Alberto Breda: "I can sit down at a console and operate on a cancer patient who is 10,000 km away."

BarcelonaTwo years ago, Dr. Alberto Breda (Verona, 1973) successfully performed a transcontinental robotic surgery between Bordeaux and Beijing. The president of the Robotic Surgery Unit (ERUS) of the European Association of Urology remotely removed a kidney tumor from over 8,000 kilometers away, a medical milestone that laid the groundwork for Europe's first robotic telesurgery program, which is just getting started. This system connects the Puigvert Foundation in Barcelona and the San Roque Hospital in Las Palmas, 3,000 kilometers apart, allowing surgeons to operate on patients from the Canary Islands from the Catalan capital.

What does telesurgery involve?

— This robotic system consists of two fundamental parts. First, there are the robotic arms inside the operating room that hold the instruments used to perform surgery, such as forceps, scissors, and scalpels. Second, there is a console that allows the surgeon to control these arms with joysticks and binoculars through which the patient can be observed. A surgeon operates the console, while another team of professionals assists the surgeon from inside the operating room, which may be located kilometers away.

How has the program been rolled out?

— It's been months of hard work. On the one hand, there's all the administrative, bureaucratic, and legal work involved in establishing a regulatory framework for the program. You can't just buy a robot and start operating overnight; you have to comply with laws, medical licenses, and insurance requirements. All of this takes time. We've also had to build a team of professionals capable of operating remotely and another capable of providing support from the operating room, since we're in constant contact throughout the entire procedure. And finally, there's the technology and infrastructure necessary to perform telesurgery. We operate with the Edge Medical robot, and we've had to connect the two hospitals by cable, although we could also do it via satellite.

He started it a month ago.

— Yes, we started last February and have already operated on eleven patients, almost all of them cancer patients. It's the first step in a larger project. We wanted to begin with a smaller program that would demonstrate the validity of telesurgery and be reproducible on a larger scale. So far, we've managed to reach an island in the middle of the Atlantic Ocean, 3,000 kilometers from Barcelona, ​​but we can go much further. Today, I can sit at a console and operate on a cancer patient who is 10,000 kilometers away. Until recently, this was science fiction.

How far can you go?

— The first robots in medicine appeared in 1990 to operate on soldiers and war casualties, as well as astronauts, from a safe location. Last year, during the European Robotics Congress held in London, we connected to a spacecraft in space and moved the robot's arms. We can also reach rural or isolated areas, such as the Amazon rainforest, or countries with limited healthcare resources in Africa or South America. We can operate anywhere in the world from Barcelona.

Apart from the robot, an expert team is needed in the operating room.

— That's correct. The implementation of the program in the Canary Islands has been led by Dr. Pablo Juárez del Dago, a robotic surgeon who was my resident and trained at the best European institutes for robotic surgery and endoscopy. I couldn't do it alone, obviously. And his team, which is also highly qualified, has worked with me and trained to be part of this project. Besides performing telesurgery, we also train professionals to perform it. For example, in the Canary Islands, there's a console they can connect to while I'm operating and see my movements.

How are patients received?

— This is one of the great challenges of telesurgery. We need to raise public awareness about what we're doing, and it works. Almost all the operations we've performed were highly complex, and all the patients were discharged on the first or second day after surgery in excellent condition and are now doing perfectly. They should know that, despite living in the Canary Islands, there's a highly qualified surgeon in Barcelona who can operate on their cancer without them having to travel or take a plane. I don't have to travel either; I can operate while rested, and the feeling I have, though it might sound a bit strange, is that I'm working from the operating room.

A virtual operating room?

— Yes, in fact, telesurgery is part of an even more ambitious concept: the virtual hospital. The physical center will always exist, of course, but we will be able to perform teleoperations on patients from anywhere in the world. We want everyone to have access to a quality healthcare system, regardless of where they were born or what resources they have.

And what is the immediate future of telesurgery?

— When we say we want it to be reproducible on a larger scale, we're not just talking about increasing the number of healthcare centers and professionals, but also including all specialties that use robotic surgery. Currently, it's only being done in urology, but the European Society for Robotics is working to create a multidisciplinary group that brings together experts from other specialties so that, in the long run, there will also be telesurgery programs for these specialties. I think the project we've launched now should be seen as a European pilot program that can later be replicated in other European Union countries. We're also in talks with other hospitals, both in Europe and beyond, to replicate the Canary Islands project.