Enabling Technologies for Remote Surgery

摘要

INTRODUCTION: There is a significant deficit in surgical capability in distributed military environments. Remote surgery could address this lack of access as a force multiplier for expert surgeons. A low-mass miniature surgical robot operated over a low-latency, secure network would allow expert surgeons, whether located in the Continental United States (CONUS), or outside the continental United States (OCONUS), to perform remote surgery. MATERIALS AND METHODS: We developed and tested a rapidly deployable end-to-end remote surgery solution combining a miniature surgical robot with a secure, low-latency network platform. Miniaturized In Vivo Robotic Assistant (MIRA) is a ∼2-lb, low-power (∼30 W) robot, with dual motorized arms, integrated camera, interchangeable end-effectors, and mono- and bi-polar cautery. It has a significantly smaller footprint than mainframe surgical robots and can be deployed in any standard operating room. The system was tested across multiple distances (5-1,800 miles) over fiber-optic networks. Remote surgeries were performed on porcine models to evaluate system performance and surgical capability. RESULTS: More than 20 successful procedures were completed across multiple testing scenarios, including colectomy, cholecystectomy, hysterectomy, partial hepatectomy, and nephrectomy. The fiber network had consistent low latency and high reliability across all distances. Seamless visual and verbal communication was maintained between remote surgeons and bedside teams. The system demonstrated successful deployment and operation in standard operating room environments with minimal infrastructure requirements. DISCUSSION: Lightweight, easily transportable MIRA systems can be rapidly set up in Role 3 and possibly in lower levels of care. In MASCAL (mass casualty) events caused by chemical, biological and radiologic attacks that limit ingress and egress over significant geographies, lightweight MIRA telesurgical systems could be readily supplied by drone and operated over secure low-bandwidth (<40 Mbps) wireless networks. CONCLUSION: This novel telesurgical platform demonstrates the potential for expanding surgical capability in military medical operations through remote expert intervention. The system's low mass, minimal power requirements, and robust performance make it potentially suitable for deployment in contested austere environments.