Florida Hospital Shows Normal Internet Lag Time Won't Affect Remote Robotic Surgeries 125
Lucas123 writes: Remote robotic surgery performed hundreds or even thousands of miles away from the physician at the controls is possible and safe, according to the Florida Hospital that recently tested Internet lag times for the technology. Roger Smith, CTO at the Florida Hospital Nicholson Center in Celebration, Fla., said the hospital tested the lag time to a partner facility in Ft. Worth, Texas and found it ranged from 30 to 150 milliseconds, which surgeons could not detect as they moved remote robotic laparoscopic instruments. The tests, performed using a surgical simulator called a Mimic, will now be performed as if operating remotely in Denver and then Loma Linda, Calif. The Mimic Simulator system enables virtual procedures performed by a da Vinci robotic surgical system, the most common equipment in use today; it's used for hundreds of thousands of surgeries every year around the world. With a da Vinci system, surgeons today can perform operations yards away from a patient, even in separate but adjoining rooms to the OR. By stretching that distance to tens, hundreds or thousands of miles, the technology could enable patients to receive operations from top surgeons that would otherwise not be possible, including wounded soldiers near a battlefield. The Mimic Simulator was able to first artificially dial up lag times, starting with 200 milliseconds all the way up to 600 milliseconds.
Spikes (Score:5, Insightful)
Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.
Re:Spikes (Score:4, Interesting)
Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.
Maybe they should queue up sets of movements that are dependent. It would also suck if the internet connection dropped right after a cut but before the bleeding could be stopped. Although I'm sure they have physical staff present in case of emergency.
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Sure they do. A fresh out of school resident who has been awake and running scut work for 48 hours. No point paying a surgeon big bucks to stand around when the money can go to the hospital's CEOs.
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...or one who is constantly checking Twitter and Facebook on their phone.
"...lol i luv catz 2 oops patient bled out fml"
Re:Spikes (Score:4, Insightful)
It would also suck if the internet connection dropped right after a cut but before the bleeding could be stopped. Although I'm sure they have physical staff present in case of emergency.
They have, and they are not just for "emergency" - they prepare the patient, start the operation (including inserting -and hopefully removing- the laparoscop and the other surgical "tools"), and finish the job. Plus: usually they are those doing the actual operation, with the more expert doctor just observing, making suggestions, and performing *some* "cuts" that the less experienced doctors are not so confident doing.
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I just hope they don't dump these humans to let bots take over.
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Sounds good until you hit a latency spike. I'd hate to be getting sutured up and see the ping times climb to 2000 ms.
If only you could LEASE a LINE... (hint hint)
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"By stretching that distance to tens, hundreds or thousands of miles, the technology could enable patients to receive operations from top surgeons that would otherwise not be possible, including wounded soldiers near a battlefield."
If only you could LEASE a LINE... (hint hint)
"Hello? Comcast? Can you transfer me to the Kabul office? I need gigabit service to a hillside fifteen miles outside of... Hello? Hello?"
Florida hospital? Where #FLORIDAMAN frequents? (Score:2, Troll)
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Exactly!
Ever try and get AT&T or any other big carrier to listen to you while you explain in detail how their "bullet-proof service" is down and needs to be fixed? They have no fucking clue! How about if the PO has a problem and they think you're trying to get free data connections? No, nothing short of home-running a private, extendable to 24,000 miles, "bullet-proof", tamper-proof, Ethernet cable with an infinite:1 s/n ratio will be good enough for me. Thanks, but I'll go with the local surgeon for no
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I have. Even telling them where the packets are being dropped often doesn't help. My favorite was when my service went out, and after four days of going back and forth with them, it turned out that they'd somehow accidentally dropped the DSL router's MAC address from the authentication list.
Re: Spikes (Score:1)
I fly UAVs professionally. It's not the latency itself, but the jitter in the latency that's "not good"
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"Hello? Comcast? Can you transfer me to the Kabul office? I need gigabit service to a hillside fifteen miles outside of... Hello? Hello?"
Sure, We can be there next tuesday sometime between 8am and 4pm local time.
(3 weeks later, after 5 cancelled appointments)
Sorry, that location is outside of our service area.
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I've never seen a leased line have a 100% uptime guarantee as it's impossible to provide. There is always some chance out an outage.
