Teleoperated Robotic Surgery: An Overview

By Ankit SinghReviewed by Susha Cheriyedath, M.Sc.Dec 11 2024

Teleoperated robotic surgery is reshaping healthcare by enabling surgeons to perform complex procedures with exceptional precision, even from remote locations. This technology combines robotics, telecommunications, and advanced computing to tackle key challenges in modern medicine, such as accessibility and accuracy.

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By offering minimally invasive solutions, teleoperated surgery is not only enhancing patient outcomes but also speeding up recovery times. In this article, we'll dive into the core technologies, applications, and broader implications of this key innovation.

What to know more about the principles of teleoperated surgery? Check out this article, "What is Remote Surgery/Telesurgery?"

The Tech Powering Teleoperated Robotic Surgery

Teleoperated robotic surgery combines advanced robotics, high-speed communication networks, and imaging technologies, making remote surgeries more precise. This integration ensures synchronization, enhanced visualization, and real-time control, enabling surgeons to perform delicate operations from a distance. The systems provide greater dexterity and more freedom of movement, improving the accuracy of complex procedures. Here’s a look at the key components driving this advancement:^1,2

Master Console

The master console acts as the surgeon’s control center. It features high-definition 3D imaging, giving surgeons a clear view of the surgical site and ergonomic controls that translate their movements into precise robotic actions. This ensures accuracy during intricate procedures.

Some consoles include tremor filtration technology to minimize unintended hand movements, giving surgeons more confidence while performing delicate tasks. Haptic feedback systems are also incorporated, allowing surgeons to feel sensations similar to directly touching tissues. These features are designed to prioritize surgeon comfort and control, with adjustable elements like finger loops and headrests to cater to individual preferences.^1,2

Robotic Arms (Slave Robots)

The robotic arms are the physical executioners of the surgeon's commands, replicating human dexterity for detailed maneuvers in confined spaces. These arms come with a variety of surgical tools, making them adaptable for various procedures. Their precision minimizes the risk of accidental tissue damage during surgery.

Systems like the da Vinci Xi feature arms with multiple degrees of freedom and advanced technologies like EndoWrist, which enhance manipulation capabilities for more intricate procedures.^1,2

Telecommunication Network

A robust and fast telecommunication network is crucial for ensuring real-time synchronization between the surgeon and the robotic system. Technologies like 5G and dedicated fiber-optic lines help minimize latency, which is essential for maintaining the accuracy and safety of procedures. Redundant communication channels further improve reliability, ensuring the surgery continues smoothly even if there are network disruptions.

Recent successes have shown the potential for telesurgery over vast distances. For instance, surgeries were successfully performed between Orlando and Dubai using 5G technology.^1,2

Imaging and Visualization Systems

Teleoperated robotic surgery systems come equipped with advanced imaging technologies, which significantly enhance the surgical experience. These include 3D cameras for improved depth perception and augmented reality overlays that highlight critical anatomical structures in real time.

Some systems even integrate fluorescence imaging, enabling surgeons to identify specific tissues or blood vessels for greater precision during procedures. Together, these technologies provide surgeons with magnified, stereoscopic views of the surgical field, crucial for precise decision-making and manipulation.^1,2

Artificial Intelligence (AI) Integration

AI is playing an increasingly important role in teleoperated surgery, aiding decision-making and improving workflow efficiency. AI algorithms analyze real-time data, suggesting the best surgical paths and predicting potential complications. These machine learning systems also continuously improve based on past surgeries, offering real-time guidance and enhancing patient safety and outcomes.^1,2

These components work together to create a seamless system that allows surgeons to perform complex procedures remotely, pushing the boundaries of modern surgical practice.

What are the Applications of Teleoperated Surgery?

Teleoperated robotic surgery is being used across various medical disciplines, improving patient outcomes and expanding the possibilities for surgical interventions.

General Surgery

In general surgery, teleoperated robotic systems are transforming procedures like hernia repairs, gallbladder removals, and colorectal surgeries. By allowing surgeons to perform operations through tiny incisions, these systems reduce tissue trauma and accelerate recovery. The precision of robotic arms helps minimize scarring, infection risks, and hospital stays, marking a major leap forward in surgical techniques.³

Cardiothoracic Surgery

In cardiothoracic surgery, robotic systems are particularly effective for intricate tasks like mitral valve repairs and coronary artery bypass grafting. The ability to operate with millimeter-level precision significantly improves outcomes, while advanced imaging technologies offer three-dimensional visualizations of delicate cardiac structures.³

Urology

Robotic technologies have made a huge impact on urological surgeries, such as prostatectomies and kidney surgeries. The precision of robotic arms allows surgeons to avoid damaging critical nerves and tissues, improving post-surgical quality of life for patients. Nerve-sparing techniques, particularly in radical prostatectomy, have become more reliable through robotic assistance.³

Gynecology

In gynecological surgeries, such as hysterectomies and endometriosis excisions, robotic systems offer enhanced dexterity and visualization, enabling surgeons to perform delicate procedures with minimal invasiveness. This is particularly beneficial in fertility-preserving surgeries, as it reduces postoperative pain, scarring, and recovery times.³

Neurosurgery

Neurosurgery requires unparalleled precision, as even the slightest mistake can have serious consequences. Teleoperated robotic systems offer neurosurgeons stability and accuracy during procedures like tumor resections and spinal surgeries. Real-time imaging provides a clearer view of the complex neural pathways, reducing risks typically associated with traditional surgical methods.³

Oncology

In oncology, robotic surgery is essential for tumor removal procedures involving prostate, kidney, and lung cancers. The precision of the technology allows for better preservation of healthy tissue, minimizing patient trauma and accelerating recovery while making cancer treatments more effective.³

Orthopedics

In orthopedic surgeries, such as joint replacements and spinal corrections, robotic systems ensure precise alignment and placement of implants. This reduces complications and enhances long-term functionality, while minimally invasive techniques help patients recover more quickly.³

Why Choose Teleoperated Surgery?

