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International surgery symposium

A robotic operation to remove a patient’s rectal cancer has been streamed live to surgeons around the world, offering anyone with internet access the ability to witness robotic surgery first-hand.

The operation, which is believed to be the first robotic procedure to be live-streamed directly via satellite, was conducted jointly by Mr Tas Qureshi, Consultant Surgeon and robotic lead at Poole Hospital, and Professor Parvaiz, Professor of robotic surgery at the Champalimaud Foundation.

Mr Qureshi transmitted surgery live from his operating theatre directly to an international symposium of experts in the field of rectal cancer surgery, held in Poole, and to a worldwide audience via multimedia platforms with live audio and Twitter feedback - the first time using a live robot.

Mr Qureshi web

Mr Qureshi comments, “The live stream enabled over 100 delegates at our symposium, and anyone online, an opportunity to witness a robotic case being performed with audio links allowing questions to be asked of the surgeons in real time. In addition, through an affiliation with the University of Portsmouth, the case was recorded using virtual reality technology, allowing anyone with a smart phone to have an ‘immersive experience’ of theatre environment, a world first for a robotic case we believe.”

The stream offered the viewer both a 360-degree perspective of the operating theatre, as well as a ‘robots-eye-view’ of the inside of the patient. The live stream was part of an International Rectal Cancer Symposium, organised by Mr Qureshi at Poole Hospital (recently named as the European epicentre for robotic colo-rectal surgery) attracting the world's leading authorities in the field. da Vinci Xi 2

The da Vinci robot, which was used for the surgery, is operated remotely from the patient using a console and provides high definition 3D images with the most sophisticated instruments available. This allows much greater precision, which benefits the patients in the short and long term. Mr Qureshi adds: “There are some myths about robotic surgery and it’s important for patients to be reassured that the robot is unable to work or move independently. I control every movement the robot makes by sitting at a console, which is like a remote control device for the robot.”

The da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no mechanical wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a 2D video monitor to see an image of the target anatomy. The surgeon must also rely on a patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments and using controls at the console to move the instruments and camera. Surgeons can also sit at dual consoles and remotely work collaboratively to assist each other.

Mr Qureshi comments on the enhanced performance of the robot: “Traditional keyhole surgery, or laparoscopic surgery, has instruments with very primitive movements. The Robot provides me 3D high definition views and wristed instruments able to peform 7 degrees of movement, the human hand has only six. This means I can very precisely access difficult areas in the body and take cancers out with better precision, and with much more confidence that the whole cancer can be taken out. This hopefully will mean patients require less  radiotherapy and chemotherapy, both of which can be difficult for patients.”

The mode of transmission of the live stream using satellite rather than physical ISDN lines has implications not just for real time teaching but also for the potential of robotic telesurgery in the future - a specialist can operate remotely from an identical console on a patient from anywhere in the world or even assist a colleague on a similar console in the operating theatre remotely.

The current constraint for robotic telesurgery is a physical reliance on the Internet with its potential to slow down transmission especially during times where an unforeseen peak in social media may suddenly devour redundant bandwidth. Point to point satellite overcomes this potential hurdle.

“It will be exciting to see this technology develop further in the coming years, providing a fantastic teaching and training platform, and perhaps allowing patients to be operated remotely all over the world, by the best surgeons,” concludes Mr Qureshi.

Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB. Tel: 01202 665511

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