director, Centre for Minimal Access Surgery


Imagine emergency open-heart surgery being performed by a robot surgeon in an ambulance parked on a street. This might be a real possibility in a few years. Scientists, doctors and technology companies are developing portable robotic units that can perform complex surgical procedures remotely from any location. When the mock surgery was a success, we realized a portable robotic unit would be a viable option. Dr. Mehran Anvari>Text

In this future scenario, a multi-armed robot would perform the operation under the direction of a surgeon manipulating endoscopic cameras from a remote workstation. The robot would act as the eyes and arms of the surgeon.

This type of portable robotic unit is being developed by the Centre for Minimal Access Surgery (CMAS), a Hamilton, Ont.-based research institute, in partnership with Bell Canada, which is providing the advanced telecommunications needed for the project.

The portable robotic unit is being touted as an important achievement in tele-surgery that involves sophisticated robots mimicking a surgeon’s hand movements from a distance.

“Robots have been used in operations where surgeons have been present in the same room. With this unit, it will be the first time a robot would be operating when the surgeon is at a different location,” said Harvey Stein, senior director of solution architecture at Bell Enterprise Group.

“Our target is to complete this project in the next five years,” said Dr. Mehran Anvari, director of the CMAS.

He said the portable robotic unit would be used in space missions, war zones and other environments where access to surgeons is extremely difficult. “It may also be used in remote regions of the Canadian North, [from] where the government spends millions of dollars to transport patients to city hospitals,” said Anvari.

The development of the robotic unit is part of a bigger mission that began three years ago as a partnership between the CMAS, NASA, the Canadian Space Agency, and several technology companies including Bell Canada and Cisco Systems.

Dubbed NEEMO 9 (NASA’s Extreme Environment Mission Operation), the coalition has been working to test the efficacy of tele-surgery in outer space.

A key goal of the NEEMO 9 coalition was assembly of a robotic unit that would allow physicians to perform surgery remotely in outer space. In April this year, a mock surgery was conducted at a laboratory station 67 feet (20 meters) below the sea near Key Largo, Florida.

Anvari directed the surgery from his high and dry office in Hamilton while the robot operated undersea.

“When the mock surgery was a success, we realized a portable robotic unit is a viable option,” said Anvari.

However, experts agree much work needs to be done before the portable robotic unit becomes a reality. A major limitation is the time delay, or latency, that occurs when the video images and signals controlling the robotic arms are transmitted over long distances to the surgeon.

To explain how latency affects actions, Anvari gave an example of the simple task of drinking coffee. When a person raises a cup to his mouth, he knows the action will end with it touching his lips. If latency were to affect this action, there would be a gap of few milliseconds during which the person would be unsure about the final destination of the cup. “When we perform surgery we cannot afford such moments as the stakes are very high.”

Previous research has shown that surgeons can adapt to latencies of 200 milliseconds to a maximum of 500 milliseconds. However, the latency surgeons would encounter while using the robotic unit over long distances would be longer, about one second. “We have to find a way to manage this problem,” said Anvari.

The NEEMO 9 mission tried to find a solution to this problem, and this research is being taken further by the CMAS.

Another concern is the cost of a portable robotic unit. Anvari said the commercialized unit will be affordable, and scientists working on tele-robotic surgery at other research facilities agree.

“As tele-surgery evolves, the costs will continue to decline. In the long run, tele-remote medical care will, in all probability, become the most cost-effective avenue,” said Dr. Christopher Schlachta, medical director at the Canadian Surgical Technologies and Advanced Robotics, a London, Ont.-based research centre.

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