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They happen because somewhere on the path a connection is overloaded and it's buffers fill up, maybe that is at your end, maybe it's at the other users end. Maybe it's somewhere in between. The internet is not and was never designed to be a network that provides bandwidth and latency gaurantees. If you want those you need to negotiate a specific route and priority access to that route between two specific locations. At that point I don't think you can reasonablly consider the conenction to be "the internet"
Ya, it's this simple (Score:1, Insightful)
How are DoS attacks going to be handled?
How is the data encrypted? (ECC I hope)
What about viruses? Is a Windows PC being used in the doctors office to communicate or are these actual real time embedded systems?
Even 1 mile away scares me.
What happens when a router between the two buildings goes down for 12 hours in the middle of open heart surgery and the surgeon is 2 hours away?
Who is liable for accidental death? The ISP, the doctor on site? The remote doctor? The robotics company?
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Error Checking Code for encryption? That sounds odd...
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It's a form of quantum encryption. Someone snooping will change the bits, causing errors. Once you detect errors you can shift garbage data down the line till they give up.
The idea came from observing teenagers talking to each other as a parent walks by.
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Give it up AC, we know who you are [slashdot.org]
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Denial of Surgery attacks? Handled by the lawyers, I'd expect.
Outsourcing (Score:1)
Who knew it would hit the hospital operating rooms so quickly?
Re: Outsourcing (Score:1)
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No kidding. How about we outsource something good like overpaid CEOs or Congress? :)
Should be pretty easy to do [amazon.com].
XSURGERY (Score:3)
150ms?? (Score:2)
If a surgeon doesn't have the hand eye coordination to notice 150ms delay, I do not want him operating on me.
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or record & monitor multitrack audio above a 6-8 ms delay.
Do you mean because of the delay between the "live" sound and the monitor sound? Just move 2 metres further away from the live sound. Problem solved!
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My robot learned to work the saxophone
It played just how I feel
It drinks scotch whiskey all night long
And dies behind the wheel...
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They got a name for the people in the world
I want a name for 3PO
The closest we got is Honda's bot
They call him Asimo
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I hope you never need surgery then, since the typical delay between observing something and *starting* to react to it is an order of magnitude *larger* than your stated maximum. And that's for a *local* observer who is already hands on. [1]
Of course, since *typical* internet lag (on a connection *not* routed through a satellite) is in the neighborhood of 30-150ms (round trip), you're still not in any actual danger since lags an order of magnitude higher than that didn't effect the surgical process.
Seriousl
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But the performance of stuff can be affected by less. You can notice irregularity in, say, tempo or timed actions at the 10ms level.
It may not necessarily affect surgical behaviors, but consider something like the all that calculus your brain does when it wants to catch a frisbee
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You won't have to worry about it for long. Da Vinci is almost certainly logging these surgeries for the purpose of training autonomous surgery robots.
Just like autonomous cars: in the beginning you'll only see "simple" operations automated(with supervision) but as time goes on: you'll have perfect repeatability from patient to patient.
There are plenty of third world countries where desperate people will sign up for a hair cut at a steep discount from an academy. By "hair cut" I mean "surgery" of course, and
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Automated surgeries will come, but it will be a while. I've had five surgeries (three knee, one shoulder, one hernia), and all doctors say the same thing when I ask...each surgery is just different enough to keep it interesting, and they always have to adjust their plan once they are in there. Hence the difference between good and great surgeons, it's their art as well as their science.
Re:150ms?? (Score:4, Insightful)
Re:150ms?? (Score:5, Interesting)
I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.
So I figured there has to be something else. The best hypothesis I could come up with is the current robotic surgery tools introduce their own lag such that the surgeons were unable to distinguish normal device response times from network latency. That, and the goals of a surgeon are completely different from an FPS shooter. A surgeon isn't trying to race anything or anyone - they don't have to shoot first. In a live operating theatre, they are methodical and cautious. It's not like there are sudden surprises that leap out at them that they have to instantly react to. Even a burst blood vessel takes a few moments to assess and plan a recovery from. So maybe if they're used to very slow approach, the latency doesn't impact them as much.
Re:150ms?? (Score:5, Funny)
I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.
Uh...if you are worried about the patient moving faster than you, perhaps it would help if you sedated the patient before starting the operation?
