Research Report : ICT612 Assignment 1

ELECTRONIC ASSIGNMENT
COVERSHEET

Student Number
Surname
Given name
Email

Unit Code
Unit name ICT612 Human Factors in Information Technology
Enrolment mode Internal
Date
Assignment number
Assignment name
Tutor

Student’s Declaration:

 Except where indicated, the work I am submitting in this assignment is my own work and has not been
submitted for assessment in another unit.
 This submission complies with Murdoch University's academic integrity commitments. I am aware that
information about plagiarism and associated penalties can be found at
http://www.murdoch.edu.au/teach/plagiarism/. If I have any doubts or queries about this, I am further aware
that I can contact my Unit Coordinator prior to submitting the assignment.
 I acknowledge that the assessor of this assignment may, for the purpose of assessing this assignment:
o reproduce this assignment and provide a copy to another academic staff member; and/or
o submit a copy of this assignment to a plagiarism-checking service. This web-based service may
retain a copy of this work for the sole purpose of subsequent plagiarism checking, but has a legal
agreement with the University that it will not share or reproduce it in any form.
 I have retained a copy of this assignment.
 I will retain a copy of the notification of receipt of this assignment. If you have not received a receipt
within three days, please check with your Unit Coordinator.

I am aware that I am making this declaration by submitting this document electronically and by using my
Murdoch ID and password it is deemed equivalent to executing this declaration with my written signature.

Signed

(Write your name in the space above)

Title: Tele-Operative Surgery
INTRODUCTION

The human factor in technology could be seen with the innovation of new technologies having an
integration model to interact and operate with people. One such promising technologies include
Tele-operative surgery, which offers a contribution to medical and healthcare domains.
Approximately 70 percent of scientific procedures were performed through the concept of
telesurgery with the help of robotic elements in the 2008 US da Vinci healthcare units [1].
Therefore, automatic teleoperations are adopted by the medical field supported by the human factor
concept. However, it is essential to understand the standard definition of theory. Tele-operative
surgery is made up of two ideas, i.e., teleoperations and telesurgery. Whereas, the term is used
interchangeably with remote surgery or telesurgery in the existing literature. “Tele-operation” refers
to an operation of a system that is accomplished from a certain distance similar to remote control
through robotics. While “remote or telesurgery” is defined as the ability with which medical
representative performs surgery from a remote location through a master controller and sensory
system that offers feedback to users [2]. Thus, a surgery performed by automatic operation from a
remote location makes it easy to perform health aid to patients effectively. Furthermore, telesurgery
systems have several components, including slave robots, master stations, nurses’ carts, and
communication mean followed by computer-enhanced connectivity.

The primary users of the Tele-operative surgery system are surgeons who are present from a distant
location, patients who are operated, as well as surgical care units in which medical help and
healthcare are required [3]. The medical professionals and healthcare domain are mainly users who
have invested in such automatic systems to obtain the best surgeries. In addition to that, the purpose
of this system to offer medical care due to issues such as shortage of surgeons, lack of geographical
access to surgeons, complications, financial responsibilities, and long-distance traveling problems
[4]. The sort of tasks performed by telesurgery systems includes dissection and suturing within a
simulated platform, as per the previous study [5]. Therefore, tele-operative surgery offers doctors to
perform different types of surgical procedures for patients with the help of an automated system.

Tele-operative surgery uses three critical technologies that support this system to work effectively.
One of the important technology supports is robotics through which automation for surgical tools
could be performed. The second support is from communication devices that connect the system for
performing through a higher speed connectivity mechanism with wireless networking. Lastly, the
concept of a management information system is also implemented to manage data present into
systems. Whereas, a video monitoring tool is also used to check and see live feeds of operation for a
surgeon at a remote location. Therefore, technologies that are mainly supported are communication,
information technology, as well as management information systems.

Therefore, the purpose of this report to understand the concept of tele-operative surgery and its
implications for being human factors connected with IT technology. Furthermore, this report
strategically explains previous background research on the topic, working, and operation of the
system, advantages, and limitations of the device to research as well as a summary for future scope
for tele-operative surgery or telesurgery or remote surgery.

