The Robots

Any telesurgery system works with the surgeon in a remote location, with the ability to manipulate the surgical robot using an input device.  One of the more notable systems is the daVinci robot (Guthart & Salisbury, 2000, p. 618).

The daVinci robot operates using a master-slave communication system (in digital communications, this means that one device dictates the terms of communication to the other) (Guthart & Salisbury, 2000, p. 619).  The surgeon's unit is the master, and the patient's unit the slave.  The surgeon's input device is a tool handle.  It utilizes seven degrees of freedom: three orientation, three translation, and one grip (Guthart & Salisbury, 2000, p. 619).  Orientation is a response to changes in the angle (for example, pivoting) of the surgeon's input device.  Translation is a response to changes in the position of the input device.  The grip degree of freedom measures forces and torques applied by the surgeon, and transmits them to the robot appropriately.  These degrees of freedom are vital to preserving the minimally invasive nature of telesurgery. 

The daVinci system also has other features intended to increase the overall safety of telesurgery.  It has a scale factor, allowing for large movements by the surgeon to be replicated on a smaller scale for high precision.  It also has an electrical control system to filter out surgeon tremor, increasing the steadiness of the system.  On the patient's end, a stereoscopic endoscope transmits two images to the surgeon.  The images are taken from nearly the same position; some depth perception is achieved using this technique, much like eyes work for a human. (Guthart & Salisbury, 2000, p. 619)

While the telesurgery may be performed over any network – even the Internet – this is not advisable.  There are two important factors to consider when choosing a network: latency and quality of service (QoS) (Hanly et al., 2005, p. 275).  Latency is the time it takes for the patient's unit to receive a signal from the surgeon's unit – or, physically, the time it takes for the robot to react to movements by the surgeon.  The QoS of a network describes the commitment of the network to the application (this includes bandwidth, as well as the overall usage of the network) (Hanly et al., 2005, p. 275).  If a network is used by many users, there will almost certainly be spikes in performance.  It is desired to use a network with low latency and high QoS for telesurgery to maximize patient safety – of course, this also increases the costs of the surgery (Hanly et al., 2005, p. 275).  One example of a dedicated network with low latency, high QoS, and available redundancies might be a national, private fiber-optic communication system, which is expensive to install and maintain.

Human Surgeons vs. Robotic 'Surgeons'

Image taken from: A Perspective on Medical Robots (IEEE, 2006, p. 2)

While we can't consider telesurgery robots as stakeholders in this controversy, we certainly can think of them as actors in an actor-network.  In fact, they form the obligatory point of passage (OPP) of this network; in the problematization stage, all negotiations surround it.  Remove the robots from this network, and the network will unquestionably breakdown.

Telesurgery robots interact with virtually every other actor in this actor-network.  They directly interact with manufacturers, hospitals, doctors, surgeons, patients, and researchers.  They also indirectly interact with governments and taxpayers through the controversy that we are investigating – the funding and costs of telesurgery technology.