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A recent comment said telerobotic surgery might be used in space, a follow up comment said that multiple minute light delays would complicate it.

But I wonder if just the fact that being in orbit, and the communication complications of the would make it logistically unfeasible.

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  • $\begingroup$ An astronaut needing surgery would prefer a very stable communication link with a short delay time and a very experienced surgeon, especially in working telerobotic in zero gravity. There should be regular simulated training sessions using a peace of pig meat. $\endgroup$ – Uwe Sep 4 '18 at 13:20
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    $\begingroup$ Here's a video that doesn't have any gory details in it. I think it would be better to ask for objective information like what the latency would/could be when comms were "normal" and also for how long continuous links last uninterrupted, how long blackouts are, etc. Asking if surgery is "feasible" might be beyond the scope of the site. I think this line of questions is really interesting by the way! Also see Difference in communication delay on ISS $\endgroup$ – uhoh Sep 4 '18 at 16:52
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    $\begingroup$ @uhoh Although I'm not a doctor, I've used a davinci surgery robot multiple times and I think it would still preform well with delay. The haptic tweezer grips inside can resist your movement and give you feedback but there's also multiple pedals inside that lock specific axis and arms fixed in 3d space. This means you can step out and let go of the controls and the robot will stay exactly where it is with the tools not moving a micrometer. $\endgroup$ – Dragongeek Sep 4 '18 at 18:27
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    $\begingroup$ @Dragongeek A video and haptic feedback latency of say 0.5 1, or 2 seconds on every single movement, is different than locking the controls and walking away, and might be even more of a challenge if that latency is variable and unpredictable. Since remote surgery is a hot topic, I wonder if there's some literature on surgery with visual and haptic feedback latency out there somewhere. Do you know if it has any queueing features? In other words, if you want to do a suture, can you click "one suture here" and a sequence is performed by the machine itself? $\endgroup$ – uhoh Sep 4 '18 at 19:01
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    $\begingroup$ @uhoh currently the davinci robot can't do procedures automatically (except limited 'tool change' movements) however it does have assistive features such as hand movement smoothing and you can constrain movement on the manipulators (ie move only linearly or set the rotation point on the body entrance port of the patient). It also has force safeguards against crashing (you can't push the tools through a table) and you can set this to block at different levels of resistance. Also, multiple surgeons can use multiple machines for the same manipulator cart and even "hand off" arms at the same time. $\endgroup$ – Dragongeek Sep 4 '18 at 21:26
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As mentioned in comments to the OP, "feasible" may mean different things in different contexts. But technical feasibility is probably not the only important issue: economic feasibility is also important. It is not, yet, economically feasible.

There are several terrestrial applications for truly remote, near or completely unsupported telerobotic surgery. For instance, the Antarctic use case pointed to in the linked question, or in remote locations worldwide. If and to the degree the tech exists to enable that, it has not been deployed notwithstanding enormous human and financial costs of failing to have it in place. Note that the radio communication delays and complications terrestrially may be similar to the issues communicating with ISS.

During surgery, even if everything goes as planned, all sorts of things happen at unpredictable times. For instance, after initial incision and retraction, there may be blood in relatively unpredictable places or at unpredictable times that obscure views and potentially injure the patient. The surgeon needs to respond to those quickly. If there is significant latency in the transmission, the surgeon cannot do so. One way to deal with this is to have a surgeon on board ISS to assist the ground surgeon using the telerobot. But that is inefficient - easier to just have the onboard surgeon do the cutting with a consulting surgeon in her ear, following along by video. No need for the robot.

If the question is limited to technical feasibility, it seems to me that the first technical issue would be maintaining the communication link throughout orbit. This would require consistent and predictable connection between the two endpoints, which is complicated. Once a consistent connection can be maintained, the remaining issues are not unique to ISS: relatively high latency, possibility of blackout, unpredictability, and lack of human backup intervention in the event of an emergency all confront terrestrial applications - they are not special to ISS. So it seems to me the unique hurdle is maintaining communication in orbit. Put differently, if we could do it on earth (we can't right now, or we would be,) then the only impediment to doing it on ISS is maintaining reliable communication throughout orbit.