BACKGROUND RESEARCH

The advancement in the medical and health showcase reflection for expansion in the field of
information and communication technologies. As per existing literature, several types of
teleoperations are explored for healthcare domain. Teleoperations include telemedicine, tele surgery,
and robotic surgery are used interchangeably. While, robotic and telesurgery comes under tele-
operative surgery domain, telemedicine is a well-defined approach which supplies medical care to
patient situated at distance that does not have well-experienced doctors or nurses’ staff.

The advancement in the medical and health showcase reflection for expansion in the field of
information and communication technologies. As per existing literature, several types of
teleoperations are explored for the healthcare domain. Teleoperations include telemedicine,
telesurgery, and robotic surgery are used interchangeably. While robotic and telesurgery comes
under the tele-operative surgery domain, telemedicine is a well-defined approach which supplies
medical care to patients situated at a distance that does not have well-experienced doctors or nurses'
staff.

Healthcare professionals are adopting telemedicine and telesurgery for diagnosis, treatment plans, as
well as disease prevention for patient well-being [6]. Tele-surgery is being promoted due to its
ability and capability to perform surgeries through modern instruments and techniques from
different miles to reduce time and delay patient health. As per accomplished studies, surgeons who
are not present physically could observe and manipulate surgical instruments in operation theatre
with the help of new electronic interfaces [7-8]. Further, telesurgery provides a specialist surgeon to
perform surgeries for heart or kidney by being present through a virtual platform beside a patient in
critical conditions such as remote and rural areas, accident scenes, the battlefield where military
officials are injured as well as long-distance situations where medical care is not present.
Telemedicine services are offered like distance counseling, telesurgery, and teleradiology for
patients [9]. Therefore, a wide scope of telemedicine is adopted by the application of features like
ICT technologies for healthcare service. In other words, teleoperations include a variety of ranges
from simple telephone connection for a service to the application of intelligent agents through vital
signs, medical images, and robotic operations [10].

However, the inclusion of such diverse technology-based systems also brings issues in context to
technicalities, and lack of knowledge for medical professionals. Whereas security and legal
frameworks also required for tracking mistakes when performing surgery through telemedicine. As
per existing literature, several issues are discussed related to tele-operative surgery. The technical
threshold is one of the problems in which network latency is disturbed for frequent distance due to
communication discomfort [11]. Surgeons need to have minimal degradation for pictures, latency,
quality of data at a higher rate, and strong communication and information technology [12]. Another
issue described is surgical robots with a lack of feedback management that cuts of information
source for doctors to operate properly on patients [13]. Additionally, another sort of challenge
discussed is lack of planning, no discussion before robotic surgeries, language barriers due to
international remote locations involved, and confusion over technical specifications in between
2D/3D views [14].

Another set of studies concludes that the infrastructure of medical services could offer the best
results if they cooperate. For example, lack of difficulties in adopting the application of remote
procedures is resistance from physicians, care providers, and patients due to lack of health policies
and worldwide availability of resources making technology adoption much stronger and effective
[15-16]. As per development history, the first tele operative surgery was accomplished in from New
York surgeon in the year 2001 at France location using asynchronous transfer mode fibre optic
communication link with no packet loss and 155m latency [17]. Whereas, the first telerobotic
remote surgical system was developed in the year 2003 across St. Joseph's Hospital in Hamilton and
North Bay General Hospital with using 15 Mbps of bandwidth network with 400 kilometers apart
distance [17]. Thus, both systems performed more than 20 extremely successful surgeries. Even
though such a successful scenario, it is not widely accepted due to three challenges, including
extreme communication cost, no trust assurance for networks, as well as higher latency. Therefore,
before using a telesurgery system, healthcare must consider all these implications so that they could
employ unique opportunities for the medical domain.

Hence, adoption of new technologies integrated with tele-operative surgery like software-defined
network, Internet of things perception, software-defined network, Internet of things perception,
machine learning, data analysis, cloud computing, fog computing, and hardware virtualization will
offer future opportunities.

How it works

The proposed system works under a master-slave system which consists of a master side console,
robotic arms provided on the side of the patient as well as a visualizing system [18]. In addition,
master side manipulators who serve as the computer interface for the surgeon to operate tools from a
remote location. Whereas, a 3D display system is also connected on the master side console so that
records could be obtained on camera as well as a video for feedback of live surgical systems. There
are four major components of the remote surgical system which combine to the final system.

