In real time, the Internet lag had no effect on the surgeon's ability to perform a remote robotic procedure, Smith said.
For example, the lag time between four Orlando campus hospitals measured 5 milliseconds; between Orlando and Tampa, 10 to 150 milliseconds. "There was no difference between that and [robotic] surgery 10 feet away," Smith added.
When the hospital tested lag time between Celebration, Fla. and a partner hospital in Ft. Worth, Texas, the lag time ranged from 30 to 150 milliseconds -- completely undetectable by surgeons.
So what if the Internet goes down?
"These results indicate that modern, well-connected facilities possess the communication bandwidth needed to safely perform telesurgery today," Smith said. "It appears that we have the technology, but we are still waiting for business cases and regulatory permissions to open the door for telesurgery."
A major hurdle to long distance telesurgery is Internet resilience. While a healthy Web connection may enable undetectable lag times, what about when a major news announcement leads to an explosion of bandwidth devouring social media activity?
Or, what happens when a bad actor decides to launch a denial of service attack?
Smith said that to date, the Nicholson Center has been able to compensate for any unforeseen Internet slowdowns or outages by using backup connections. And, if all else fails, the hospitals in which the telesurgeries are being performed will have a surgeon on call if needed. In other words, the patient will need to be in a hospital, at least in the immediate future, so a local surgeon can respond in case of an emergency.
Then, of course, there are major liability questions, such as who do lawyers go after if a telesurgery procedure goes south? Do they go after the hospital performing the procedure, the hospital with the robotic surgery equipment or do they go after AT&T or Verizon because the connection was lost?
But Smith said the benefits could outweigh the risks.
For example, wounded soldiers could be transferred to a nearby facility where a specialist thousands of miles away could provide topflight care.
In fact, the Nicholson Center's current telemedicine tests are being funded by a $4.9 million grant from the U.S. Department of Defense.
Additionally, medical volunteer services, such as Doctors Without Borders, could offer surgery to the rural masses, without the burden of having to fly around the world.
The benefits of robotic surgery
As laparoscopic surgery has gained popularity over the past 30 years, advancements have allowed greater precision with instruments; some laparoscopic procedures are so exact that surgeons can no longer perform them without robotic assistance.
For example, Smith said, when scopes use magnification, surgeons holding the long knitting needle-like laparoscopic instrument experience tremors from their slight, but uncontrollable body movements. Surgeons spend years developing muscle control in an attempt to quell the tremors. As surgeons age, though, tremors increase.
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