The first exploration of cross-operator, cross-network domain "5G+ fixed-network dedicated line" multi-point collaborative remote clinical real-time interactive teaching surgery mode achieved of worldwide complete success

On April 10, 2022, in the operating room of the second inpatient Department of Peking University First Hospital, Prof. Xuesong Li of the Department of urology was performing a pyeloplasty operation with the domestic KangDuo (the brand of Sagebot, the same below) endoscopic robotic surgery system. Meanwhile, 6 kilometers away, Prof. Zhigang Ji from the Department of Urology in the Telemedicine Center of Peking Union Medical College Hospital observed and monitored the surgical process in front of the KangDuo Surgical Robot doctor control desk. During the dissection of variations and key surgical steps, Prof. Ji took over the control of the system and remotely operated the surgical robot arm system located in Peking University Hospital to complete intraoperative real-time interactive instruction and necessary surgical procedures. During the operation, both parties switched control for many times, the process was smooth, the 3D high-definition video picture of the remote end was clear and smooth, the robot arms responded in a timely and stable manner, without obvious delay, and the operation was accurate and effective. The sound and scene video interaction of both sides were perfect, and the assistant cooperated with each other smoothly. This marks the successful establishment and implementation of the multi-point collaborative remote clinical real-time interactive teaching mode of "5G+ fixed network dedicated line" that explores cross-operator and cross-network domain for the first time in the world.

5G network is a new generation of broadband mobile communication technology featuring high speed, low delay and large connection. Expanding its application in the medical industry will effectively enable telemedicine. Currently, 5G infrastructure construction in more developed areas of China is growing rapidly, but due to the fact that many hospitals in counties, prefecture-level cities in China only have fixed network coverage. In order to realize the hardware infrastructure construction of remote surgery completely based on 5G network conditions, it still needs to be further improved. In addition, as mobile, telecom and Unicom networks coexist in China's communication industry, the development of telemedicine will inevitably encounter a cross-operator situation. Therefore, based on the current situation of extensive coverage of domestic fixed network business, combined with the advantage of 5G network high-speed and low-delay, we innovatively adopt the cross-network domain and cross-operator network transmission path between 5G network and fixed network special line, and in the non-carrier special guarantee environment, the end of fixed network special line adopts 30M common bandwidth to guarantee the implementation of remote surgery through technical means. As far as possible, the actual scenario of remote surgery application at the present stage is restored, so as to improve the current medical technology level and diagnosis and treatment efficiency of hospitals in different regions, better cope with the construction of hierarchical diagnosis and treatment system and medical poverty alleviation work, which is more in line with the current basic national conditions of China, and effectively improve the sense of gain of patients in the field of health care.

In the previous single-console remote surgery mode of surgical robot, there are many problems such as ethical safety and medical liability in remote surgery operation. Especially, because the surgeon is far away from the patient, when there is an emergency or abnormal situation during the operation, the surgeon cannot deal with it on the spot, resulting in increased medical risks, which seriously hinders the development of remote surgery. In this remote surgery, the multi-point collaborative remote real-time interactive teaching mode is based on the learning curve of the early stage of robotic surgery or complex surgery carried out by local physicians. Through the control transfer of the remote multi-point console, the real-time supervision of the remote medical experts in the whole process of local surgery is realized, and the teaching operation is implemented in the key steps of surgery. In the event of network interruption or remote console failure, the local doctor can continue to operate the surgical robot using the local console to complete subsequent treatment, thereby controlling and reducing the risk of remote surgery.

In December 2018, the domestic KangDuo laparoscopic robotic surgery system carried out the first international attempt of remote animal surgery based on 5G network, and in September 2019, it successfully carried out the world's first multi-point collaborative 5G remote animal surgery. In October 2021, the team of urology Department of Peking University First Hospital successfully carried out a remote animal surgery experiment with double console using a fixed-line network between the central hospital and Miyun Hospital, 80 kilometers away. In March 2022, it carried out 5G+ fixed-line remote surgery operation test between the telemedicine Center of Peking Union Medical College Hospital and the operating room of Peking University First Hospital. The development and technical testing of the above basic tests provided solid technical support and confidence for the successful implementation of remote clinical surgery.

Multi-point collaborative remote real-time interactive surgery mode reduces the medical risks of remote surgery by a single remote console robot, and solves the problem of uneven distribution of high-end mature medical talent resources caused by regional development differences. It makes full use of new technologies, new businesses and new models to enrich the forms of medical assistance, expands the connotation of telemedicine services, improves the accessibility of medical services, and is in line with the healthy China strategy of promoting quality medical resources to the grassroots.