Surgery digitized: Telesurgery becoming a reality

Digitizing the interface between surgeon and patient will upend the traditional medical paradigm.

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There's been a lot of talk around the topic of telesurgery and how far we are from this being a feasible reality. CEO of Asensus Surgical Anthony Fernando says this future is possible through 5G but this infrastructure has to be available everywhere. Moreover, the fundamentals of robotic-assisted surgical practices need to be widespread before we can progress further. 

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Companies like Asensus have taken steps to digitize the interface between the surgeon and patient through "performance-guided surgery"—the convergence of surgical technology and augmented intelligence. Augmented intelligence enables a robotic-assisted platform to perceive (computer vision), learn (machine learning), and assist (clinical intelligence) in surgery—providing a true digital surgical assistant for the first time.

 So what does that mean for telesurgery, which is beginning to emerge as a realistic concept? I connected with Anthony Fernando, CEO and President, Asensus Surgical, to find out.

GN: What have been the primary hurdles (technological, regulatory, and from a market readiness standpoint) to practical telesurgery?

Anthony Fernando: Before we delve into practical telesurgery, let's first take a look at the current surgical landscape to provide context on the evolution of surgery and how we can achieve telesurgery. Currently, approximately, 40% of surgeries are being done open (invasive), 50% of surgeries being done laparoscopically (less invasive, but harder for the surgeon), and 3-5 % are being done robotically (which yields an unquantified improvement over laparoscopy). So, of the three types of surgery, laparoscopy is most common, with many trained surgeons and strong patient outcomes.

By augmenting laparoscopy with some of the benefits of robotics, effectively called Digital Laparoscopy, surgeons and patients can experience the robotic benefits while continuing to leverage their laparoscopic skills.

In order to enable telesurgery, the interface between the surgeon and the patient needs to be digitized and the Asensus Surgical's Senhance system has digitized the interface between the surgeon console and the patient side robotic manipulators with an ethernet style communication interface. In addition, the Senhance system's Intelligent Surgical UnitTM (ISUTM), is the world's first and only augmented intelligence and machine vision capable surgical system approved by the FDA for use in robotic-assisted surgery.

So practical telesurgery can be achieved through current Senhance technology, and 5G will allow that, given high bandwidth and low latency, but you need true 5G. It's not everywhere, in fact it is only in a fraction of US cities. Once 5G infrastructure is widespread, the conversation about telesurgery will be more realistic and we will have to overcome the regulatory barriers in addition as well.  Moreover, the fundamentals of robotic-assisted surgical practices need to be widespread before we can progress further. 

GN: Practically, what will telesurgery look like in its early stages with respect to types of procedures, necessary personnel and infrastructure, etc.? What would the benefits be of widespread telesurgery?

Anthony Fernando: Surgery today is inconsistent. Surgeons of all skill levels, experience, and training perform similar procedures, but have vastly different outcomes. The Journal of Patient Safety estimates that there are over 400,000 U.S. deaths that occur yearly due to avoidable complications arising from medical errors. This accounts for roughly one-sixth of all deaths in the U.S. each year. Technology-assistance surgery vastly reduces avoidable complications by mitigating surgical variability.

With a broader, more robust 5G network, widespread telesurgery has the potential to unlock advanced surgeon training, enhanced surgical collaboration, increased efficiency, and the ability to provide healthcare to remote and underserved areas.

As I see it, initially telesurgery will occur inside of a hospital where one surgeon sitting in one room performing 2 or 3 surgeries in different operating rooms in parallel while the support staff in each room assisting the surgeon. This could then be at a hospital system level and could expand to a city, state and finally intercontinentally. In a similar fashion a second surgeon or trainee could join remotely and assist as well.

GN: How will 5G support or enable the rollout of telesurgery technologies?

Anthony Fernando: True 5G technology is necessary for widespread adoption of telesurgery. It's the high bandwidth of 5G, low latency and attainment of a fast enough internet connection that will permit telepresence in real time and allow the surgeons to effectively work on the patient as if they were in the same room. Large-scale adoption of this could revolutionize healthcare and surgical treatments around the globe - especially in small hospitals and developing areas that don't have as much access to top notch healthcare.  Coupled with 5G, robotics provide invaluable assistance, allowing procedures to be performed less invasively, reducing complications and delivery times. 

GN: Robots are being utilized more and more for a growing variety of surgical techniques. Can you explain how the current applications, including your company's technology, are paving the way for practical telesurgery?

Anthony Fernando: Next-level technology completely changes the idea of what's possible. As technology enhances and changes the world we live in, we're able to make inroads in a new era of surgery reimagined. Moving beyond inefficiency, unpredictability and outdated technology in the operating room is a new surgical standard.

The digital interface between the surgeon and patient is the key to unlocking telesurgery.

Asensus is successfully digitizing surgery and building machine learning algorithms and AI that can enable the future of surgery. For instance, the ISU unlocks the power of computer learning to recognize anatomy, leverages image analytics for the first 3D virtual measurement capability in surgery, and harnesses the power of a virtual assistant to facilitate certain procedures in tandem with the surgeon.

The ISU also enables computer vision capabilities for the first time in surgery to make for a smarter surgical decision process. This means this technology records an image and applies intelligent algorithms to enhance the surgeon's ability to meaningfully use information from the surgical field in real-time.

Asensus also offers a telemonitoring platform called Senhance Connect that brings surgical peers together, a feature that became increasingly important during the COVID-19 pandemic. Senhance Connect allows surgical peers from around the world to remotely observe a surgical case being conducted on Asensus' Senhance Surgical System via cameras and communicate with an expert surgeon about the most advantageous practices. For example, a surgeon can benefit from the expertise of a colleague who specializes in a certain operation.

GN: Augmenting human capabilities is an important function of surgical robotics. Do you expect human surgeons to be phased out for some types of procedures in the future? What kind of timescale are we talking about?

Anthony Fernando: If you think about good surgery, it's an art. So digital robotics only enhances and elevates a surgeon's abilities, but by no means replaces the surgeon. But technology should not just be for the elite. Robotics, AI and machine learning are also bridging any lapse in technical skill and creating an "equal playing field" of surgical expertise across hospital facilities. By providing wider access to expert surgeons via telesurgery, these hospitals can leverage AI-acquired surgeon data to improve ongoing training, providing greater consistency, safety and satisfaction of patients. Our goal is to create a digital twin of a surgeon who can always work alongside a surgeon with the intent of taking the best knowledge and best practices from everywhere and enabling it to be leveraged anywhere.