1. Timothy J. Broderick, MD, FACS Associate Professor of Surgery/BME University of Cincinnati NASA NEEMO US Army TATRC DARPA Trauma Pod Mobile Robotic Telesurgery

2. Telemedicine and Telesurgery Telecommunication: sending message by means of electronic transmission of impulses Telemedicine: application of telecommunications in medical care Surgical Robot: a powered, computer-controlled manipulator with artificial sensing that can be programmed to move and position tools to carry out a wide range of surgical tasks (telemanipulator) Telesurgery: remotely performed surgery through combined use of telecommunications and a surgical “robot”

3. Telecommunications in Surgery

4. Attn Michel Now for the alligator pt. He is a 51 year old Police Reserve who resides at Tana River District approx 200 kms from Mombasa. The District derives its name from Tana River which is the longest river in Kenya and supplies most of the hydroelectric power in the country, It is inhabited by a large number of alligators which annually maims/kills a large number of poeple and domestic animals. Mamba Village gets some of the alligators from there. The subject sustained his injuries 10 days ago when he went to fetch water from the river in the evening( Because of fear of alligator attcks it is males who dare go to the river on the evenings. An alligator jumped from underwater and bit his right hand as he was drawing water causing the injuries described earlier. He is in got nutritional status is right handed and is also a farmer so he uses both his hands while performing his daily tasks including shooting a rifle. He has no motor or sensory deficit and is able to flex and extend his fingers.He is having daily dressing with betadine and as of today the wound is clean and is on splint. Telemedicine

5. Computer Motion Zeus SRI M7 Intuitive daVinci*University of Washington Telesurgery Systems

6. Robotic Telesurgery Operation Lindbergh 8Mbps 155msec ATM network + Zeus TS New York - Strasbourg Laparoscopic cholecystectomy Sept 7, 2001 CMAS 45 Mbps 144msec IP MPLS VPN + Zeus TS Hamilton - North Bay Laparoscopic Nissen Fundoplications February 28, 2003

7. Robotic Telesurgery Using daVinci Network DistanceDelay3D VisionRobotic Motion Telesurgery Firsts Cincinnati to Sunnyvale Public Internet (3Mbps) 2500 miles 900 msPoor Polycom SmoothUS daVinci 3D Denver to Sunnyvale Public Internet (3Mbps) 1300 miles 450 msGood Haivision SmoothCollaborative (2 -> 1) April 2005

8. NEEMO 9 Robotic Telesurgery Telesurgery firsts: Extreme environment (SRI M7) Microwave wireless (less than 10 Mbps) Lunar latency (2+ sec -> 10 minute suture) Latency compensation (> 500 msec): Techniques (slow, one handed) Technology (bandwidth, CODEC, automation) April 2006

9. Mobile Robotic Telesurgery Internet Remote Patient (high desert) Expert Surgeon (desert and UW) UW robot AV PUMA SUAV DDL @ 1.2 Mbps (15 ms) Latency @ 200 ms (CODEC) June 2006

10. Robotic Surgery in Microgravity Targeted open procedures NASA: Spaceflight DoD: CCAT Robotic surgery in parabolic flight Upgraded SRI M7 Telerobotic (802.11g in aircraft) Inanimate (suturing) Semi-autonomous function August 2007

11. DARPA Trauma Pod Autonomous, telesurgical combat casualty care Critically Injured warfighter Multiple video streams and robot controls Wireless UAV based communication and transport Bandwidth and more bandwidth…

12. Mobile Robotic Telesurgery Conclusion High bandwidth, low latency wireless telecommunication can improve the quality of and access to surgical care

13. timothy.broderick@uc.edu