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Long-distance remote surgeries allowed under revised guideline


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Specialist physicians will be able to use remote-controlled surgical-aid robots to operate on patients in far-off places under a revised health ministry guideline that lifted a ban on such procedures.

The Japan Surgical Society (JSS) is now compiling its own guidelines for the practice, which will enable, for example, a top surgeon in Tokyo to operate on a patient in a remote part of Hokkaido.

Although it may take a few years to prepare the environment, set up the infrastructure and ensure safety of remote surgeries, those involved are excited about the move.

“The revision of the guideline will enable legal preparations for remote surgeries, and Japan could become a world leader in this field,” said Kenichi Hakamada, a professor at Hirosaki University who is involved in setting up a JSS committee on the guidelines. “It would allow patients to receive high-quality surgery wherever they are located.”

Japan faces a severe shortage of surgeons, and some patients in serious condition who cannot travel have been forced to forgo operations.

A surgical-aid robot called “da Vinci,” developed by U.S. company Intuitive Surgical, is expected to be used for remote endoscopic operations.

More than 350 da Vinci robots have been set up around Japan. Health insurance covers 14 kinds of surgeries, such as removing stomach cancer, performed by the robots.

The robot consists of a main body with several arms that is connected by a communication line to another device, which the surgeon uses to operate the main body.

Cameras attached to the tips of the arms allow physicians to view the images on a monitor. The arms can also handle medical instruments used in the operations.

But up until now, the doctors operating da Vinci have been present in the surgery room.

The health ministry’s guidelines concerning online medical practice had said that doctors, in principle, must meet their patients at least once in person. The guidelines also prohibited doctors from performing surgeries by remote away from their patients.

However, the ministry drafted revised guidelines on June 10 to allow remote surgeries. The revisions are expected to take effect as early as July.

In response to the ministry’s move, the JSS will set up an expert committee to prepare its own guidelines on such topics as safety and which patients are eligible for remote operations.

The JSS will conduct demonstration surgeries by connecting robots in university hospitals via optical lines.

Two control devices connected to the main body of the da Vinci robot can be operated simultaneously.

This allows a specialist physician outside the operating room and a surgeon beside the patient to operate together. It is assumed that the specialist is in charge of the difficult parts of the surgery.

If a control device malfunctions or an optical line becomes disconnected, the surgeon in the operating room can still control the robot or continue the operation manually.

Remote surgeries have already started in China on a trial basis, but few have been performed elsewhere.

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