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Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue

BACKGROUND: Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narr...

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Autores principales: Akasaka, Harue, Hakamada, Kenichi, Morohashi, Hajime, Kanno, Takahiro, Kawashima, Kenji, Ebihara, Yuma, Oki, Eiji, Hirano, Satoshi, Mori, Masaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202925/
https://www.ncbi.nlm.nih.gov/pubmed/35709190
http://dx.doi.org/10.1371/journal.pone.0270039
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author Akasaka, Harue
Hakamada, Kenichi
Morohashi, Hajime
Kanno, Takahiro
Kawashima, Kenji
Ebihara, Yuma
Oki, Eiji
Hirano, Satoshi
Mori, Masaki
author_facet Akasaka, Harue
Hakamada, Kenichi
Morohashi, Hajime
Kanno, Takahiro
Kawashima, Kenji
Ebihara, Yuma
Oki, Eiji
Hirano, Satoshi
Mori, Masaki
author_sort Akasaka, Harue
collection PubMed
description BACKGROUND: Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important. OBJECTIVES: To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments. METHODS: Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance. RESULTS: Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041). CONCLUSIONS: In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue.
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spelling pubmed-92029252022-06-17 Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue Akasaka, Harue Hakamada, Kenichi Morohashi, Hajime Kanno, Takahiro Kawashima, Kenji Ebihara, Yuma Oki, Eiji Hirano, Satoshi Mori, Masaki PLoS One Research Article BACKGROUND: Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important. OBJECTIVES: To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments. METHODS: Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance. RESULTS: Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041). CONCLUSIONS: In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue. Public Library of Science 2022-06-16 /pmc/articles/PMC9202925/ /pubmed/35709190 http://dx.doi.org/10.1371/journal.pone.0270039 Text en © 2022 Akasaka et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Akasaka, Harue
Hakamada, Kenichi
Morohashi, Hajime
Kanno, Takahiro
Kawashima, Kenji
Ebihara, Yuma
Oki, Eiji
Hirano, Satoshi
Mori, Masaki
Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title_full Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title_fullStr Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title_full_unstemmed Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title_short Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
title_sort impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202925/
https://www.ncbi.nlm.nih.gov/pubmed/35709190
http://dx.doi.org/10.1371/journal.pone.0270039
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