Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
PLoS One. 2022 Jun 16;17(6):e0270039. doi: 10.1371/journal.pone.0270039. eCollection 2022.
Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important.
To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments.
Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance.
Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041).
In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue.
远程手术的社会实施需要在经济的商业网络上实现低延迟和高度可靠的视频/操作信号传输。然而，在使用商业线路时，通信带宽经常会随着网络拥塞和窄带线路的干扰而波动，这些线路成为瓶颈。因此，验证通信线路低于所需带宽时对手术性能和外科医生疲劳的影响非常重要。
当带宽低于手术机器人要求时，明确图像传输和可操作性的通信带宽环境影响，并确定在次优环境下的外科医生疲劳水平。
使用新开发的手术机器人，通过商业 IP-VPN 线将两个相距 150 公里的医院连接起来。13 名外科住院医师在 1-Gbps 至 3-Mbps 的带宽下远程执行定义的缝合程序。在带宽变化前后评估通信延迟、数据包丢失、任务完成时间、夹具运动距离、视频降级和机器人可操作性。使用 Piper 疲劳评分-12（PFS-12）测量与外科医生表现相关的疲劳。
1-Gbps 和 3-Mbps 线的往返通信时间平均为 4 毫秒。从相机到监视器的视频传输延迟相当，为 92 毫秒。手术机器人信号传输速率平均为 5.2 Mbps，因此切换到 1-Gbps-3-Mbps 线路会导致显著的数据包丢失。外科医生认为存在明显的粗糙度、图像失真、复视和 3D 图像降级（p = 0.009），但不改变延迟时间或操纵性。所有外科医生都可以完成任务，但任务完成时间和夹具行程的客观测量明显延长（p = 0.013，p = 0.041）。此外，PFS-12 显示在 1-Gbps 和 3-Mbps 时术后疲劳增加。在 3-Mbps 时疲劳增加显著（p = 0.041）。
在带宽低于最佳水平的远程手术环境中，即使延迟时间和可操作性相当，视频降级导致的数据包丢失也会导致手术性能下降。这可能会导致外科医生疲劳增加。
