*Application and Prospect of Telesurgery: The Role of Artificial Intelligence DOI: http://dx.doi.org/10.5772/intechopen.111494*

health safety. Therefore, there is a need for the development of telesurgery in China. Although the research on telesurgery in China started late, it is developing rapidly.

In the early twenty first century, the Naval General Hospital used a remote surgical robot system to perform stereotactic biopsy surgery for brain tumor patients, completing the first off-site brain surgery in China. Beijing Jishuitan Hospital applied the masterslave robotic surgery system to perform remote orthopedic assisted surgery operations. Although the two surgeries were completed successfully, the telesurgery system in the study only played the role of auxiliary positioning and image transmission.

The application of 4G network communication has promoted the development of telesurgery in China, and its network stability is better than that of satellite communication. In 2015, the domestic "Myriad S" surgical robot completed remote wireless animal experiments at an interval of about 170 km with the help of 10 Mb/s bandwidth commercial network. Although the whole experiment was relatively successful, the narrow bandwidth and high latency of the 4G network still limit the extension of the clinical application of telesurgery.

### **2.3 The status of telesurgery abroad**

In 2003, Anvari M's team set up a telesurgery system between a teaching hospital and a rural hospital 400 km apart in Hamilton. This study led to the completion of 21 telesurgeries in 2005, successfully establishing the world's first tele-robotic system to serve rural communities.

In 2014, a study by Xu et al. showed that a time delay below 200 ms is ideal for remote surgery, but up to 300 ms does not affect the successful completion of the procedure. A higher network latency would affect the safety and accuracy of the procedure, or even make it impossible for the operator to perform the operation. This conclusion has also been used as a criterion for network selection in many domestic and international remote studies [4].

Since the beginning of 2019, many foreign studies have started to use 5G networks for remote surgery. And satisfactory surgical results have been obtained. Lacy's team applies 5G network to remote surgical coaching of young physicians in off-site locations [5]. In February 2019, a Spanish medical team used 5G network to remotely perform an intestinal tumor resection. This is the world's first human remote surgery done using 5G network.

#### **2.4 The current status of telesurgery in China**

The commercialization of 5G network is a sign that China's telesurgery has entered modernization, and its low latency, high bandwidth, and high mobility meet the demand for real time, high efficiency and stability of remote surgery, advancing the research boom of domestic telesurgery. In December 2018, the People's Liberation Army General Hospital applied a domestic self-developed surgical robot to successfully complete 5G telesurgery animal experiments in Fuzhou. The physician remotely controlled the robotic arm and the lens arm to remove part of the pig liver, and the intraoperative high-definition 3D image and sound transmission were in real time and stable. The robotic arm operated flexibly with good master-slave consistency, and the one-way average time delay between the two ends was less than 150 ms. In September 2019, the National Institute of Hepatobiliary Surgery completed the world's first multi-point collaborative 5G remote multidisciplinary animal experiment with stable network latency, smooth surgical operation, and stable intraoperative animal vital

signs. The surgical experiment allowed two physicians located in Beijing and Suzhou to perform gastrointestinal resection and liver resection on the experimental animals through remote control of the robotic arm. This experiment broke the traditional mode of single-point consultation and surgery between doctors and patients, and provided patients with multidisciplinary remote consultation and treatment options, realizing multidisciplinary cooperation in telesurgery.

Chinese telesurgery is developing rapidly with the help of 5G networks. And it has transformed from a single-center, few-sample exploration model to a multi-center, large-sample clinical research model. Since September 2020, Prof. Niu Haitao's team at the Affiliated Hospital of Qingdao University has conducted a large sample, multicenter remote robot-assisted urological surgery study based on animal experiments and simulated time-delay experiments. More than 50 cases of telesurgery have been completed, further confirming the safety and feasibility of telesurgery [6].

In February 2023, Prof. Niu Haitao's team completed the first case of quantum telesurgery in China. The implementation of telesurgery with the help of quantum communication technology means that the development of telesurgery has entered a brand new stage, which greatly expands the spatial scope for physicians to perform complex surgeries and creates more convenient conditions for people in remote areas to enjoy high-quality medical services.

In order to ensure the high requirements of network for telesurgery, more and more new network technologies are applied to the network line. The multi-link aggregation transmission technology is a more mature and widely used network technology in telesurgery. Multi-link aggregation technology ensures data transmission capability for remote surgery. It adds a virtual layer on top of the traditional link layer, which implements the distribution of data frames that are distributed to each link through a rotation algorithm, successfully aggregating the transmission bandwidth of multiple physical links, thus achieving the effect of high-speed transmission with bandwidth overlay on the same terminal. Multi-link transmission and single-link transmission can coexist, and either multi-link transmission or single-link transmission can be selected according to the actual needs of the application. As an auxiliary technology of the networking scheme, it can guarantee the future development of telesurgery after the 5G network mode is popularized and has great development potential.