Slave Robots

In the diagram below, slave robots represent symbol 1 in which components are again divided into
sub-compartments. 1a is the positioning stage, which will offer robot placement and orientation to
the patient. In the context of that, the system structure contains a vertical sliding axis as well as three
vertical pivot joints [19]. As a result, robot weight for the patient operation will have proper
adjustments. Further, the second and third stages represent 1b, which is the external robot structure
and 1c instrument. 1b and 1c will provide an instrument to move from the operating side to the
internal wrist for tooltip rotation axes. In addition, 1c again has more four parts, including interface
containing robots, the long shaft from the trocar, internal wrist rotation for tool around any axis and
tool. Further, a 1d endoscope will perform functions included with the other three components.

Master Station

The robot control takes place at master station symbol two, where the surgeon operates the surgery
virtually. 2a is an input device from which control and displacement occur so that robots could
replicate the performance. In context to that, for allowing stable movements, an armrest 2b will be
attached so that closed input devices handle properly. Furthermore, the surgeon could also offer to
provide different commands from 2c, including foot pedals, switches, and buttons, which are
connected on the device armrest effectively [18]. The component 2d will offer controlling through
electric scalpels as well as 2d will provide video display and visual feedback.

Nurses cart

The symbol 3 represents an additional cabinet so that robots could be carried from one place to
another as well as 3a controllers offer medical equipment placements, and 3b is external video
display [18]. Whereas, the cabinet will also provide nurses, professionals, and surgeons to check
visualization of surgical procedures.

Communications means

Finally, communication means are also implemented to reduce communication delay so that
efficiency could be improved. In addition to that, force feedback is generated so that proper working
and stability could be obtained.
 Figure 2. Components and Work structure of Telesurgery System Source [18]

Types of Tele-operative surgery systems

In the supervisory controlled robotic system, the surgeon will plan the surgery into offline mode
from a computer terminal model for the patient with different forms of surgeries. Furthermore, the
surgeon will then download the surgical plans into a surgical robot who will have an understanding
of what to conduct in surgery operation. Lastly, now robot will execute the surgery as per designed
and preplanned operation. However, the surgeon will supervise the operations of the robotic
movement. In the robotic telesurgical system, the surgeon will control the robot in real-time by
using a haptic interface through which feedback will go into the surgical instrument, whereas robots
will, with complete trust, replicate the motions of the surgeon connected to the interface. In addition
to that, the master-slave surgeon will get feedback in real-time by the help of camera recording as
well as feedback through instruments.
 Figure 3: Types of Telesurgery Systems Source [19]

BENEFITS AND RISKS

Benefits:

There are several benefits of using the tele-operative surgery system, which currently exists. One of
the essential aspects of the system is improvisation inability, accuracy, lack of tremor, and 3D stereo
vision as well as capability to monitor and operate in a broad scope of countries and cities [20].
Therefore, a system that offers accuracy in operational functions will make fewer mistakes in
complex surgeries. Whereas, if surgeons have a well and capable infrastructure, they could perform
operations from any corner across the world and with utmost simplicity. Furthermore, video
monitors capture live feeds for the patient every minute, making surgery less complex or
complicated. Thus, improvisation is in basic operational features, and functionality will also
propagate usage of the system in the near future.

Another benefit includes higher quality surgery procedures into locations that are extremely
complex such as rural areas, spacecraft, and military battlefields overseas [4]. For example, virtual
interactive presence is implemented for such extreme conditions by implementing local and remote
workstations, video capture devices, video displays as well as connected them with a global point to
point communication [21]. Therefore, it is beneficial to perform telesurgery in underdeveloped
areas, military services, and space.

The next advantage is the reduction of travel-oriented financial problems for surgeons and patients
both to appear as well as dangers [22]. For instance, several medical cares require surgeons to
frequently visit them for follow up care in rural areas making finance an issue. Thus, nurses, as well
as doctors, monitor and interpret the operations that are crucial from remote location saving
expenses.

Additionally, telesurgery offers a 3-D dimensional display system so that surgeons and medical
units could get feedback for operational activities through visual representation. Furthermore, a 3-D
display device such as autostereoscopic display surgical information with live surgery video is
offered to several surgeons from on the same operation at the same time so that cooperation and
efficiency for the patient could be achieved [23].

