Robotic surgeons around the world lend a ‘hand’ to fight prostate cancer

7 September, 2016

More than 220,000 American citizens were diagnosed with prostate cancer in 2015, and close to 30,000 American men die annually from the disease. Many of these lives could have been saved if their cancer had been diagnosed early enough.

To increase public understanding of the disease, America recognizes September as National Prostate Awareness Month. Originally a U.S. Senate resolution in 2001, American presidents now annually declare the month as such through a presidential proclamation to “honor all those we have lost, and redouble our efforts to beat prostate cancer once and for all.”

To that end, doctors around the world have made huge strides in prostate patient treatment and recovery by turning to cutting-edge technology to simplify operations and increase education.

On May 23, thousands of registered viewers got a free cinematic glimpse into the exciting future of such medicine with the Worldwide Robotic Surgery Event (WRSE24), a 24-hour global undertaking that streamed live robotic surgeries and lectures from four continents using LiveArena Broadcast channels, Microsoft Azure and Azure Media Services.

The May WRSE24 event represented the third installment in an ongoing medical series in which some of the world’s leading robotic surgeons broadcast live operations to a captive audience of mainly robotic doctors in training, as well as other interested, non-squeamish parties.

These events serve as the culmination of almost two decades of work by Dr. Peter Wiklund, a noted urologist and surgeon, and the chairman of molecular medicine and surgical sciences at the Karolinska Institute in Stockholm, Sweden. “Live surgery is very educational because you see how surgeons deal with different problems,” says Wiklund. “It’s much more realistic for the people watching because the surgeon and viewers get the exact same view.”

Wiklund first encountered robotic technology in 2002 at the Karolinska University Hospital. At the time, urologists were exploring laparoscopic surgery, also called minimally invasive surgery (MIS), for treating conditions such as prostate cancer. “We were using long instruments where small movements translate to big ones,” recalls Wiklund. “Plus when you moved your hand to the right, the instrument would go to the left. It was backwards, awkward, and took time to train.”

Wiklund discovered that a family in Sweden had donated money to the hospital’s cardiology department to purchase robotic equipment for research and education. Interested in the possibilities for his field, he started borrowing the equipment for some of his prostate cancer operations. When the cardiology department discontinued its program, Wiklund took over. Within a few years he found himself traveling around the world conducting robotic operations at other facilities with similar equipment.

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In theory, you’d expect robotics to be more restrictive in movement than hands, but Dr. James R. Porter, medical director of Swedish Medical Center’s robotic program and a participant in WRSE24, thinks otherwise. “When you do laparoscopic surgery, the instruments are straight and you have no flexibility,” he says. “With robotic surgery, the instruments have a higher degree of freedom, meaning more range of motion, enabling you to do very complex things in a tight space.”

That doesn’t mean the procedure doesn’t come without challenges. One of the major issues for surgeons such as Wiklund concerns what athletes call the home-field advantage. “When you travel and do surgery, you don’t operate on your own patients, work with your own teams, or use your own instruments,” says Wiklund. “You also operate in front of hundreds of other surgeons, which some surgeons don’t enjoy.”

Another issue concerns the travel itself. The surgeon has to get to the hospital, as does the audience. Everyone is on the move and no one is where they’re used to being.

To address these challenges, Wiklund in 2005 started streaming operations from Karolinska over the internet, on a private connection, mostly to conferences. While the solution provided reach and resolved the travel issue, it didn’t deliver a very good image and raised questions about security.

Then in 2009, Wiklund learned about LiveArena, a streaming service run by the family that donated the robotic systems to his hospital. At the time, LiveArena focused on streaming live sports, primarily from youth hockey clubs. It had never ventured into the medical field, but was intrigued by the possibility.

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“We travelled to the Karolinska Institute and hooked up our production solutions to the robot to see if we were able to get a signal,” says Pontus Eklöf, COO at LiveArena. “We then ingested that into Azure and Azure Media Services to stream live surgical procedures from start to end.”

Because LiveArena had only recently started using the cloud, it could not predict the outcome of its efforts. The company, however, was excited by the cloud’s potential. “We found it really intriguing to be able to provide a fully end-to-end service where someone else took responsibility for the infrastructure and we could solely focus on developing the software to put on top of that infrastructure,” recalls Eklöf.

In looking for a cloud service provider, the company had explored Azure and AWS. Azure proved the better fit because the company already used the .NET framework as the foundation of its platform and Windows Media Services for its on-premises functionality. Visiting the Redmond campus and sitting down with Microsoft leaders solidified the company’s opinion. “Their vision aligned well with our thinking of enabling anyone to have their own TV channel to stream content,” recalls Eklöf.

LiveArena currently streams 30,000 live events every year. With Azure Media Services, it can stream up to 600 live events simultaneously.

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With the LiveArena platform at its disposal, Wiklund and a peer urologist, Dr. Justin Collins, developed WRSE in 2014. The goal of the event is to create more discussion around robotic surgery. To date, each of the events has accomplished just that, progressively drawing a larger crowd, with the audience last May reaching close to 4,000 registered viewers.

These viewers can interact with the surgeons and studios in real-time with social media. Skype, Microsoft, Yammer and Microsoft Pulse have all helped create an interactive environment for audience participation. Viewers of WRSE24 can virtually attend lectures and operations, many of which overlap in real-time, so they can also stream content after the event.

During the procedure, the surgeons take questions via Twitter and Microsoft Yammer. While this would seem a distraction, the doctors say the opposite is actually true. “It really makes you focus on all aspects of the operation,” says Porter. “Plus, being able to listen and communicate while you’re doing things with your hands is a normal part of surgery. Even if I wasn’t teaching somebody, I’d be constantly communicating with my team.”

In less than 15 years, Wiklund estimates that robotic surgery has grown from a small fragment into an industry with more than 3,000 systems in use and upwards of 10,000 medical practitioners. Going forward, Wiklund intends to hold more WRSE events and expand the curriculum into other specialties. In November, he will lead the fourth installment, which will include teaching master classes along with surgery.

“I think this is really helpful for surgical teaching because when we start doing things with a video camera, laparoscopic surgery and robotic tools, we allow ourselves and others to learn,” says Wiklund. “To be able to take surgery one step further and educate others is a real benefit to everyone and a valuable resource. The surgeon and viewers get the exact same vision, making it a perfect opportunity for this type of demonstration. This is only the beginning.”

Photos and video by Kelly Guenther.