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I read the article, thinking this was an incorrect claim in the summary. Nope, the article insists in several places that it was "undetectable" by the surgeons. Now, anyone who's played any online FPS knows that 50ms ping times are not only detectable, but are approaching unplayable because some punk kid that's only 10ms away from the server is always taking the head shots before you can even see him.
So I figured there has to be something else. The best hypothesis I could come up with is the current robotic surgery tools introduce their own lag such that the surgeons were unable to distinguish normal device response times from network latency. That, and the goals of a surgeon are completely different from an FPS shooter. A surgeon isn't trying to race anything or anyone - they don't have to shoot first. In a live operating theatre, they are methodical and cautious. It's not like there are sudden surprises that leap out at them that they have to instantly react to. Even a burst blood vessel takes a few moments to assess and plan a recovery from. So maybe if they're used to very slow approach, the latency doesn't impact them as much.
That 50ms lag in a game is noticeable because there are other people who are also experiencing latency and the game is doing things to compensate for everyone being at a slightly different point of reference. If you were just controlling a camera pointed out your window with a 100ms latency, your mind would not notice the latency between your motion with the hand and the results with your eye.
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A surgeon isn't trying to race anything or anyone
The surgeon is trying to finish the surgery before the patient dies.
Surgeons are very skilled at doing their jobs quickly.
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Accuracy and stability are FAR more important than speed. 150ms delay isn't really all that much when you're only making small, deliberate movements.
These doctors aren't trying to perform a rocket jump in your chest cavity. They're trying to line up the perfect headshot against a mostly unmoving target.
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When I talked to one of our VAR's he said that one of the local hospital chains was one of his best and worst customers, best because of all the expensive gear they bought, worst because they were so demanding. They actually paid to have trenching done to make sure that their backup link at one facility went out a different CO which was on a different uplink facility (ie truly divergent paths with no single mode of failure), and that was just for PACS, not telesurgery.
Errr... that's not that unusual (Score:2)
I work in DR Architecture, and diverse routes are a pretty common customer request, and for us that just means diverse routes from the customer's IT facility to our DR data canters. Industrial firms, banks, health insurance companies, whatever.
Kids these days (Score:2)
Now even doctors are spending all their time playing online video games.
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As long as it isn't this game:
http://en.wikipedia.org/wiki/S... [wikipedia.org]
I am all for gaming surgeons.
Concast 150ms... Right... (Score:1)
Re:It's about time.... (Score:5, Funny)
Next is holograms lawyers in courtrooms!!!
Please state the nature of the legal proceeding...
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Next is holograms lawyers in courtrooms!!!
Don't fret. Congress is staffed almost entirely by lawyers, and there is zero chance they'll let their bread-and-butter be outsourced or replaced by machines. They already won't even pass laws to simplify laws, in order to keep their jobs as clever interpreters of the cracks between the laws.
They'll damn everyone else to a subcontracted devil running an outsourced version of hell, but they've proven they're going to protect their jobs forever.
What about severe lag? (Score:5, Insightful)
Florida Hospital Shows Normal Internet Lag Time Won't Affect Remote Robotic Surgeries
So what? It's not normal lag you are worried about. It's severe lag which on the normal internet you cannot guarantee you can eliminate. It's interesting information but I'm not sure if it's really useful information.
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Does packet drop actually exists in the wild? Outside of noise over long distances? In the normal world? That is my question to that.
Packet loss means whoever is between A and B, is fucking up. Somewhere.
Be it having wireless transfer somewhere on the backbone, faulty infrastructure, or destroyed wires. I don't think Packet Loss and "loss of Connection" actually exists in the actual wild.
Add in 3-4 extra paths for packages, and we might got something robust.
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Packet loss isn't a sign of breakage, it's a necessary part of a working network.
Without the packet loss, protocols can't tell that they need to throttle their packets.
If you stick the packets in a queue, then you'll continue to receive them faster than you can deal with them, since you've broken the mechanism protocols are using to detect throughput, and since memory is finite, you'll still end up needing to discard packets, so all you've succeeded in doing is having just as much packet loss as before but
Just wait... (Score:2)
Re:Just wait... (Score:4, Interesting)
I have to admit, this one had me scratching my head.
