Feasibility of long-range telesurgical robotic radical gastrectomy in a live porcine model

Abstract

Background: Telesurgery has been made increasingly possible with the advancements in robotic surgical platforms and network connectivity. However, long-distance trans-national complex robotic surgeries such as the gastrectomy have yet to be attempted. Methods: Multiple trans-national network connections by Science Innovation Network (SINET), Japan Gigabit Network (JGN) and Arterial Research and Education Network in Asia-Pacific (ARENA-PAC) were established and tested by multiple surgeons in a dry box model. Surgeons’ perceptions of the different networks were recorded. Three robotic radical D2 gastrectomies in live porcine models were performed at a hospital in Toyoake, Japan by a surgical team in a hospital in Singapore approximately 5000km away using the hinotoriTM Surgical Robot System (Medicaroid Corporation, Kobe, Japan). Results: The live porcine robotic gastrectomies were all completed under 205 minutes with no intraoperative complications. From the different networks that were tested, the differences in latency ranged from 107-132ms and did not translate to any significant differences in surgeon timings and perceptions. Conclusions: Trans-national telesurgical radical D2 gastrectomy is feasible in a porcine model. There is no appreciable difference between surgeon performance and perception with network latencies of 107-132ms. Long-range telesurgery as clinical practice may become possible in the future.