However, the rise in circuit and processing power for multiple antennas and transceivers deteriorates energy efficiency. Also, the data transmission power for 5G is three times higher than for 4G technology. One of the advanced processors used in today's mobile equipment is NVIDIA Tegra, which has a multicore system on chip (SoC) architecture with two ARM Cortex CPU cores to handle audio, images, and video. The state-of-the-art software coding using JAVA or Python has achieved smooth data transmission from mobile equipment, desktop or laptop through the internet with the support of 5G communication technology. This paper discusses some key areas related to 5G-based healthcare systems such as the architecture, antenna designs, power consumption, file protocols, security, and health implications of 5G networks.