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

Abstract

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.

Figure 1

Software update on hinotori Surgical Robot System aimed at monitoring the operation speed of the hands control.

Figure 2

(A) Global Network Set-up. Four geographically distinct network links were set up between Research and Education Networks. Two network links ran through SINET, operated by Japan’s National Institute of Informatics (NII). The JGN network link, by Japan’s National Institute of Information and Communication Technology (NICT), transmitted data via Hong Kong. ARENA-PAC, operated by the WIDE project, transmitted data via Guam. (B) The two robot pods (Surgeon Cockpit and operation unit) are connected via the campus networks. Within the pods, there are multiple devices and sensors with their IP address. The two pods communicate with each other via a series of routers and switches through a private IP protocol.

Figure 3

(A) Task set-up was with Ethicon VICRYL 3-0 SH-1. (B) Suture had to be passed through both black dots (C) Suture was tied down. Achieving the above was deemed as successful task completion.

Figure 4

(A), Infra-pyloric dissection (station 6 lymph nodes) of the radical gastrectomy. Images (i)–(vi) involve isolation and ligation of the right gastroepiploic artery. (B) Suprapancreatic dissection of the radical gastrectomy. Images (i)–(iii) show the isolation and ligation of the coronary vein, and images (iv)–(v) detail the isolation and ligation of the right gastric artery originating from the left hepatic artery.