There are several other advantages of telesurgery, which had made it accepted among masses. Some
of them include surgical collaboration in real-time, improvement in surgical accuracy by making
health tissue safety methods, thereby improving patient recovery [4]. As per new advance
technology such as virtual reality simulator, DV-trainer provides training to new and experienced
surgeons so that they learn surgical operations by guiding untrained for performing operations
through a live videoconferencing [24]. Therefore, tele-operative surgery is a very effective way to
offer medical and healthcare in improving surgical operations through technology-oriented systems.

Risks/Technological Limitations:

One of the crucial risks and primary difficulty with tele-operative surgery comes due to more
distance resulting in lower quality network issues within infrastructure implemented, making
communication much lagging [25]. The internet problems could bring network issues making tele
surgical treatment complex and could also risk a patient’s life. Another risk is latency variation that
will decrease the performance of the operator in robotic telesurgery with disturbed performance into
operations [26]. Thus, latency or speed is considered one of the risks which will make surgical
inaccuracies by making delay for communication lines or coding-decoding of video signals [27].

Cyber-attack is another risk which could threaten a patient’s safety, security, and data privacy due to
sensitive information present on computer network and information technology. Furthermore, as per
this issue, telesurgeries are not accepted widely due to a single Tele surgical protocol that
determines security requirements. However, it lacks issues for authentication, confidentiality,
security policies over national and international environments [28]. Thus, the potential risk could
deliver confidential information to cybercriminals who will alter or block communication due to a
lack of backup systems for data storage.

Implementation cost is another risk that could disturb the propagation of telesurgery instruments and
systems. For instance, developing countries could not afford robotic systems or higher quality
communication networks on longer geographic locations [29]. Thus, the cost is a concern because of
much more scale level cost budgets; it is extremely difficult to adopt a telesurgery system into
underserved locations. Whereas legal and ethical concerns are another sort of issue which could stop
surgeons from practicing medicine. The lack of regulations and licensure requirements for different
countries with legal requirements to complete geographical surgery through remote locations could
stop doctors from performing surgeries [29]. While some technical failure occurs and a patient’s life
is at risk, then full responsibility and measures must adhere. Thus, all such risks while developing a
tele-operative surgery system should be taken into consideration before imitating the project
proposal.

CONCLUSION

To summarize, tele-operative surgery is a very innovative technology that will offer the medical
field a broad perspective to operate and cure patients with complex diseases. Although several types
of concepts are included, some of them proposed were telesurgery, remote surgery, teleoperation,
and robotic surgical systems, which follow the same idea to operate from a remote location on a
patient with the help of automatic robots. Furthermore, significant users of such systems include
novice and experienced surgeons, patients, and healthcare units, which will receive better
infrastructure for the public. There were several types of tele-operative surgery systems, which
makes it hugely different in operations. For example, the supervisory controlled robotic system, and
the supervisory controlled robotic system differ due to their offline and live conditions to monitor.

As per the review, several issues and barriers were identified for the system, including
communication and network latency, video feedback problems, 2D-3D dimensions, lack of
planning, no discussion before robotic surgeries, language barriers due to international remote
locations involved and confusion over technical specifications in between 2D/3D views.
Furthermore, security and data confidentiality are another concern due to which personal
information becomes a threat. However, several policies to include security and legal parameter
were also considered in studies. Additionally, medical services coordination between doctors and
patients is another concern, making it extremely difficult to implement new technologies. Thus, all
such issues were concerns about the adoption of new human aided technologies into medical domain
expansion.

Whereas several possible advantages were also found in the telesurgery systems effectively. Some
of them included ability, accuracy, lack of tremor, 3D stereo vision, and capability to monitor and
operate in a broad scope. These benefits will make it possible for a healthcare organization to
promote and accept newer innovative technologies. On the other hand, cyber threats and other
technical issues could also occur, which will reduce the opportunity for worldwide acceptance.
Lastly, financial cost implementation also becomes a barrier to adopt functionality and features.

