A surgeon from St. Joseph’s Healthcare in Hamilton was able to perform remote suturing on a patient simulator located in Aquarius Habitat off the shores of Key Largo, Fla. on Sunday.
Dr. Mehran Anvari, with McMaster’s Centre for Minimal Access Surgery (CMAS), performed the operation on the simulator, which was located 19 m under water in the Aquarius Habitat, operated by the U.S. National Oceanic & Atmospheric Administration.
“We were challenged by NASA and the Canadian Space Agency to develop technologies and techniques to reach a patient in an extreme environment in the absence of a physician or surgeon,” said Dr. Anvari. He was part of a joint mission to test a portable robotic platform that can be dropped into an extreme environment and set up locally using relatively common telecommunications technologies.
Scientists were also testing the effect of signal latency (up to three seconds) and whether this hinders the capability to perform tele-robotic surgery in remote settings – both on earth and for future space missions.
NEEMO 9 (NASA’s Extreme Environment Mission Operations) tested remote surgical technologies in an underwater environment, where conditions are similar to those found in space. The mission is a joint effort between CMAS, the Canadian Space Agency, NASA, the U.S. Army Telemedicine and Advanced Technology Research Center and the National Space Biomedical Research Institute.
In an extreme environment you have to use whatever is available, said Dr. Anvari, and you don’t have the luxury of requesting an IP VPN network. While the natural time delay from Hamilton to Aquarius Habitat is somewhere around 350-500 milliseconds, scientists wanted to test time delays of two to three seconds, which is the delay from the earth to the moon and back. This is similar to two satellite hops from one end of the globe to another.
“We proved that remote tele-surgery is not only viable to connect community hospitals to teaching hospitals as we did three years ago, but tele-surgery can allow you to reach the most remote patient in an extreme environment,” said Dr. Anvari. This could help to minimize the risk of deep-space travel, providing astronauts with access to medical care while they’re millions of kilometres from earth. It could also be used in disaster zones, where a surgeon in North America, for example, could access a patient in a disaster zone in Africa or Asia with a couple of satellite hops.
The mission included network technologies from Bell Canada, including its MPLS virtual private network (VPN), high-speed dedicated Internet, site-to-site IPSec tunnel, FW security and wireless access. The VPN is based on MPLS technology from Cisco Systems.
“For this experiment they wanted it to be extreme and unpredictable and see how well things worked under those conditions,” said Harvey Stein, senior director of solution architecture with the Bell Enterprise Group. “They did have technical issues with some of the computers that didn’t like the high pressure of the environment – they’re under about three atmospheres of pressure.”
Some applications are more latency-sensitive than others, he said, depending on whether you need immediate visual feedback of your motions. This research is looking at how well people can adapt to latency. “It’s almost like playing an instrument – with practice you can get very good at it,” he said. “So dealing with latency is sort of the same thing.”
It’s still an emerging field as technology converges on a number of fronts, including surgical techniques, microscopic surgery, telecommunications, robotics technology and video-compression technology.
While space is not a huge market, said Stein, Bell’s interest lies with providing clinical applications to remote parts of Canada, as well as other remote applications in areas such as mining.