Even with all the advanced technology aboard the Starship Enterprise, Star Trek's Dr. McCoy still had to be in the same room as his patients. But that's not the case any more, here in real life.
In fact, it’s hardly even a gimmick anymore. Telesurgery is now considered a mature technology.
As with so many technical advances in medicine and other fields, telesurgery has its roots in the space program. It was back in the 1970s when NASA first lit a fire under researchers to come up with some answers to questions like, “What happens if an astronaut at a space station is in need of an emergency appendectomy?”
The groundwork for long-distance surgery was laid in the 1980s with advancements in laparoscopic surgery. This technique, also known as “minimally invasive surgery,” describes the procedure where an operation is performed in one area of the body from an incision made elsewhere through the use of a long fiber-optic cable.
The key component in the equation is the robot at the patient side of the link, which is controlled quite granularly by the remote surgeon. The doctor sees what the robot sees, and the robot moves its arms and hands in response to the doctor's own movements. There is complete two-way communication between the surgeon and the assisting team at the patient's bedside.
The efforts of NASA were assisted by the US Army, who have a keen interest in being able to perform procedures upon wounded soldiers without endangering medics. These culminated in 2001 with the first transatlantic operation conducted by surgeons in New York from IRCAD (Institute for Research into Cancer of the Digestive System) on a patient in France. Remotely controlling a three-armed robot named ZEUS, equipped to hold 28 different surgical implements, the surgeons behind “Operation Lindbergh” set the telesurgery standard.
Five years later at Aquarius, the underwater laboratory off of Key Largo, a remote-controlled robot was used to sew up a cut in conditions more accurately simulating space surgery.
Strictly speaking, however, telesurgery is not robotic surgery. The latter phrase is more accurately used to describe the work done by a machine that has been wholly programmed in advance by a doctor. Telesurgical devices, such as the Da Vinci system manufactured by Intuitive Surgical, are controlled in real-time by the remote surgeon.
In at least one very meaningful area, telesurgery can actually improve a doctor's game. The user interface provides the surgeon withthe means to filter out the normal jitters and tremors that typically plague a surgical procedure. The surgeon can review his moves and maneuvers, and their implications, within a complete 3D visualization before actually performing them.
“Mission,” as they like to say at NASA, “accomplished.” Yes?
Except there is that not-so-small matter of astronomical distances. Network latency is an annoyance when you’re watching your favorite series on Netflix, but when you’re having your gall stones removed, the stakes are a bit higher. The established time-delay for Operation Lindbergh, with surgeon and patient separated by 7,000 kilometers, was 135 milliseconds. That was pretty good, physics-wise, with the technical procedures having been abetted by network and telecommunications experts from France Telecom.
However, studies indicate that a delay of more than 150-200 milliseconds would be preemptively dangerous. Satellite transmission would introduce a lag of more than 600 milliseconds. And the lag when patching a patient up on a Mars mission would be 20 to 30 seconds. Worse yet, every two weeks direct communication would be blocked by the sun! What's a sick astronaut to do?
One approach is a mix of telesurgery and true robotics. A sequence of procedures would be pre-programmed into the robotics system that could be triggered remotely, and/or with assistance on the station itself. Such techniques would be effective up to about 380,000 kilometers, or roughly earth-moon orbital distance. Past lunar orbit, special “predictive” engineering algorithms are being fabricated which project the intended motion of surgical tools “ahead in time” and can push the boundaries of telesurgical lag up to 2 seconds.
At even greater distances, medicine would rely less on telesurgery and more on telementoring. Master surgeons back on earth, through exchanges with their space-bound colleagues of a combination of data transfers, still images, some motion video, and electronic chat would walk the space medics through the steps required for the operation. NASA estimates that such telementoring procedures would be effective in conditions of up to 50 to 70 seconds of delay – or a distance of approximately 10 million kilometers.
At a delay threshold of 60 seconds, it is neither convenient nor practical for doctors on earth to call the shots. Although the terrestrial teams can provide support, missions to Mars and the outer planets would require a trained surgeon on board (“Dr. McCoy, report to Sick Bay!”) to handle any unforeseen medical emergencies.
The good news is that space has seen no shortage of doctors. Since 1973, 23 astronauts have also been MDs and have participated in 49 missions into The Great Expanse. And we're churning out more. Baylor College of Medicine established the Center for Space Medicine in 2008. The center brings together multiple Baylor College of Medicine departments, the National Space Biomedical Institute, NASA, and other academic, industry and government groups with a mission to “be a world academic leader in space biomedical research and education and translate the advances in knowledge and technology to benefit life on earth.” Excelsior!