Remote surgical assistance thanks to 5G

With the support of the FPS Economy, SMEs, Self-Employed and Energy.

Surgical advances never cease: technology is evolving and procedures are becoming increasingly complex. At the same time, there is a growing shortage of specialised surgeons, so hospitals are having to resort more and more often to remote interventions by external experts to assist the team in the operating theatre.

Kortrijk-based imaging specialists Barco have developed a solution that caters to this need: NexxisLive. This software enables experts from outside the hospital to communicate in real time with the operating team. “The external expert has access to a live feed of the operation and can immediately interact and make notes on the images,” says Tom Kimpe, VP Technology & Innovation at Barco.

Assisting operations via 5G

The reactions to NexxisLive are encouraging, but Barco has received feedback from customers that they want to deploy the solution in a broader range of circumstances. “NexxisLive is primarily designed for use on a high-quality screen with high resolution and a stable fixed network connection,” Kimpe explains. “We assumed that external experts would always have access to a fixed workstation. However, in reality they often find themselves being consulted at unexpected times, for instance when they are in transit and only have a tablet or smartphone handy.”

When the FPS Economy launched a call for new 5G initiatives, the pieces of the puzzle finally fell into place. “A series of discussions with Orange Belgium made it clear that both from a technical and an efficiency perspective it would be useful to bring NexxisLive to a mobile platform over 5G,” Kimpe recalls. The companies teamed up with Kortrijk-based app developer Sweet Mustard, the Chirec hospital in Brussels and KU Leuven to submit a grant application to the federal government. The project was approved this year and has since been launched.

Bandwidth, latency and security

In his capacity as 5G Customer Solution Architect at Orange Belgium, Stefaan Van Aken is directly involved with the project. He sees three reasons why 5G is the ideal technology for a mobile version of NexxisLive: bandwidth, latency and security. “The expert must have an accurate picture of the operation, as even the smallest details and colour nuances can be of clinical importance,” he says. “That’s why NexxisLive sends high-definition images to the mobile device, which sometimes requires high bandwidth of up to 100 Mbps. The expert must also be able to communicate with the operation team in real time and indicate areas of the images. This is only possible with minimal latency. With a 5G slice of the network, we can guarantee that bandwidth and latency.”

The third reason to opt for 5G is security. “Video images of an operation are the most intimate images of a human being imaginable,” says Van Aken. “With 5G, we can send those images across an entirely secure connection from the hospital to the external expert. As soon as the expert opens the NexxisLive app on their tablet, the slice is activated and all communications take place on a private connection between the app and the operating theatre.”

Extensive test phase

Barco started the 5G project with a usability study based on discussions with the Brussels Chirec hospital group. After all, the interface of NexxisLive had to be adapted to the characteristics of a mobile device, Kimpe explains: “Instead of a high-resolution screen with a keyboard and mouse, we now have to work with a small screen with a touch interface. So we can’t show all the video images simultaneously and we have to make it easier to switch between different cameras.” Sweet Mustard are developing an Android app for this purpose, with a first proof of concept expected by the end of 2023.

In its 5G Lab in Antwerp, Orange Belgium has already carried out an initial test with a 5G standalone (SA)-compatible tablet and has been able to confirm that the mobile network has sufficient bandwidth to provide the required image quality. “When the app is ready we will test it by establishing a private connection with the Chirec group’s Delta hospital,” says Van Aken. As 5G SA hasn’t been rolled out nationwide yet, the pilot project requires a location where it can be activated on the mobile phone mast used to connect the surgeon’s device. “For large-scale use, 5G SA would have to be deployed across the country. Only then can we let a surgeon follow procedures when they’re on holiday in the Ardennes, for instance.”

In a second phase of the project, the partners will examine whether it is possible in the long term to operate surgical robots over a 5G connection. This would enable hospitals to have critical parts of an operation performed remotely by an external surgeon. “Naturally this imposes even stricter requirements in terms of latency,” Kimpe says. “To make this happen, we are working with KU Leuven university, as they have a test laboratory for robot surgery with a simulated 5G environment. Consequently, that test will take place over an actual 5G connection,” Van Aken adds.

Constructive collaboration

Kimpe feels that the first 5G collaboration between Barco and Orange Belgium has been a success: “The collaboration was smooth and constructive throughout the project. Orange invited us to the Antwerp 5G Lab to illustrate the operation of 5G standalone, and with Sweet Mustard, they gave us a training session on the correct use of 5G and showed us how slices work. In turn, we invited Orange to our own test space to demonstrate how the communication between an external expert and an operating theatre works within NexxisLive. The fact that Orange Belgium focuses on delivering an end-to-end solution is of great added value to us. They not only bring in their expertise on the mobile network, they also supply the security design.”