Transcontinental robot assisted telesurgery
Professor Frank Fitzek
In 2001, surgery had a man-on-the-moon moment. In New York City, an endocrine surgeon sat down at a robotic console and operated on a patient, removing his diseased gallbladder.
What was so special about this? The patient was thousands of miles away in Strasbourg, France.
It was called Operation Lindbergh and the world had seen the first case of what we now call remote surgery, or telesurgery. The surgeon - Professor Jacques Marescaux - founded the European Institute of Telesurgery at the University of Strasbourg in 1994. His stated aim was ‘to start the future technological revolutions in the field of surgery, and not to fall behind them.’
Nearly 15 years on from Operation Lindbergh, and the possibility of routine remote surgery is coming yet closer - along with other technological revolutions in healthcare, which will change the way sick people are treated almost unrecognisably.
REMOTE SURGERY SHOULD BE ESTABLISHED AROUND 2025-2030, PROF. FITZEK PREDICTS. AND IT'S NOT JUST SURGERY THAT WILL CHANGE - ANY KIND OF MEDICAL EXAMINATION OR PROCEDURE WILL BE POSSIBLE REMOTELY, TOO, USING THE SAME 5G TECHNOLOGY.
The technology, once seen as impossibly futuristic but now on the visible horizon, is that of virtual reality, or the ‘tactile internet’, and the way it will work is through 5G - the fifth generation of mobile communications systems which will follow on from our current 4G era.
A brief history of mobile communications: the 1G era in the 1980s involved analogue cordless phones - we could hear one another on the move. 2G, from 1991, brought us digital mobile phones and SMS. With 3G from 2001, we saw the first smart phones with the Internet. And since 2010 we have had 4G, which is faster than ever, not just on smart phones but also tablet computers.
5G, predicted by 2017-2020, seems like a linear follow-up from 4G, but it will in fact feel exponentially different.
Professor Frank Fitzek, chair of the Communication Networks group at the Dresden University of Technology, which co-ordinates one of Europe's first 5G research centres, the 5G Lab Germany, explains: ‘The telephone was about places. The Internet was about people. Now 5G is about things.’
The Internet of Things, which 5G will allow, will mean that instead of the 7 billion online devices the world currently has (which equates to one mobile phone per human being), we will have a vast network of 500 billion such devices, from sensors to cars, according to Prof. Fitzek, which will all communicate with one another. For example, while we are driving we could be able to link with devices in other vehicles, which will allow us to see the road from different perspectives, improving visibility and safety.
Not only will we be able to see and hear through devices, but also we will be able to touch. 5G will see a massive reduction in latency, the delay between sending an instruction and getting a response. Our devices' latency in 2015 is currently around 50 milliseconds, but, says Prof. Fitzek, ‘We have to bring it down to 1 millisecond. When you touch something the delay from your arm to your brain - what you touch and what you see - is 1 millisecond.’ This is why, when devices can operate as fast as our brains do, we will have virtual reality, a so-called ‘tactile internet’.
And these devices, controlled by humans, will communicate in ground-breaking ways that will change healthcare forever. Remote surgery, one of the main medical applications of 5G, will take Operation Lindbergh wireless. In 2001 we had to have a special room for the doctor and for the patient. With 5G the doctor could be looking at a control device anywhere and all we will need with the patient is a robotic arm performing the doctor's actions.
Dr Marescaux's centre explains how it could work for doctors: ‘Virtual reality translates real data into digital data, allowing [us] to turn a medical scan into a virtual 3D clone of the patient. The surgeon can then [perform] the procedure on the patient's virtual clone, as these simulations are becoming increasingly realistic. During the intervention, the superimposition of virtual data on real data (augmented reality) permits a transparent view that should soon allow for the automation of complex surgical movements. This automation will only be possible by developing the field of surgical robotics.’
The 5G Lab Germany in Dresden is another centre working on 5G virtual reality. It has invented augmented reality goggles which allow the viewer to feel like he or she is touching a hard or soft ball. In reality there is no ball.
Prof Fitzek explains that the doctor will be able to feel like she can touch the patient's body and sense hard bones or soft tissue as well as seeing it, even though the patient may be thousands of miles away. Remote operations will, crucially, be done in real time thanks to 5G's incredibly low latency.
Remote surgery should be established around 2025-2030, Prof. Fitzek predicts. And it's not just surgery that will change - any kind of medical examination or procedure will be possible remotely, too, using the same 5G technology. Doctors and nurses will be able to give injections, take blood, give medicine, and attend to emergencies from far away.
Remote healthcare will be able to give medical aid in many situations where we currently struggle - in warzones or natural disaster areas, for instance; or if people are on a submarine or a plane, or in a remote area.
And carers or approved family and friends will be able to operate a humanoid robot which will aid elderly or disabled people in their own homes - lifting them out of bed or the bath for instance.
Fitzek stresses that ‘it's still personal’ - this is not a robot performing tasks automatically. A person will be steering the robot, talking with the person they are helping, and experiencing what the robot senses.
So what technology is needed to develop to allow this? One field of research is security. Of course, only a doctor should be able to perform operations or prescribe medicines. And so, Prof Fitzek explains: ‘We have to think about security so that no one is steering the device except you.
‘Currently we only use one single path in the Internet - we have one user and one cloud and that's good for hackers because they know where to attack your data. What we want to exploit is something called multipath - so that we send our data over multiple passes.’
‘Maths is the key to it. A packet [of information] is dangerous - it can be inspected by others. Instead of sending packets, we have to send coded information - send mathematical equations through the internet.’
We also have to think about what 5G researchers call resilience, or reliability - if you're steering devices you have to know that you can do it 100 percent of the time without losing the network connection and, notes Prof Fitzek, ‘this is quite complex in wireless devices’.
He adds: ‘We have to dramatically change our networks. Our services like health monitoring will run in the cloud. Where is the cloud? In the US. If you want to do medicine in 1 millisecond, the speed of light is too slow. Now you have two options - to change the speed of light, which Einstein couldn't do, or you have to get your cloud closer to the user. Proximity is the key. That means the cloud which runs my service has to be in the range of 100km around me.
‘But I'm not static, so the cloud has to move. This is something totally new to us - nowadays we are in a totally static network domain.’
And even then, we can't just have one cloud - we will need multiple clouds for security. But if you want to exploit multiple passes, multiple clouds, we get a problem called duplicates.
Prof. Fizek explains: ‘It's like collecting Pokémon cards - it's easy to start a collection but hard to finish it because you get doubles. This is the same as a network - if you want to send data over different passes, you sometimes get doubles and sometimes you miss. We have to solve these problems.’
Ultimately, researchers in the 5G field need to think about a multiplicity of clouds distributed over the network, which will move with each user, with real-time latency and flawless resilience.
A tough call, but it will happen, soon. And then, although it's hard to imagine now, the quest to establish 6G, whatever that will mean, can begin.
What can 5G do for you? http://europa.eu/rapid/press-release_MEMO-14-129_en.htm
IRCAD France http://www.ircad.fr/the-institute/