Telesurgery in Gibraltar set to expand as AI transforms healthcare, robotic surgeon says

Professor Prokar Dasgupta, the world-renowned robotic surgeon who carried out three telesurgeries from London to patients in Gibraltar, has said the programme will expand to allow specialists in other fields to operate remotely on patients on the Rock.

Prof Dasgupta was speaking during his first visit to Gibraltar, where he delivered a presentation at St Bernard’s Hospital on AI and the future of healthcare.

Prof Dasgupta carried out the first telesurgery from London on a patient with prostate cancer some 2,400km away in Gibraltar.

Since then he has completed two more telesurgeries to patients in Gibraltar, with the third operation broadcast to a European conference.

Prof Dasgupta said the programme would now move beyond prostate surgery and into other specialities.

“We are about to embark on another live surgery in September, again for a European conference,” Prof Dasgupta said.

“But then, the exciting part is that we are going to expand this into gynaecology for ladies, and then into bowel surgery.”

“So, this is not just going to be for prostate cancer. This is going to serve ladies and those who have bowel problems.”

He said robotic bowel surgery was already being carried out in Gibraltar, while the telesurgery programme would expand further.

“Traditional robotic surgery for bowel is already happening in Gibraltar. Telesurgery, the programme is going to expand, which is very exciting.”

Prof Dasgupta is a urologist specialising in prostate cancer and said other surgeons and their teams would carry out the planned gynaecological and bowel procedures.

He added the telesurgery procedures between London and Gibraltar had produced good outcomes and that patient results were central to assessing whether the technology should continue to be used.

He said the remote procedures involved a delay of only around 60 milliseconds, but stressed that technological performance alone was not enough to justify the approach.

“If the outcomes were not good, then we would have had to think again.”

Prof Dasgupta has never physically met the Gibraltar patients he operated on, with the consultations done online and the surgery remotely.

“I have never physically met them because I haven't been in the same room as them,” he said.

This was his first visit to Gibraltar after having completed three telesurgeries.

“I think the reason why we could do this kind of surgery from London to Gibraltar is as much Gibraltar as London,” he said.

“In fact, I would say Gibraltar's contribution is more than London.”

“Because it's a small community, a community which trusts each other, where you have direct links to the university, direct links to the hospital administrators, to the government.”

“I think it makes things a lot easier. The bureaucracy here is a lot more agile, where people
want to do things for the benefit of the population.”

“I think that comes from this kind of living in a small area, where you are wanting to do what
is best for your patients. I think Gibraltar made it possible. I'm absolutely convinced, having
come here, that Gibraltar played a huge role.”

His presentation also examined the growing role of artificial intelligence and autonomous
surgery.

He explained that robotic surgery could be classified according to levels of autonomy, from
zero, where the surgeon has complete control, to five, where a machine would carry out an operation without human interference.

He said the technology already existed for machines to carry out increasingly complex tasks,
but that currently surgeries cannot be fully automated, and likely this will not happen in his lifetime. With the highest tech at level three out of five on the autonomy scale.

He said the public were becoming more willing to take part in trials involving autonomous surgery, but that this presented a particular challenge for complex surgery.

“I think for complex surgery, trying to train these robots to completely autonomously do a
complex operation, I think is going to be very, very challenging because to train the machines
to do that will be very, very difficult,” Prof Dasgupta said.

“I think we are gradually getting there, but we have to make sure that we do it responsibly.”

“We have to make sure that the public trust it, only then we are going to win.”

Prof Dasgupta said he believed autonomous surgery could potentially develop significantly over the next decade, although he said it was unlikely that machines would replace surgeons completely in his lifetime.

“Maybe within the next 10 years, we have trials where these machines perform autonomous surgery better than a human being, in which case I'll be happy to be proven wrong, but I think for the time being at least, that is wrong.”

He said surgeons were generally supportive of robotic surgery where they remained in control of the machine, but were much more sceptical about the prospect of being replaced by autonomous systems.

“Today, standard robotic surgery is where the surgeon is in the same room as the patient,”
Prof Dasgupta said.

“The surgeon is controlling the arms of the robot and the camera from a computer console while being seated in the same room as the patient.”

“With telesurgery, as you have seen for the first time in the UK, we have operated from the London Clinic all the way to St. Bernard's in Gibraltar.”

“Now, that is also robotic surgery where the surgeon was 2,400 kilometres away.”

Prof Dasgupta said AI should instead be used to support surgeons.

“It's created by us, trained by us. It should be there to augment our performance.”

He also pointed to limits on where robotic surgery could be used, adding that traditional surgery remained important in situations where speed was critical such as in an emergency or where robotic technology was not available.

He added there was also unequal access to robotic surgery globally, including in the UK, as it depends on location with cities having more robotic surgery facilities.