The COVID-19 pandemic, whose cumulative cases and deaths were recorded to be 761,402,282 and 6,887,000 as of 29th March 2023 (see figure 1 for WHO region wise data), disrupted the delivery of regular healthcare services globally. Non-urgent medical services took a backburner during lockdowns to avoid the risk of spreading infections and to cater to the overwhelming task at hand – the management of pandemic-related illnesses. As the world made its recovery and the healthcare systems slowly got back on track, the need for physical distancing between surgeons and patients in order to prevent infections, gave rise to the rising popularity of Telesurgery. Currently, around 42% of surgeries conducted are open surgeries, 48% of them are done laparoscopically (less invasive), and only 4-5% are performed robotically. Of the 3, laparoscopy is the most common, with better patient outcomes. Digital laparoscopy or telesurgery endeavors to integrate robotics into laparoscopy, thereby bringing the best of both worlds to the complicated field of surgery.
Telesurgery is an emerging surgical procedure that combines wireless technology with robotics to connect surgeons with patients who are based far from each other. This technology is growing due to the advancements in digital imaging, the increasing digitization of the interface between the surgeon and the patient, the integration of artificial intelligence and machine learning into robotics, and the presence of high-speed internet connections. This is called performance-guided surgery and it acts as a true digital surgical assistant to surgeons. Telesurgery has the power to revolutionize surgical treatments and the overall global healthcare systems. The first robotic surgery was performed on a patient in France in 2001, called the 'Lindbergh Operation'. The telesurgically-performed cholecystectomy was completed in 54 minutes without any complications.
Surgeons can perform robotic surgery on patients far away, while sitting comfortably in a control room. High-definition 3D cameras allow the surgeon to zoom into the site being operated upon. Haptic feedback technology enables robotic arms to copy the natural hand movements of the surgeon. With the robotic arms, the surgeon can access hard-to-reach places such as the pelvic region and perform surgeries with 3mm robotic instruments that further lessen the invasive nature of these surgeries. This minimizes the chances of damaging surrounding tissues and reduces blood loss, and the risk of infections. In short, a patient can recover quickly after telesurgery. For instance, the surgeons at Windsor Regional Hospital, Ontario, Canada, who had performed the first robotic-assisted hip replacement surgery on a 46-year-old police officer, reported that the use of robotic surgery helped them to execute their plan based on the patient’s specific needs, with greater accuracy and consistency, and in a less traumatic fashion. They also added that owing to the precise nature of the procedures, recovery times are known to be reduced. The accelerometer technology cancels out tremors in a surgeon’s hands and takes their anxiety out of the equation, resulting in improved surgical accuracy.
Telesurgery strengthens the critical decision-making capability of surgeons by delivering them all the information and insights related to the patient and the surgery and maximizing the accuracy of the health outcomes (see Figure 2). Other benefits include -
Just like any other emerging technology, telesurgery too comes with its own set of limitations that need to be addressed to achieve global scalability. They are -
1. There is a global need for strong network connections with low latency and greater bandwidth in order to make telesurgery a viable option. Increased latency of more than 2 seconds can prolong the duration of the surgery and produce inaccurate results.
2. While telesurgery removes any geographical barriers that may hinder access to world-class healthcare, it is yet to overcome the legal and ethical issues that may arise with cross-regional collaborations as laws differ from state to state and country to country.
3. Billing can also become a headache when different medical centers collaborate in telesurgery.
4. The cost of robotic systems, their acquisition, and maintenance, are other challenges that healthcare institutes need to overcome.
5. There is a high risk of cybersecurity threats when it comes to telesurgery applications.
In order for surgeons to effectively operate on patients as if they were in the same room, there is a dire need for a high-speed network and low latency. The use of a 5G network can reduce the latency period to about 0.01 seconds. Several remote surgeries have already been performed successfully thanks to the 5G network. Improvements in haptic feedback technology and tactile robotics can result in precise and effective surgeries. IoT devices such as sensors can collect, analyze, and conduct data transfer in real time. They help make accurate diagnoses, manage workflows, increase productivity, and lower costs, thus ensuring patients get better treatment.
The worldwide telesurgery market generated around USD 7 billion in 2023. It is further projected to garner over USD 20 billion by the end of 2035. In the United States, over 850,000 robot-assisted surgeries were performed in the year 2020. Moreover, the U.S. firm, Intuitive Surgical, has been a global leader in robotic surgery for the past 5 years. They are well-known for their robotic system called the da Vinci. Another U.S.-based company, Stryker, comes second with its Mako Robotic Arm. They are highly used in orthopedic surgeries such as partial knee arthroplasty and absolute hip arthroplasty. Here is an outlook of all the different markets associated with telesurgery (see Figure 3).