Teleoperated robotic surgery brings several key benefits that improve both surgical precision and patient outcomes:⁴

• Precision: Robotic arms provide steady, accurate movements, reducing human error.
• Minimally Invasive: Smaller incisions mean less pain, faster recovery, and minimal scarring.
• Access to Specialized Care: Patients in remote areas can access top surgeons.
• Reduced Fatigue: Ergonomic designs reduce surgeon fatigue, helping them stay focused during long procedures.

Challenges and Ethical Considerations

While teleoperated robotic surgery holds great promise, it also faces some challenges and ethical concerns:⁴

• High Costs: The substantial investment required for robotic systems can limit access, particularly for smaller healthcare facilities.
• Training Demands: Surgeons and staff need extensive training, which can slow down widespread adoption.
• Technical Limitations: Network latency and equipment failures could disrupt procedures, potentially jeopardizing safety.
• Regulatory Hurdles: Gaining approval from medical boards and regulatory agencies can slow the introduction of new systems.
• Accountability: Determining responsibility in case of equipment failure or adverse outcomes remains complex.
• Data Privacy: Securing patient information is critical to prevent cyber threats.

In an interview we conducted with CMR Surgical, the Cheif Medical Officer also outlined some of the obstacles that still need to be overcome before we can see the widespread integration of automation and robotics in the healthcare sector:

Hospitals are embracing more technology to reduce healthcare costs and improve the quality of care. They're looking to the most cutting-edge technologies to help them address demands on the healthcare system. Cost is, of course, a key obstacle to adoption, and it's important that this technology is not just available to wealthy nations. Our mission is to increase access to keyhole surgery for millions of people, and that includes in low and middle-income countries.

Another obstacle has been the space and infrastructure required by other robotic systems, as well as the challenge of providing high utilization – which is not always possible when your system is fixed within one operating room.

Mark Slack, Chief Medical Officer at CMR Surgical

Recent Advances in Teleoperated Robotic Surgery

Recent developments in teleoperated robotic surgery are improving surgical precision, visualization, and accessibility. Key advancements include the integration of augmented reality (AR) systems, which provide surgeons with enhanced intraoperative views. These AR systems overlay critical anatomical data onto the surgical field, helping reduce errors during complex procedures.⁵

AI is also making strides in identifying key anatomical structures during surgery, helping surgeons navigate more effectively. For example, studies have shown that AI can quickly and accurately highlight blood vessels, nerves, and organs, which is especially beneficial for less experienced surgeons.

Additionally, semi-autonomous surgical systems are making progress. Robots like MAKOplasty combine preoperative imaging with real-time data to enhance a surgeon’s capabilities. Although fully autonomous robots are still in the experimental phase, they hold great promise for the future of surgery.⁶

Telesurgery, or remote surgery, is also evolving rapidly. These systems offer benefits like better depth perception, enhanced dexterity, and improved hand-eye coordination, making remote interventions more feasible and efficient. They also allow for data collection during operations, which can be used for AI supervision and to train new surgeons.⁷

Conclusion

Teleoperated robotic surgery has the potential to revolutionize healthcare, offering precision and improving patient outcomes. Healthcare professionals should consider staying up-to-date on the latest advancements in AI and 5G technology and explore hands-on training to better understand these tools. As the regulatory landscape continues to evolve and efforts to reduce costs progress, teleoperated surgery will become more accessible, shaping the future of surgical care.

CMR Surgical; Transforming Surgery through Robotics

References and Further Reading

1. Remirez, A.A. et al. (2021). A Teleoperated Surgical Robot System. In: Marcus, H.J., Payne, C.J. (eds) Neurosurgical Robotics. Neuromethods, vol 162. Humana, New York, NY. DOI:10.1007/978-1-0716-0993-4_3. https://link.springer.com/protocol/10.1007/978-1-0716-0993-4_3
2. Barba, P.et al. (2022). Remote telesurgery in humans: a systematic review. Surgical Endoscopy 36, 2771–2777. DOI:10.1007/s00464-022-09074-4. https://link.springer.com/article/10.1007/s00464-022-09074-4
3. Gamal, A. et al. (2024). Clinical applications of robotic surgery platforms: a comprehensive review. J Robotic Surg 18, 29. DOI:10.1007/s11701-023-01815-4. https://link.springer.com/article/10.1007/s11701-023-01815-4
4. Mohan, A. et al. (2021). Telesurgery and Robotics: An Improved and Efficient Era. Cureus, 13(3), e14124. DOI:10.7759/cureus.14124. https://www.cureus.com/articles/54068-telesurgery-and-robotics-an-improved-and-efficient-era#!/
5. Penza, V. et al. (2023). Augmented Reality Navigation in Robot-Assisted Surgery with a Teleoperated Robotic Endoscope. IEEE Xplore. DOI:10.1109/iros55552.2023.10342282. https://ieeexplore.ieee.org/document/10342282
6. Kitaguchi, D. et al. (2023). Artificial intelligence for the recognition of key anatomical structures in laparoscopic colorectal surgery. British Journal of Surgery 110, 10. DOI:10.1093/bjs/znad249. https://academic.oup.com/bjs/article/110/10/1355/7239117
7. Tian, W. et al. (2020). Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases. Neurospine, 17(1), 114–120. DOI:10.14245/ns.1938454.227. https://e-neurospine.org/journal/view.php?doi=10.14245/ns.1938454.227

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