Finally, several opportunities will make improvements to represent remote surgical systems in-
between perspective. Presently, telesurgery is only done within the closeness of patients though
wireless commands. Therefore, the distance between the surgeon and patient should be reduced
between communication and network bandwidth. Furthermore, several robotic systems are operated
without any training sessions. Thus, a basic training plan should be discussed and given to
healthcare providers, making them well-prepared for telesurgery operations.

Furthermore, a possible future scope for the system is integration for voice commands, which will
operate different functions. On the contrary, teleoperated surgery systems must have integrated
diagnostic testing equipment. Thus, another scenario includes for the future to make robotic small
and through sensors, cameras, and new integral instruments. Furthermore, if such developments are
implemented in the future, then more adoption systems could be propagated.
 REFERENCES

[1] T. Haidegger and B. Zoltán, Extreme Telesurgery Robot Surgery, 1st ed. INTECH Open Access
Publisher, 2010.

[2] T. Haidegger, J. Sándor and Z. Benyó, "Surgery in space: the future of robotic
telesurgery", Surgical Endoscopy, vol. 25, no. 3, pp. 681-690, 2010. Available:
10.1007/s00464-010-1243-3.

[3] N. Raison, M. Khan and B. Challacombe, "Telemedicine in Surgery: What are the Opportunities
and Hurdles to Realising the Potential?", Current Urology Reports, vol. 16, no. 7, 2015.
Available: 10.1007/s11934-015-0522-x.

[4] P. Choi, R. Oskouian and R. Tubbs, "Telesurgery: Past, Present, and Future", Cureus, vol. 10,
no. 5, pp. 1-5, 2018. Available: 10.7759/cureus.2716.

[5] D. Cahill, "Telesurgery: Surgery in the Digital Age", Dartmouth Undergraduate Journal of

Science, vol. 19, no. 3, pp. 1-6, 2017. [Accessed 15 May 2020].

[6] E. Krupinski and R. Weinstein, "Telemedicine in an Academic Center—The Arizona

Telemedicine Program", Telemedicine and e-Health, vol. 19, no. 5, pp. 349-356, 2013.
Available: 10.1089/tmj.2012.0285.

[7] R. Wootton, N. Patil, R. Scott and K. Ho, Telehealth in the developing world, 1st ed. London:
Royal Society of Medicine Press Ltd, 2009.

[8] M. Gregoski et al., "Development and Validation of a Smartphone Heart Rate Acquisition
Application for Health Promotion and Wellness Telehealth Applications", International
Journal of Telemedicine and Applications, vol. 2012, pp. 1-7, 2012. Available:
10.1155/2012/696324.

[9] N. Raison, M. Khan and B. Challacombe, "Telemedicine in Surgery: What are the Opportunities
and Hurdles to Realising the Potential?", Current Urology Reports, vol. 16, no. 7, 2015.
Available: 10.1007/s11934-015-0522-x.

[10] S. Kumar and J. Marescaux, Telesurgery: An Audit In Telesurgery, 1st ed. Berlin, Heidelberg:
Springer, 2008, pp. 179-184.

[11] V. Silva, T. McGregor, R.Rayman, and P.P.W Luke, “Telementoring and Telesurgery: Future
or Fiction?, Robot Surgery”, Seung Hyuk Baik, IntechOpen, 2010, DOI: 10.5772/6895.
Available: https://www.intechopen.com/books/robot-surgery/telementoring-and-telesurgery-
future-or-fiction

[12] C. R. Doarn and G. R. Moses, “Overcoming Barriers to Wider Adoption of Mobile Robotic
Surgery: Engineering, Clinical and Business Challenges.,” in Surgical Robotics - Systems,
Applications, and Visions., J. Rosen, B. Hannaford, and R. Satava, Eds. 2011, pp. 69–102.

[13] R. M. Satava, “Future Directions in Robotic Surgery,” in Surgical Robotics: Systems

Applications and Visions, J. Rosen, B. Hannaford, and R. M. Satava, Eds. Springer, 2010, p. 1

[14] S. A. Elprama, K. Kilpi, P. Duysburgh, A. Jacobs, L. Vermeulen and J. van Looy, "Identifying
barriers in telesurgery by studying current team practices in robot-assisted surgery", in In 2013
 7th International Conference on Pervasive Computing Technologies for Healthcare and
Workshops, Italy, 2013, pp. 224-231.

