Groundbreaking Remote Surgery: How a Pig’s Endoscopy in Hong Kong Was Controlled From 9000 Kilometer

A New Era of Telesurgery: Performing an Endoscopy Across Continents

In the constantly evolving world of medical technology, telesurgery has emerged as one of the most revolutionary fields. Recently, researchers made a groundbreaking advancement by successfully performing an endoscopy on a pig in Hong Kong while operating from 9,300 kilometers (5,779 miles) away in Zurich, Switzerland. This remarkable procedure, conducted as part of a collaboration between researchers at ETH Zurich and The Chinese University of Hong Kong, highlights the incredible potential of telesurgery in transforming the future of medicine.

Utilizing a superfast internet connection and sophisticated robotic technology, doctoral student Alexandre Mesot manipulated the endoscope from Zurich while monitoring images of the procedure in real time, with only a 300-millisecond delay. Using the joysticks of a PlayStation controller, he navigated the device inside the pig’s stomach, marking a major milestone in the capabilities of remote medical procedures.

This remarkable feat signifies a breakthrough in the field of telesurgery, a growing field that has garnered attention in recent years. With the help of advanced technology, surgeons may no longer need to be in the same room—or even the same country—as their patients, opening new possibilities for global healthcare access. As demonstrated by this innovative project, the convergence of robotics, high-speed connectivity, and medical expertise has the potential to reshape the landscape of surgery.

The Power of Teleoperated Surgery: From Concept to Reality
The concept of teleoperated surgery may sound like something out of science fiction, but the groundwork for such advancements has been laid for decades. The first major telesurgery milestone occurred in 2001 when the world witnessed a successful transatlantic surgery, where a surgeon operated on a patient thousands of miles away. Since then, researchers and healthcare professionals have continued to push the boundaries of what is possible in remote surgery.

In more recent years, scientists have even experimented with operating surgical robots in space. In one instance, a surgical robot on the International Space Station (ISS), orbiting 400 kilometers (250 miles) above Earth, was successfully controlled by a team on the ground. While these early experiments were impressive, the Hong Kong-Zurich project took things to an entirely new level by increasing the distance between surgeon and patient to over 9,000 kilometers. Such distances present significant technical challenges, particularly in ensuring a stable and uninterrupted internet connection—a critical factor for the precision required in surgical procedures.

A Closer Look at the Procedure: Innovation in Action
In the operating room in Hong Kong, a team of surgeons anesthetized the pig and inserted the endoscope through its mouth into the stomach. The endoscope used for the procedure wasn’t an ordinary one; it was a cutting-edge device specially developed by the team at ETH Zurich. Unlike conventional endoscopes, this one navigates using a magnetic field, giving it extraordinary flexibility and precision.

“Not only can the endoscope be bent in any direction thanks to its magnetic head; it’s also smaller and easier to maneuver than conventional devices,” explained Mesot, who carried out the procedure from Switzerland. This flexibility allowed him to bend the endoscope’s head backward by 180°, providing a full view of the stomach entrance. Equipped with a tiny gripper, the endoscope was also able to take tissue samples from the stomach wall—an essential function for conducting biopsies during endoscopic procedures.

One of the significant advantages of this new endoscope design is its smaller size, making it easier to insert via the nose rather than the mouth, particularly in human patients. This innovation not only improves patient comfort by reducing the need for deep sedation but also makes the procedure more suitable for children, who typically require smaller instruments.

The Future of Telesurgery: Expanding the Possibilities
This successful remote endoscopy procedure on a pig marks a significant step forward in the development of telesurgery and opens up exciting possibilities for the future of healthcare. According to Professor Bradley Nelson of the Multi-Scale Robotics Lab at ETH Zurich, the team’s next goal is to conduct a similar teleoperated endoscopy on a human patient.

“There’s a lot of potential in this technology. Here, I’m thinking of minimally invasive procedures in the gastrointestinal tract, such as cancer screening,” said Professor Nelson. Such procedures could be especially valuable in regions where access to specialized medical care is limited. By using telesurgery, expert surgeons could operate on patients in remote or underserved areas without needing to travel, improving access to high-quality healthcare across the globe.

The benefits of telesurgery go beyond convenience. In emergency situations, particularly in isolated locations, the ability to perform remote surgical procedures could mean the difference between life and death. For example, a trauma patient in a rural area could receive immediate treatment from a specialist in a distant city or country, without the need to transfer the patient to a fully equipped hospital.

Additionally, telesurgery has the potential to revolutionize medical training. Surgeons in training could practice procedures remotely under the supervision of experienced surgeons in different locations, accelerating the learning process and enhancing the quality of training programs worldwide.

Challenges of Telesurgery: Connectivity and Human Factors
While the success of this remote endoscopy highlights the immense potential of telesurgery, there are still challenges that need to be addressed before such technology becomes widely adopted in clinical practice.

One of the most significant challenges is ensuring a stable and high-speed internet connection. Even a brief loss of connectivity during a procedure could have serious consequences. For instance, mid-procedure broadband interruptions could jeopardize the success of the surgery and pose risks to the patient. To address this, researchers are exploring ways to ensure fail-safe, stable connections, including the use of redundant communication systems.

Moreover, human factors must be considered. Remote surgeons need to rely entirely on visual feedback from the endoscopic camera, making it essential to have a clear and uninterrupted view. Any delays in transmitting images or controlling the surgical instruments can impact the precision of the operation. Although the 300-millisecond delay experienced during the Hong Kong-Zurich experiment was minimal, it still represents an area for improvement.

Ethical and Regulatory Considerations in Telesurgery
With the advent of telesurgery, ethical and regulatory issues also come into play. Who is responsible for the patient's care if the surgeon is not physically present? How can healthcare systems ensure that remote surgeries meet the same safety and quality standards as in-person procedures? These questions highlight the need for developing comprehensive guidelines to govern the use of telesurgery in clinical settings.

Furthermore, patient consent becomes a key consideration. Patients need to be fully informed about the risks and benefits of undergoing a teleoperated procedure, and regulatory bodies must ensure that strict safety protocols are in place to protect patient well-being.

The Pig's Perspective: A Milestone in Animal Testing
While the human impact of this breakthrough is clear, it's worth noting that the pig involved in the procedure emerged from the operation unscathed. According to reports, the pig survived the endoscopy and, as far as anyone is aware, did not suffer any ill effects from being at the center of a momentous medical innovation.

Animal testing remains a critical step in developing new medical technologies. The successful outcome of this procedure suggests that further testing, and eventual trials in human patients, could lead to widespread adoption of remote endoscopic surgeries in clinical practice.

Conclusion: A Glimpse Into the Future of Healthcare
The successful teleoperated endoscopy on a pig represents a pivotal moment in the evolution of telesurgery. With advancements in robotic technology, high-speed internet connections, and medical innovation, surgeons are no longer bound by geography. As this technology continues to evolve, we may soon see a future where specialists can provide life-saving care to patients thousands of kilometers away, regardless of their physical location.

The potential applications of this technology extend far beyond endoscopy. From minimally invasive procedures to complex surgeries, telesurgery could revolutionize global healthcare, providing greater access to specialized treatments, reducing patient travel, and transforming medical training and collaboration.

As researchers move forward with plans to perform remote procedures on human patients, the boundaries of what is possible in medicine continue to expand. Telesurgery has the potential to reshape healthcare as we know it, offering a glimpse into a future where distance is no longer a barrier to world-class medical care.