Don't medical safety guidelines always require safe handling of the *worst* case scenario, not the *average* case scenario? Hospitals have network outages, and have plans in place to mitigate that. How do you mitigate a surgeon losing link while he's cutting the right ventricle? When you're yards away and the link goes down, you just scrub in. When you're on the other side of the world....
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When you're on the other side of the world....
You either get surgery like this, or likely no surgery at all. A chance at a good outcome, or no good outcome at all. Sorta like surgery itself.
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No. Data is data. So are doctors apparently. Both act the same way. You can't just run some shoddy network connection and then kid yourself that you're good. It's far better to forget the network entirely and just ship the actual doctor. It's much like shipping physical media.
There remain jobs and tasks for which Cloud hype snake oil just doesn't cut it. The network isn't good enough and probably will never be. So you just need to stop pretending.
If you're on the other side of the world, you're still better
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just ship the actual doctor.
Do you know how many doctors they have in America? How about in Liberia?
According to the CIA World Factbook, in 2008 the U.S. had 2.4 doctors per every 1000 people. In Liberia, they had 0.01 per 1000, but that was before ebola killed 40 of their 120 physicians. Volunteer doctors have helped a little, but not too many want to risk their own lives in such a hot zone. The need is almost beyond comprehension.
Oh, and of those 80 remaining doctors, how many do you think specialize in surgery, and have hours in t
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You solve this by running the remote surgery in a hospital that still has local doctors and nurses. One general doctor can be in house and prepped for surgery, on call for one or more operating theatres. The patients will still need local nurses to prep the patients, physically administer the anesthesia (in the case of a remote anesthetist), and handle all kinds of tasks. The remote surgeon makes the cuts, does the work, then closes up behind himself as he leaves. The whole time the local nurse(s) is(ar
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The hospitals won't want to schedule just one surgery at a time, they have lots of operating theatres. So the link goes dead with a whole bunch of patients open on the tables. "One general doctor .. on call for one or more operating theatres"? Ha ha. That doctor is going to be called "Marathon Man" if he survives that scene, let alone the patients.
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Oh, and if it's a time-critical disaster scenario, the patient is still better off with a remote surgeon than with no doctor at all. If the surgeon physically cannot get to the field hospital in the next two hours, and your choices are limited to:
A) bleed to death from a punctured lung because there's nobody here to sew you up, or
B) take your chances with Comcast delivering enough bytes for a doctor two states away to sew you up,
most people will opt for B.
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Most people are idiots.
You're far better off depending on a warm body on the ground that can be told what to do if necessary. In an actual disaster, some random schmuck with a medical kit is going to be much more reliable than any sort of fancy cloud enabled robotic surgery kit.
In an actual disaster, a field surgeon would probably be easier and quicker to set up than some overwrought bit of civilized technology.
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Apparently not. There was a recent article about some kind of medical pump with a network connection for "ease of use" but it was a huge security hole with direct root access to the device. And with the unknown quantity of the local hospital's IT staff, who the hell knows what kind of security nightmare is brewing in there?!
No, the medial community is blissfully unconcerned with real-world Internet and Intranet security when it comes to "new," "fancy," ultra-modern equipment that will jack up the fucking me
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Well, in this case, the device itself is standard issue for many hospitals; the novel bit is accessing it over the internet instead of leaving it on the intranet as has traditionally been the case.
Having been part of the "let's make this emulator do multiplayer over the internet" group back in the day, I agree with you... there's a LOT that can go wrong. If they're not designing for failure (in both software and operating protocol), they're in for a world of hurt eventually.
50ms might not sound like much (Score:2)
but when you're playing World of Tanks, 50ms is the difference between getting the first shot in and losing.
I would not want anything with comparable or worse lag poking around inside me particularly when the one thing that the whole shebang relies on (POWER) is the one thing that's out of control of any person directly involved in the operation.
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but when you're playing World of Tanks, 50ms is the difference between getting the first shot in and losing.
And when you're trying to collide protons in the LHC, 0.0001ms is the difference between discovering the Higgs and not.
Remote surgery is about as similar to FPS gameplay as FPS gameplay is to running the LHC.
when the one thing that the whole shebang relies on (POWER) is the one thing that's out of control of any person directly involved in the operation.
