Transcript 09212005-robots-harnett

Advanced Network
Opportunities for
Surgical
Tele-Robotics
Fall 2005 Internet2
Member Meeting
Brett Harnett*
Assistant Professor, Research
Department of Surgery
*Contributors
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Brian Miller, PhD, Intuitive Surgical
Ken Wood, BS, Senior Systems Engineer, TATRC
Barry C. Herman, MSE, Researcher, WRAMC
Jean-Marc Gosselin, Haivision Systems, Inc.
– Peter Maag
Coming to a home near you?
Courtesy: Wired Magazine
Having Vision
In 1924,
Radio News
envisioned a doctor
examining a
remote patient via
the electromagnetic
spectrum.
A Paradigm Chasm
“It has become appallingly obvious
that our technology has exceeded
our humanity. ”
~Albert Einstein
Think Creatively
Even if you are a doc
Nomenclature
• Telemedicine: application of
telecommunications in medical care
• Telesurgery: remotely performed
surgery through combined use of
telecommunications and a surgical
robot
How Stuff Will Work?
Operation Lindbergh
Sept 7, 2001
8Mbps 155msec ATM network + Zeus TS
New York - Strausbourg
Laparoscopic cholecystectomy
The daVinci
Images courtesy of Intuitive Surgical
Traditional vs. Robotic
Diagrams courtesy of Intuitive Surgical
ATA Demonstration
The message:
“Raising The Bar: Improving Technology in
the Continuum of Care”.
• Key Partners
• Intuitive Surgical (medical robots)
• Walter Reed Army Medical Center
• Johns Hopkins University
• University of Cincinnati
Courtesy: HaiVision
Network Configuration
10 Mbps
Sunnyvale ISP
NextWeb
8 Mbps
Public
Internet
Denver ISP
Priority Networks
1.8 Mbps
1.8 Mbps
Denver - ATA Show
Sunnyvale - Veterans Hospital
ATA Demo
April 2005
- No VLAN
hai560
- No QoS
hai560
Courtesy: HaiVision
ATA Configuration
• hai560 codec on show floor at ATA
Denver
• hai560 codec in Operating Room at
Sunnyvale Veteran’s Hospital, CA
• Local ISPS in Denver and Sunnyvale
connected over public Internet
Courtesy: HaiVision
Critical Interaction Attributes
• Critical Interaction Attributes
• Low latency for hand-eye coordination
– typically 40ms network and less than
120ms video encoding
• Best video quality – full resolution DVD
quality
• Resiliency to network jitter and lost
packets
• High reliability hardware and software
– no resets, reboots, etc.
Courtesy: HaiVision
Surgical Performance
Mean Times: Suturing
Mean Errors: Suturing
Real Time Internet Connections:
Implications for Decision Making in Laparoscopy
• Purpose:
– To determine if low bandwidth Internet connection can provide
adequate image quality to support remote surgical consultation
• Method:
– Lap CCY in Ecuador & DR remotely proctored via Internet connection
– Local and remote images were screen grabbed and placed in a webbased tool
• Result:
– First to identify critical laparoscopic anatomy via an Internet connection
– Successful proctoring of 6 lap CCY via an Internet connection
– In the web-based tool, remote/local images indistinguishable
• Conclusion:
– Low bandwidth, Internet-based telemedicine can support intraoperative
consultation in laparoscopic surgery.
Broderick et al. Ann Surg 234(2): 165-71; 2001
Battlefield Extraction
Credit: USAMRMC / TATRC
We must focus…
Telecom Issues
Telemedicine
Telesurgery
Security
Encrypted
Encrypted VPN
Protocol
IP
IP
Bandwidth
Kbps
Mbps
Latency
Async & Sync
Sync - Lowest
QoS
Low
High
Availability
Widespread
Limited
Cost
Low
Prohibitive
Primary Issues
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Bandwidth - How much is really needed?
Scalability – To what extent?
QoS – Surgical grade network with prioritization
Inter-Networking - Peering points, tariff
agreements
Standards - Ensuring interoperability and cost
reduction
Security – Privacy, loitering, DoS, etc.
Military requirements – on the battlefield
NASA – Orbital and lunar, not interplanetary
Metrics
• Performance
– Latency
– Jitter
– Packet Loss
• From Commerce Internet (CI) to CI with QoS
• From CI to Cincinnati Bell LAN Advantage
• From CI to Internet2
SYNCHRONOUS transfer; UDP
Internet2 Can Do
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Virtual Reality
Telepresence
Avatars
Reverse Sensory Underload
Challenges
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Bandwidth
Scalability
QoS
Haptics & visual fidelity
Interoperability
Risk analysis/liability
Operationally - contingency plans when…
When Things Go Wrong
In a Nutshell
• Standardization efforts should continue, with
emphasis on interoperability standards of network
protocols and interfaces for telerobotic surgery.
These would be validated/benchmarked via
demonstrations, possibly between institutions that are
part of an organized standards collaboratory.
• The network could extend between robots, robots
and other O.R. equipment, interfaces with clinical and
imaging information systems, onwards to possible
function on Internet2 to allow surgeons to train,
collaborate and tele-mentor cases. This could
eventually be used for telesurgical applications both
within and outside of a given hospital.
Mission Critical
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(Translation: Thank you!)
Brett Harnett
Research Assistant Professor
University of Cincinnati
Center for Surgical Innovation
[email protected]