NTT Demonstrates Telesurgery Support Between Two Distant Hospitals Using IOWN APN
Achieving high-precision and stable remote control of surgical support robots and a communication environment as if participants were in the same operating room

News Highlights:

Background

Telesurgical support using surgical support robots⁴ is expected to contribute to solving social issues such as regional medical care disparities caused by a decline in the number of surgeons in rural areas. It also contributes to improving medical standards through regional medical support and the training of young surgeons. The Japan Surgical Society is taking the lead in establishing Telesurgery Guideline⁵, which is scheduled for revision in fiscal year 2025, to facilitate the social implementation of telesurgical support.

Objectives of the demonstration

In order to verify the applicability of telesurgical support, the following issues were considered for this demonstration.

Details of joint the demonstration

Hirosaki University Hospital and Tsugaru General Hospital in Aomori Prefecture were connected using APN (All-Photonics Connect powered by IOWN⁶, provided by NTT EAST). A realistic demonstration was conducted using a telesurgical support robot on an artificial organ model.

Figure Configuration of Telesurgical Support Using APN

This demonstration was supported by the Japan Agency for Medical Research and Development (AMED) under the project "Advanced Medical, Nursing, and Health Data Utilization Infrastructure Project (Practical Application Research Project for Advanced Telemedicine Network)" and "Realization of Remote Surgery Using a Surgical Support Robot (24hsa422001h0003)".

Results of this demonstration

■ High-precision remote operation of the surgical assistant robot

In evaluating the communication quality of the APN, quantitative communication quality measurements showed that the one-way transmission delay was 0.28 milliseconds, with an average jitter of 0.00 microseconds and a maximum jitter of 0.02 microseconds (Table). Compared to conventional guarantee-type circuits, APN exhibited approximately four times better latency performance and over 120 times higher maximum jitter performance. This time, the evaluation was conducted over a distance of approximately 30 km. However, since APN can minimize the impact of distance-related delays and jitters, its effectiveness is expected to be even greater over longer distances.

As a result, high-precision remote control of the surgical support robot was achieved using a transmission environment that minimizes the effects of network delays and jitters. It was confirmed that operators in remote locations can perform remote surgery support in a manner similar to robot-assisted surgery performed without the use of a network.

■ High-quality communication as if participants were in the same operating room

For the evaluation of remote communication, surgeons experienced the communication environment firsthand and provided high ratings in response to a questionnaire, which included questions such as whether they felt a natural sense of presence in communication.
　Based on these evaluation results, we confirmed that the APN can be used to transmit audio and video signals with a large capacity, low delay, and no jitter. Additionally, by integrating a 3D acoustic speaker OPSODIS 1, binaural microphones, a high-definition 4K remote camera, and large monitors, we successfully created a high quality communication space. This enabled an immersive communication environment, making it feel as if participants were in the same operating room.

Remote Operation
Left: Onsite facility (Hirosaki University Hospital), Right: Remote facility (Tsugaru General Hospital)

[Comments from Dr. Kenichi Hakamada, Director of Hirosaki University Hospital]

Role of participating company

The roles of each company in this initiative are as follows.

Outlook

Based on this demonstration, further field trials will be conducted to promote the social implementation of telesurgical support. The IOWN APN technology will contribute to improving healthcare quality, enhancing accessibility to advanced medical services, and promoting digital transformation in the medical industry.

¹hinotori^TM
hinotori^TM is a domestic surgical support robot that received manufacturing and marketing approval from the Ministry of Health, Labour and Welfare in August 2020 (approval number: 30200BZX00256000), and has been approved for use in urology, gastrointestinal surgery, gynecology, and respiratory surgery in Japan. International expansion starting in Singapore.

²IOWN
The IOWN (Innovative Optical and Wireless Network) concept is a concept of a network and information processing infrastructure, including devices, capable of providing high-speed, high-capacity communications and enormous computing resources by optimizing individuals and the entire system based on all kinds of information and utilizing innovative technologies centered on optics. For details, please visit the following website.
■ What is the IOWN concept?
https://www.rd.ntt/iown/index.html

³APN
APN (All-Photonics Network) introduces photonics-based technology to everything from the network to the devices, and realizes transmission with ultra low power consumption, high quality, large capacity, and low delay, which is difficult to achieve with current electronics-based technology. For details, please visit the following website.
■ What is the All-Photonics Network?
https://www.rd.ntt/e/iown/0002.html

⁴Telesurgical support
A type of robotic surgery performed at an onsite facility, in which a leading telemedicine operator technically supports the operation of the onsite operator through a surgical support robot. In order for the remote operator to operate the robot, the operation support robot at the onsite facility and the remote facility will be connected via a network. Telesurgery surgeon understand the operation situation through video and audio, and if necessary, change the operation authority of the surgical support robot to assist the operation. Remote surgery support is based on the assumption that surgeons and surgical staff are always in the operating room of the onsite facility and have the ability to complete surgery at the onsite facility in the event of an unexpected situation.

⁵Telesurgery guidelines
Telesurgery guidelines are standards for appropriate remote surgery using surgical support robots. It was decided by the Japan Surgical Society, and the first edition was published in June 2022. For details, please visit the following website.
■ Telesurgery Guidelines
https://jp.jssoc.or.jp/modules/info/index.php?content_id=227 (Japanese)

⁶All-Photonics Connect powered by IOWN
All-Photonics Connect is a point-to-point connection between customer-designated locations that enables high-speed, high-capacity, low-latency, and low-power communication at 10Gbps/100Gbps/400Gbps/800Gbps. For details, please visit the following website.
■ What is All-Photonics Connect powered by IOWN?
https://business.ntt-east.co.jp/service/koutaiikiaccess/ (Japanese)

⁷OPSODIS 1
The OPSODIS 1 is a stereophonic speaker equipped with the "OPSODIS®" stereophonic technology. OPSODIS is a 3D audio playback technology jointly developed by Kajima's Technical Research Institute and the Institute of Sound and Vibration Research, University of Southampton, England, which is renowned worldwide in the field of acoustic technology. The feature of this system is that it realizes a natural 3D sound field by combining signal processing such as unique crosstalk cancellation and speaker layout in which high-frequency speakers are placed symmetrically from the center side. It delivers sound directly to the listener without using reflections from walls or ceilings, and reproduces a natural 360 degree sound field such as up and down, left and right, front and rear, and perspective.

About NTT

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