Maintaining reliable communication throughout orbit is certainly hypothetically possible. For instance, if obstructions were cleared and enough geosynchronously orbiting satellites hung in the air, we should be able to maintain line-of-sight with ISS throughout its orbit, and communication maintained. This is in the works - for instance, see this relevant question concerning end-to-end optical communication between ISS and a ground station.The significant variable latency is not unique - the telerobotic system must have a way to deal with unexpected events in the case when communication drops, and a way to recognize and prepare for latency. This probably means that the system needs to be backed by a powerful AI that can do things like recognize and clamp off unexpected bleeders.

Bottom line - if by "telerobotic surgery" you mean long-distance waldos, high and variable latency communication makes their use impossible or dangerous. If the telerobots have advanced with a significant AI, and if the communication problem has been addressed, then it may be feasible. At present, that is the stuff of (hopefully not far off) sci-fi.

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It is feasible. Network latency is a challenge however it is one that is not unique to space. Although that is dependent on the length of the operation because having to reroute instructions across the planet to keep in contact with a moving vehicle would be a bit more challenging.

There is one major counter argument to its feasibility though. Normally when such robots are used there are medical personnel on standby in that location who can jump in in the event something has gone wrong. For instance, the robot could break down, power could be lost, the network could go down. This is still very much a problem and even more so in space where you only have your crew and a whole list of technical things that can go wrong.

That being said, I would see a robotic surgeon as a backup/skillset enhancement to the mission rather than a replacement for medically trained crewmembers. Say a crewmember gets impaled through the brain, I doubt they would have a neurosurgeon on board and he definitely wouldn't be stable enough for re-entry but they could just dial one up to try and stabilize him. Or say the medical personnel are injured and need stabilization.

Bottom line is, a capability that can increase mission success without adding much in the way of resource cost/allocation is always great to have.

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  • $\begingroup$ I think you might be mis-stating how 'telerobotic surgery' works. The medical person is not on standby they are 100% doing the surgery remotely. ncbi.nlm.nih.gov/pubmed/12140630 $\endgroup$ – James Jenkins Sep 4 '18 at 16:13
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    $\begingroup$ @JamesJenkins no I think you might be confused with my wording, the lead doctor is working remotely however there are medical personnel present who can jump in in the event of system failure. To my knowledge, no current telerobotic surgery is performed in total absence of medical personnel, though there are plans to make such systems available for places that cannot field such personnel like battlefields. $\endgroup$ – anon Sep 4 '18 at 16:18
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    $\begingroup$ Concur, after reading your comment and re-reading the answer I see it now. $\endgroup$ – James Jenkins Sep 4 '18 at 16:28
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Reinforcing Matt's answer:

  1. On Earth, the alternatives to telesurgery are simply superior. If you can afford to build a robotic facility in the middle of nowhere, why not instead build a helicopter landing pad, and whisk the patient away to a proper trauma center?

  2. Don't assume that just because you can find articles about telesurgery, that it is established practice. People have been promising it for a long time. The military is often portrayed as a prime customer, but despite decades of attempts at telesurgery, they still evacuate the wounded to proper hospitals.

  3. You have a major chicken-and-egg problem with training:

    • The argument for telesurgery is that you can have an experienced surgeon doing it.
    • But no surgeon has that experience doing it, much less with a latency of minutes.
    • To get that training, the surgeon would need to practice on patients with an inferior and probably dangerous technology. It is unethical to do that.
    • Practice on animals will get you only so far. Remember, the entire justification of telesurgery is that you are using an "expert" that is superior to what the crew can do.
  4. Okay, so your surgeon has practiced the procedure for X, but situation Y develops instead.

  5. The existing model of dealing with problems in space works well. Spaceflight requires the expertise of aerospace engineers, chemists, computer programmers, medical doctors, physicists, etc. Yet we don't fill our crews with one aerospace engineer, one chemist, etc. Instead, we send up people who are good at solving urgent problems and following orders, and then we keep experts in Mission Control (or on call as needed).

  6. Arguably, you will get just as good results by having a doctor on crew, who can do the procedure themselves after consulting with mission control. In case the doctor is compromised or needs assistance, the remaining crew should get 2-3 months training in basic space medicine, including assisting real human surgeries for 1-2 months. That would give them enough training to follow instructions given from mission control, as well as deal with urgent situations.

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