Telesurgery may soon be practical option in Japan

The Yomiuri Shimbun
A surgeon wearing 3D glasses manipulates a surgical robot, while looking at a monitor showing an operating table in Fukuoka City, at Kyushu University Beppu Hospital in Beppu, Oita Prefecture, in March.

FUKUOKA — Telesurgery, where, for example, surgeons in urban areas remotely perform surgery on patients in rural areas, is heading toward practical use in Japan.

Behind this is the further advancement of telecommunications technology, which has made it safer to manipulate surgical robots from a distance.

The innovative medical procedure is particularly promising for rural residents because it will allow advanced surgeries to be performed even in areas with few surgeons.

There remain, however, issues on ensuring patients’ safety, so the Japan Surgical Society aims to publish guidelines for performing telesurgery by the end of this year.

In March, Kyushu University conducted a telesurgery demonstration by connecting its affiliated hospital in Fukuoka City with another affiliated hospital in Beppu, Oita Prefecture, about 100 kilometers away.

At Kyushu University Beppu Hospital, a monitor displayed an animal placed on an operating table at the hospital in Fukuoka. The animal was used to create a situation similar to human surgery.

“I will make the incision in this area,” a surgeon in Beppu said as he gripped both hands to manipulate a surgical robot in Fukuoka.

On the operating table, the scalpel attached to the end of the robotic arm moved delicately as the surgeon in Beppu moved his hands. A surgeon in Fukuoka also took turns operating the robot, and a kidney was removed from the animal in about an hour.

Manipulating the robot from Beppu was the university’s Associate Prof. Junichi Inokuchi, who said: “It did not feel distant. It was smooth.”

Last year, Kyushu University conducted a test to control a medical robot remotely by connecting with Hokkaido University and Sapporo Medical University. Hirosaki University in Aomori Prefecture is also engaged in similar tests for telesurgery.

High-speed communications

Universities are beginning to focus research on telesurgery since the Health, Labor and Welfare Ministry revised guidelines for online medical care in 2019. The guidelines set forth a policy to put telesurgery into practical use.

The current situation was prompted by the development of communications technology. Although research on the technology has been conducted for about 20 years, concerns about communication delays had not been completely resolved because vast amounts of data need to be exchanged. Communication delays could cause life-or-death problems, for example, in the case of sudden bleeding, if there is a large time lag between the surgeon’s manipulation and the robot’s movements, it could lead to massive loss of blood.

Kyushu University received the cooperation of NTT West Corp. to provide a high-speed communication line for its tests, confirming that the time lag between the surgery room and the robot console was about 5 milliseconds, even over a distance of about 100 kilometers.

Surgical robots are becoming popular particularly in laparoscopic surgery for cancer. Besides the da Vinci surgical systems made in the United States, domestically produced surgical robots have also appeared in recent years. Kyushu University used in its March test a robot under development by Riverfield Inc., a Tokyo-based startup launched by the Tokyo Institute of Technology.

Assistance to primary doctor

In the case of problems such as communications being interrupted, the surgery can be continued locally.

“There is always a primary doctor next to the patient,” said Eiji Oki, an associate professor at Kyushu University. “The experienced specialist surgeon remotely assists the primary doctor in performing the surgery.”

He explained that even telesurgery requires a primary doctor and other medical staff on-site who have the skills to carry out the surgery.

The Japan Surgical Society is working with telecommunications carriers and lawyers to create guidelines on telesurgery, which will specify requirements for the telecommunications environment, careful explanations of the benefits and risks to patients and how to deal with problems that may arise. After the society releases the guidelines, telesurgery will enter the phase of clinical use for human patients mainly at university hospitals.

“It is important that staff at the location of the surgery and remote surgeons communicate with each other and prepare for various problems that may occur,” said Satoshi Hirano, a professor at Hokkaido University involved in compiling the guidelines. “Telesurgery will also provide an opportunity for surgeons in rural areas to learn advanced techniques from their mentors at university hospitals and other institutions.”