What if the internet connection breaks? Concerns around cross border surgery

A urological surgeon present in Wuhan (China) operated on a 57-year-old woman patient admitted in a hospital in Hyderabad.

Can a surgeon operate on a patient who is 3900 km away from the operating table? — robotic telesurgery made it possible for an Indian-origin surgeon to perform a cross-border, virtual surgery for the first time, using a high internet connectivity.

Reportedly, virtual surgeries of this kind require broadband speeds of around 30 to 50 megabits per second to prevent any breakage in the connection.

While the procedure reflected a transformative step forward in the surgical realm, it also made people curious of what happens if the internet gets disconnected due to logistical reasons.

The urological surgeon present in Wuhan (China) operated on a 57-year-old woman patient admitted in a hospital in Hyderabad.

The 57-year old woman had showed up at Asian Institute of Nephrology and Urology (AINU), a hospital located in Banjara hills of Hyderabad, reporting difficulty in urination.

The woman had an abnormal narrowing of the ureter (a tube that carries urine from the kidneys to the bladder). While the doctors had placed a stent (a small tube inserted into a blocked vessel or another tube) to expand the ureter and restore the flow of urine into the bladder, the intervention didn't help her much.

Her symptoms kept returning, indicating a persistent blockage in the urine passage.

The only viable treatment to her recurring symptoms was to perform a ureteric reimplantation — a surgical procedure where a damaged part of the ureter is detached and reconstructed to allow the flow of urine without it going back towards the kidneys (anti reflex).

While a surgeon can perform an open surgery to reach up to the narrowed ureter, with the assistance of the da Vinci surgical systems that allow robotic surgeries, the lead urologist Dr. Syed Md. Ghouse (Director Robotic & Minimal Access Urological Surgery at AINU), who was then present in the Tongji Hospital (China), decided to do a cross border robotic surgery.

The patient consented to have a remote robotic surgery, the first of its kind in the country.

How was the surgery performed?

There are three units to the surgical system used by Dr. Ghouse — a robotic arm that would operate on the patient, a 3-D camera capturing and providing magnified visuals of the surgical site and a console where the surgeon sits and controls the movement of the robotic arm using some levers, even at a significant geographical distance. 

The virtual system is supported by a high connectivity internet service, informed the lead surgeon.

As per the surgical team, the surgery was performed with less than ‘100 millisecond latency’ which implied the internet data was exchanged between the surgical remote and the robotic arms in less than a blink of an eye.

As per the operating surgeon, it felt like he was physically present at the surgical site.

Dr. Ghouse sitting near the surgical console. 

To ensure patient safety, a twin team of surgeons were present at two distant focal points - two with the virtual operating system in Wuhan and two by the side of the patient, monitoring the robotic arm in Hyderabad.

The teams remained connected over a high-quality virtual call.

Internet connection - a concern

The entire surgical procedure was held by a delicate, high connectivity internet connection which raises concerns around a possible break in the network in midst of the surgery.

As per The Hindu, there are at least two to three leased lines of internet, if one fails, other covers up for the unprecedented gap.

Also, Dr. Ghouse informed the media outlet that the surgical assistants sitting next to the patient bed can always take over the surgery in case they notice any unusual time gap. 

“This milestone reflects how technology is redefining the boundaries of surgical care. With robotic platforms and robust connectivity, we can now deliver highly specialized procedures across continents with the same precision as being physically present. This is a significant step towards equitable access to advanced cancer care,” said Dr. Ghouse.