MSS006: EVALUATING TELEOPERATED SURGICAL ASSISTANCE FOR TRAUMA RELATED VASCULAR REPAIR SURGERIES
Paul F Hwang, MD, FACS1; Jaeyeon Lee, PhD2; Ethan Quist, MS2; Wesley Huff, MS2; Jon Chambers, PhD2; Nathan Fisher, MS2; Jason Lim, PhD3; Michael Yip, PhD3; Nicholas Marion, MS4; Steven Hong, MD5; 1Walter Reed National Military Medical Center, Bethesda, MD; 2Defense Health Agency, Medical Research & Development Command (MRDC), Telemedicine and Advanced Technology Research Center (TATRC), Fort Detrick, MD; 3University of California San Diego, La Jolla, CA; 4SRI International, Menlo Park, CA; 5Wake Forest Atrium Health, Charlotte, NC
Introduction: The Army predicts challenges in timely surgery access. Telerobotic platforms can aid overwhelmed Forward Surgical Teams (FSTs) in mass casualty scenarios and prolonged care during denied evacuation windows by offering expert surgeon assistance remotely. The studies under this project aim to establish trust in forward deployed telerobotic surgery for urgent vascular repair interventions. It evaluates the efficacy of latency mitigation techniques in trauma-relevant procedures, specifically temporary vascular shunt placement and microvascular anastomosis procedures. By collaborating with our partners SRI International, UCSD, USUHS, and Wake Forest Atrium Health (WF), TATRC will conduct experiments to assess the safety and efficacy of a novel configuration of surgeon and teleoperated robotic assistant teams against the standard of care two surgeon teams through in-lab trials.
Materials and Methods: Unpredictable latency in networks requires accurate mitigation models. The research team is developing an adaptive motion scaling framework and control the movement scaling of the teleoperated robot based on the latency noticed in the network. TATRC with its clinical partners are conducting in-lab ex-vivo trials on the vascular repair procedures to evaluate a baseline of safety and efficacy by measuring the success of the procedures, time of completion, and surgical errors. These trials are conducted with teleoperating under nominal latency, as well as various levels simulated static and dynamic latency ranging from 500ms to 2000ms.
Results: Our data analysis has revealed several key results: the trials achieved a success rate of nearly 100% with only one failed trial over the 288 teleoperated trials, the error rate observed was on average 3 errors per procedure which slowed the time to completion however, will continue to fall with more trials, and the average time to completion for TVS was 1:58 and 7:12 for the MVA. The high success rate indicates that our protocols and procedures are effectively ensuring safety and efficacy. The low error rate reflects the precision and reliability of our methods, and the efficient time to completion in comparison with the current standard of care showcases the optimization of our task procedures.
Conclusion: Teleoperated robotic surgery enhances in-theater surgical access, crucial for lifesaving intervention within the ‘Golden Hour’ post-injury. Surgical assistive robotic platforms can also allow for specialist surgeons to tele-mentor and tele-assist deployed general surgeons in non-routine procedures during prolonged care and denied evacuation windows, further enhancing the capability and capacity of the deployed surgical team.