[15] Ranganathan and S. Balaji, "Key Factors Affecting the Adoption of Telemedicine by
Ambulatory Clinics: Insights from a Statewide Survey", Telemedicine and e-Health, vol. 26,
no. 2, pp. 218-225, 2020. Available: 10.1089/tmj.2018.0114.

{16] R. Satcher et al., "Telemedicine and telesurgery in cancer care: Inaugural conference at MD
Anderson Cancer Center", Journal of Surgical Oncology, vol. 110, no. 4, pp. 353-359, 2014.
Available: 10.1002/jso.23652.

[17] S. Chughtai, "Tele-supervision of operative procedures; A humanized robotic

approach", Journal of Chemistry and Applied Chemical Engineering, vol. 02, 2018. Available:
10.4172/2576-3954-c2-005.

[18] E. Halit and J. G. Webster, The E-Medicine, E-Health, M-Health, Telemedicine, and Telehealth
Handbook, 1st ed. Florida, USA: CRC Press, 2015, pp. 37-59.

[19] N. Nathoo, M. Çavuşoğlu, M. Vogelbaum and G. Barnett, "In Touch with Robotics:
Neurosurgery for the Future", Neurosurgery, vol. 56, no. 3, pp. 421-433, 2005. Available:
10.1227/01.neu.0000153929.68024.cf.

[20] M. Stark, T. Benhidjeb, S. Gidaro and E. Morales, "The future of telesurgery: a universal
system with haptic sensation", Journal of the Turkish German Gynecological Association, vol.
2012, no. 1, pp. 74-76, 2012. Available: 10.5152/jtgga.2012.05.

[21] M. Shenai, R. Tubbs, B. Guthrie and A. Cohen-Gadol, "Virtual interactive presence for real-
time, long-distance surgical collaboration during complex microsurgical procedures", Journal
of Neurosurgery, vol. 121, no. 2, pp. 277-284, 2014. Available: 10.3171/2014.4.jns131805
[Accessed 15 May 2020].

[22] H. Hougen et al., "Optimizing and validating the technical infrastructure of a novel tele-
cystoscopy system", Journal of Telemedicine and Telecare, vol. 22, no. 7, pp. 397-404, 2016.
Available: 10.1177/1357633x15610040.

[23] D. Zhao, L. Ma, C. Ma, J. Tang and H. Liao, "Floating autostereoscopic 3D display with
multidimensional images for telesurgical visualization", International Journal of Computer
Assisted Radiology and Surgery, vol. 11, no. 2, pp. 207-215, 2015. Available: 10.1007/s11548-
015-1289-8.

[24] P. Gambadauro and R. Torrejón, "The “tele” factor in surgery today and tomorrow:
implications for surgical training and education", Surgery Today, vol. 43, no. 2, pp. 115-122,
2012. Available: 10.1007/s00595-012-0267-9.

[25] T. Haidegger, J. Sándor and Z. Benyó, "Surgery in space: the future of robotic
telesurgery", Surgical Endoscopy, vol. 25, no. 3, pp. 681-690, 2010. Available:
10.1007/s00464-010-1243-3.

[26] T. Haidegger and Z. Benyo, "Surgical robotic support for long duration space missions", Acta
Astronautica, vol. 63, no. 7-10, pp. 996-1005, 2008. Available:
10.1016/j.actaastro.2008.01.005 [Accessed 15 May 2020].

[27] S. Xu, M. Perez, K. Yang, C. Perrenot, J. Felblinger and J. Hubert, "Effect of latency training
on surgical performance in simulated robotic telesurgery procedures", The International
Journal of Medical Robotics and Computer Assisted Surgery, vol. 11, no. 3, pp. 290-295,
2014. Available: 10.1002/rcs.1623.
[28] S. Iqbal, S. Farooq, K. Shahzad, A. Malik, M. Hamayun and O. Hasan, "SecureSurgiNET: A
framework for ensuring security in telesurgery", International Journal of Distributed Sensor
Networks, vol. 15, no. 9, p. 155014771987381, 2019. Available: 10.1177/1550147719873811.

[29]"Telesurgery prospects in delivering healthcare in remote areas", The Journal of the Pakistan

Medical Association, vol. 69, no. 1, pp. S69-S71, 2020. Available:
https://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/767/. [Accessed 15 May 2020].