By Angelina Cappiello
The ever-evolving field of medicine is forging a new frontier of robotic surgery that extends beyond the operating room. The concept is Remote Telesurgery, and it’s revolutionizing access to critical healthcare by enabling surgeons to perform surgical procedures on patients in distant locations using robotic systems and advanced telecommunications technology.
This futuristic approach to surgery may seem more sci-fi than reality, but if Remote Telesurgery takes off, it is sure to help overcome geographical barriers, advancing the way surgical care is delivered around the world.
In a recent cover interview with Preferred Health Magazine, respected gastrointestinal and HPB surgeon Dr. Sharona Ross discussed the impact of telesurgery on the future of medicine and the additional training that will be required for surgeons.
"Telesurgery can potentially be used for any surgical procedure that is already being performed robotically," said Dr. Ross, an innovator in the field of Advanced Foregut & HPB Robotic Surgery.
“This approach offers significant advantages: surgeons can operate and train other surgeons remotely. This can ensure that all patients, even those in underserved countries, receive the same high-quality standard of care, regardless of the surgeon's physical location.”
Dr. Sharona B. Ross, MD, FACS, is a nationally and internationally renowned HPB (Pancreas/Biliary System) and Complex Foregut surgeon. With almost 20 years in her field, she emerges as a pivotal figure in elevating Minimally Invasive and Robotic Surgery on a global scale. Dr Ross is currently overseeing the first surgeon-led IDE Pilot Study of the SP (single-port) robot that is FDA-approved. The study will allow for the SP to be applied to complex Foregut and HPB operations.
Dr. Ross and her team at Advent Health were one of the first practices in the nation to incorporate augmented/virtual reality in surgical planning for pancreatic cancer operations using Surgical Theatre - a 3D rendering based on specialized imaging which they used for education and planning before and during an operation. With this technology, her team was able to visually demonstrate to patients and their families the steps of an operation and how their cancer is associated with the major blood vessels and other organs. As the Director of the Advanced GI, Foregut, and HPB Fellowship Program, where she has been pivotal in driving mentorship, surgical advancements, and fostering an environment of learning and development.
“As a highly experienced HPB Upper GI Surgeon with nearly two decades in the field, the concept of performing surgery using such advanced technology might have seemed like science fiction earlier in my career,” said Dr. Ross. “However, the rapid advancement in medical technology has made it a reality, presenting new opportunities and challenges in surgical practice.”
So how does it work?
Telesurgery involves several key components including Robotic Surgical Systems: These systems include robotic arms that are controlled by the surgeon. The most commonly known system is the da Vinci Surgical System. Telecommunication Technology: High-speed, reliable internet connections and advanced data transmission technology are essential to ensure real-time control and feedback. Imaging and Visualization: High-definition cameras and imaging devices provide the surgeon with detailed views of the surgical site. Control Interface: Surgeons use a control console equipped with hand controls and foot pedals to manipulate the robotic instruments. Movements made by the surgeon at the console are translated into precise movements by the robotic arms at the patient's side.
Benefits of Telesurgery:
• Access to Expertise: Telesurgery allows patients in remote or underserved areas
to access highly specialized surgical expertise.
• Reduced Travel: Patients and surgeons do not need to travel long distances,
which can save time and reduce costs.
• Minimally Invasive: Robotic surgery often involves smaller incisions,
leading to less pain, reduced scarring, and faster recovery times.
• Precision and Control: Robotic systems can offer greater precision
and control compared to traditional surgical methods.
"Telesurgery offers a multitude of benefits, such as providing specialized expertise to patients in remote areas and minimizing the need for travel. It also allows for minimally invasive robotic procedures, reducing pain and faster recovery, " said Dr. Ross. "Additionally, the precision and control offered by robotic systems can potentially lead to improved surgical outcomes."
Still in its infancy stages, Telesurgery holds promise for the future of surgical treatment and patient access to surgical expertise. But, it may face some challenges.
What challenges does telesurgery face?
Dr. Ross: "Telesurgery encounters several challenges, including technical limitations that require high-speed and reliable internet connections to prevent critical lag or disconnection. The setup and maintenance of telesurgery systems can be costly.
In addition, extensive training is necessary for surgeons and medical staff to operate robotic systems effectively. Ensuring data security and patient privacy is also a significant concern, along with navigating varying regulations and medical protocols across different countries."
What legal and ethical concerns are raised by telesurgery?
Dr. Ross: " Using telesurgery presents significant legal and ethical considerations that require effective management. "It is essential to prioritize the secure handling of patient data to uphold trust and safeguard patient privacy, said Dr. Ross. It is imperative to fully educate patients about telesurgery's potential risks and benefits to enable their active participation in the decision making process. Implementing robust measures to protect the transmitted data during telesurgery from cyber threats is crucial to upholding the procedure's integrity. Collaboration is necessary to address potential challenges arising from varying medical laws and protocols across different countries in the context of cross-border telesurgery. Lastly, clear protocols for determining liability in the event of complications or errors during telesurgery are essential to ensure patient safety and uphold accountability. "
What procedures will most likely be performed via telesurgery?
Dr. Ross: "Telesurgery has the potential to be utilized for a wide range of surgical procedures currently performed robotically. This innovative approach offers significant advantages, allowing surgeons to operate and provide training to other surgeons remotely. This has the potential to ensure that all patients, including those in underserved areas, receive the same high-quality standard of care, regardless of the physical location of the surgeon. In addition, local surgeons can enhance their operational efficiency by using "Flip Rooms," a concept where a surgeon can sit at a console in one location and be seamlessly connected to their next case in another operating room. This seamless connectivity minimizes turnover time and streamlines the surgical process for improved patient care."
Will patients have a choice of including telesurgery as a part of their procedure?
Dr. Ross: Patients should be able to choose telesurgery if it is deemed suitable for their condition. Informed consent is essential, and patients should be provided with comprehensive information regarding the benefits, risks, and alternatives to help them make informed decisions.
How will surgeons be trained/certified to perform via telesurgery?
Dr. Ross: "Surgeons undergo a rigorous training and certification process to become proficient in telesurgery. The process encompasses simulation training, robotic system training, certification programs, and continuous education. Surgeons utilize advanced surgical simulators to hone their skills in telesurgery procedures through repeated practice. They also gain practical experience with robotic surgical systems under the guidance of experienced practitioners.
By completing accredited programs and certification in robotic surgery, surgeons ensure their readiness and proficiency in telesurgery. Surgeons are encouraged to pursue ongoing training to stay abreast of the latest advancements and continually refine their telesurgery skills.
Advice for Doctors Interested in Telesurgery
Dr. Ross: "As medical professionals, it is important to embrace new technologies responsibly and prioritize patient care. When considering telesurgery, we should stay informed about the latest advancements in telesurgery and robotic systems and seek specialized training to gain the necessary skills and experience. Connecting with other professionals in the field can provide valuable knowledge and support. As we integrate these technologies into our practice, let's advocate for their adoption to benefit our patients and profession."
Dr. Sharona Ross is a Board-certified Advanced Foregut and HPB Surgeon
at AdventHealth in Tampa, FL, and founder of the