Tele-Robotic Surgery for Combat Casualty Care: Proof of Feasibility.

OBJECTIVE: These experiments test the feasibility of tele-robotic surgery for the shipboard care of combat casualties. SUMMARY BACKGROUND DATA: Limited research on the effects of telecommunications latency on tele-robotics has been a consistent concern in the growth of tele-robotic surgery. These experiments are designed to provide well-controlled real-world data on robotic surgical performance with electronically added latency that simulates combat-relevant, satellite-based tele-robotic communication. METHODS: Surgeons at 2 university hospitals separated by 1096 km bi-directionally performed remote cholecystectomy (Ch) and right colectomy (Co) dissections on cadaver subjects. Varying latency between 0 and 300 ms was electronically added. Network performance, OR time, Global Performance (GP), and Surgery Task Load Index (TLX) were determined. Statistical analysis: simple linear regression. RESULTS: Network latency was 28 ms, jitter 0.03 ms, with zero packet loss. Including robotic intrinsic latency of 50 ms, total latency (TOT) varied from 78 to 378 ms. 12 Ch and 14 Co were performed by 4 surgeons. Co OR time unexpectedly decreased with TOT (P=0.005), but Ch did not (P=0.47). OR time was strongly associated with general surgeon experience (P=0.024). TLX was strongly associated with surgeon experience (P<0.001) but not TOT (P=0.47). GP was consistently between 4/5 and 5/5 across all domains and did not correlate with TOT (P=0.41). Each surgeon showed rapid cognitive and motor adaptation to increasing latency. CONCLUSIONS: Experienced robotic surgeons rapidly develop cognitive and motor adaptation to tele-robotic latency. Satellite-based tele-robotic surgery in combat environments may add greater latency than fiber-optic-connected civilian applications. Our data indicate a significantly greater tolerance for latency than previously reported. Development of telerobotic surgery for combat casualties is highly feasible.