Mobile Robotic Telesurgery Timothy J Broderick MD FACS

Mobile Robotic Telesurgery Timothy J. Broderick, MD, FACS Associate Professor of Surgery/BME University of Cincinnati NASA NEEMO US Army TATRC DARPA Trauma Pod

Telemedicine and Telesurgery • Telecommunication: sending message by means of electronic transmission of impulses • Telemedicine: application of telecommunications in medical care • Surgical Robot: a powered, computer-controlled manipulator with artificial sensing that can be programmed to move and position tools to carry out a wide range of surgical tasks (telemanipulator) • Telesurgery: remotely performed surgery through combined use of telecommunications and a surgical “robot”

Telecommunications in Surgery

Telemedicine Attn Michel Now for the alligator pt. He is a 51 year old Police Reserve who resides at Tana River District approx 200 kms from Mombasa. The District derives its name from Tana River which is the longest river in Kenya and supplies most of the hydroelectric power in the country, It is inhabited by a large number of alligators which annually maims/kills a large number of poeple and domestic animals. Mamba Village gets some of the alligators from there. The subject sustained his injuries 10 days ago when he went to fetch water from the river in the evening( Because of fear of alligator attcks it is males who dare go to the river on the evenings. An alligator jumped from underwater and bit his right hand as he was drawing water causing the injuries described earlier. He is in got nutritional status is right handed and is also a farmer so he uses both his hands while performing his daily tasks including shooting a rifle. He has no motor or sensory deficit and is able to flex and extend his fingers. He is having daily dressing with betadine and as of today the wound is clean and is on splint.

Telesurgery Systems Computer Motion Zeus Intuitive da. Vinci* SRI M 7 University of Washington

Robotic Telesurgery Operation Lindbergh 8 Mbps 155 msec ATM network + Zeus TS New York - Strasbourg Laparoscopic cholecystectomy Sept 7, 2001 CMAS 45 Mbps 144 msec IP MPLS VPN + Zeus TS Hamilton - North Bay Laparoscopic Nissen Fundoplications February 28, 2003

Robotic Telesurgery Using da. Vinci Network Distance Delay 3 D Vision Robotic Motion Telesurgery Firsts Cincinnati to Sunnyvale Public Internet (3 Mbps) 2500 miles 900 ms Poor Polycom Smooth US da. Vinci 3 D Denver to Sunnyvale Public Internet (3 Mbps) 1300 miles 450 ms Good Haivision Smooth Collaborative (2 -> 1) April 2005

NEEMO 9 Robotic Telesurgery firsts: Extreme environment (SRI M 7) Microwave wireless (less than 10 Mbps) Lunar latency (2+ sec -> 10 minute suture) Latency compensation (> 500 msec): Techniques (slow, one handed) Technology (bandwidth, CODEC, automation) April 2006

Mobile Robotic Telesurgery UW robot AV PUMA SUAV DDL @ 1. 2 Mbps (15 ms) Latency @ 200 ms (CODEC) Remote Patient (high desert) June 2006 Internet Expert Surgeon (desert and UW)

Robotic Surgery in Microgravity • Targeted open procedures NASA: Spaceflight Do. D: CCAT • Robotic surgery in parabolic flight Upgraded SRI M 7 Telerobotic (802. 11 g in aircraft) Inanimate (suturing) Semi-autonomous function August 2007

DARPA Trauma Pod Autonomous, telesurgical combat casualty care Critically Injured warfighter Multiple video streams and robot controls Wireless UAV based communication and transport Bandwidth and more bandwidth…

Mobile Robotic Telesurgery Conclusion • High bandwidth, low latency wireless telecommunication can improve the quality of and access to surgical care

timothy. broderick@uc. edu