The Role of Virtual Reality, Telesurgery, and Teleproctoring in Robotic Surgery

Surgical robotic systems are not only telemanipulation tools, but also computer interfaces integrating multiple additional features (e.g., real-time display of 3D reconstructions of preoperative imaging, allowing virtual and augmented reality guidance). Double console systems already support proctoring within the same operating room, and they could be set up at any distance with an adequate network connection, allowing for teleproctoring and intraoperative telesurgical assistance. In 2001, the Lindbergh Operation demonstrated that remote robotic surgery can be performed safely. This completely telesurgical transatlantic cholecystectomy was performed via the surgeon console in New York, United States, controlling the ZEUS robotic system’s patient-side cart in Strasbourg, France. Back in the early years of robotic surgery, the cost for the availability of a high-speed terrestrial optical-fiber network with asynchronous transfer mode (ATM) technology for data transport was substantial, and remote telesurgery was cost-effective neither for routine procedures nor for increasing access to healthcare. The advent of fifth-generation cellular networks (5G) generates a technology standard for broadband connectivity with low latency. Its availability provides a more economical solution than ATM technology, and 5G networks will become the backbone for a democratized robotic telesurgery. Download speeds can reach the gigabit per second (Gbit/s) range, and broadband capacity will further increase during the rollout of 5G networks. In combination with near-instantaneous latency, 5G will even allow the integration of virtual and augmented reality into telesurgery.