Modern hospital surgery has relied on power for decades, and they usually get by without an electrician in the room. It's connectivity that's going to cause the problems here.
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I'm guessing he hasn't seen the big standby generators with big fuel tanks that hospitals have. Lots of grocery stores too, for that matter.
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You know what they say about assuming...
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You know what they say about assuming...
It makes an ass out of u... and... Ming [movievillains.com]?
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Hungry Hungry Hippos?
Over the Internet = miserable failure. (Score:1)
Are they _really_ trying to do this over conventional global Internet backbone? I sincerely hope not. It is simply not reliable enough, and WILL experience drop-outs, latency spikes, and other disruptions due to all kinds of different scenarios.
You CAN buy non-Internet data links you know. There is lots of dark fiber available for this kind of thing and providers willing to sell it. It may be expensive, but at least it's not a miserable failure of a design and taking extreme chances with surgery.
At Least (Score:2)
At least they're not using UDP.
404 Patient Not Found (Score:2)
Cause of death? (Score:5, Funny)
Wow. "How'd he die?" "Lag." Been true plenty of times in World of Warcraft, and now possible IRL.
Sourceforge (Score:1)
Oh, yeah, that's why. [dice.com]
SHAME ON YOU DICE!
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Dear Prospective Patient... (Score:5, Funny)
1. 500ms response time $500.00
2. 250ms response time $750.00
3 100ms response time $2000.00
4. 50ms response time $5000.00
Sincerely, AT&T
We Appreciate Your Patronage
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Why did you have to say that? It might have taken them a while before they thought of it on their own.
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Stop putting so many people in prison?
Get ready medical professionals... (Score:2)
Looks like you're the next group to get your jobs outsourced.
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Wires like these (even for my business - an OC3 in new construction) go and stay fully underground coming up through a chase in the basement/floor, it could be cut inside but that is why internal security of your data is important. If the hospital is doing this they have IT there all the time - and security. It is unlikely (not impossible) that they will have an issue with anything you are worried about. They also use disparate connections with failover built in I suspect.
Eventually this will be the Norm (Score:2)
Surgery is a scary thing. Having robots or remote surgeons makes us nervous because it amplifies the unknowns. We are already very good at imagining bad what-if scenarios in these situations.
Likely if lag times become too great the machines will go into a safe mode until a better connection is restored, and yes there may be unlikely/unlucky scenarios where the patent dies from not being able to receive timely treatment/intervention because no qualified surgeon is close by. Of course thousands if not hund
The brain adapts well to lag (Score:4, Insightful)
The brain adapts very well to lag. If you rig up a button and a light, so the light lights up when you push the button, then gradually introduce a delay, the brain will - up to a certain point - adapt and you'll still think the button push and light are happening at the same time. Remove the delay without warning, and you'll be convinced that the light lit up before you pushed the button.
Surgery isn't like a first-person shooter, cries of "but the lag!" notwithstanding. Surgeons aren't, for the most part, waiting for the right bit of aorta to bob into their crosshairs so they can jab it with a scalpel, nor are they competing against other surgeons to get the first stitch in.
Of course spikes in lag - and connections dropping entirely - are a big concern. But I don't think anyone's suggesting hospitals all move to remote working just because they can just yet.
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Jitter (Score:3)
I would expect much like digital telephony lag is not much of challenge to overcome unless its really really big.
Jitter would be a problem. The human brain is pretty good at adapting to consistent latency, anticipating events, delaying or cramming inputs as required to compensate. Where that breaks down is when the latenecy is sometimes 200ms and other-times 500ms without predictability. Controlling jitter on the public parts of the Internet is hard.
No. (Score:2)
The hospital didn't show that normal lagtime won't affect remote robotic surgeries. It looked for possible effects of that sort and didn't find any. That's a good result, but it's only the start of a process that might show that doing this is reasonably safe for patients.
The real world is much more demanding and uncontrollable than simulation. Remember the Therac-25 incident. Thorough functional testing apparently showed that the machine was perfectly safe; it didn't take into account the difference between
Excuses! (Score:1)
Coming soon: the ad revenue stream .. (Score:2)
Your surgical procedure will continue in 60 seconds. Meanwhile please enjoy this brief in-stream advertisement.
Wha?! Where's the "Skip This Ad" button? Wha?!
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