For generations, geography has been one of the biggest barriers to specialized surgical care. Advances in robotic surgery, telecommunications and cybersecurity may soon make distance far less relevant.
A recently published international consensus statement in the World Journal of Surgery outlines how health systems can safely implement remote robotic-assisted surgery, including standards for training, patient safety, cybersecurity, informed consent and emergency preparedness. The recommendations were developed by experts from 14 countries through a consensus conference organized by the Clinical Robotic Surgery Association.
Access to expertise without requiring travel
Momentum is accelerating. While not yet approved by the U.S. Food and Drug Administration, more than 1500 remote robotic procedures have been performed worldwide, and an upcoming study on a randomized trial will demonstrate that remote robotic surgery produces outcomes comparable to in-person robotic surgery for select urologic procedures. Experience across multiple countries has shown that surgery can be performed safely across significant distances using modern robotic platforms and secure communications networks.
For oncology, this raises a simple question: What if patients no longer had to choose between staying close to home and receiving specialized surgical expertise? Yet patients frequently seek care closer to home because of travel burdens, family responsibilities, insurance limitations, ongoing valued relationships with local oncologists, or limited access to specialty centers. Remote robotic surgery could help extend subspecialty expertise into community hospitals and geographically distant regions while allowing patients to remain within their local health systems and with their trusted oncologists.
At City of Hope, investigators have spent years evaluating long-distance telesurgery workflows in preclinical and animal models. The goal was to determine whether complex surgical procedures could be performed safely and reliably when surgeon and patient are separated by distance. In one study, surgeons in California remotely performed 20 procedures on models located in Illinois using a telecommunications network spanning more than 3,600 roundtrip miles. Procedures included nephrectomy, colectomy, cholecystectomy and gastric operations. All were completed without loss of robotic control, network interruption, audiovisual failure or intraoperative complications. Average network latency was 58 milliseconds, with no packet loss recorded. Most participating surgeons reported that the remote experience was comparable to conventional robotic surgery.
Building the framework for clinical adoption
As promising as the technology is, implementation will require clear safeguards for patients and providers. The international consensus recommendations emphasize informed consent, standardized training, team credentialing, emergency preparedness, cybersecurity requirements and prospective outcomes tracking. The guidelines also call for institutions to record cases in registries to support ongoing evaluation of clinical, technical and network performance.
If the technology, training and safeguards continue to advance together, geography may become far less important in determining who has access to specialized cancer surgery.
The recommendations represent one of the first internationally agreed frameworks for remote robotic surgery, a process coordinated through the City of Hope Department of Surgery. At the institutional level, success will depend on far more than purchasing a robotic platform. Health systems will need secure communications infrastructure, trained surgical teams, standardized workflows and participation in registries that track outcomes as the field evolves.
For decades, patients have traveled to expertise. Remote consultation popularized over the recent years now allow cancer treatment decisions to be rendered through telemedicine. Remote robotic surgery raises the possibility that therapeutic expertise could also increasingly come to patients. If the technology, training and safeguards continue to advance together, geography may become far less important in determining who has access to specialized cancer surgery. We will still need to optimize the surgeon-patient consultations to be sure that in addition to favorable cancer outcomes afforded by remote surgery, the human relationship between doctor and patient remains intact.
City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the U.S., is leading the development of international consensus recommendations for remote robotic-assisted surgery. To learn more about City of Hope, visit: www.cityofhope.org. Discover the latest innovations in cancer research on City of Hope’s new podcast, “On the Edge of Breakthrough: Voices of Cancer Research.” Available on Spotify, Apple Podcasts, and at cityofhope.org/edge-of-breakthrough.
