Telesurgery: blockchain to the rescue

Chris Froud, senior associate and patent attorney at Withers & Rogers, analyses how the accessibility of telesurgery systems also makes them more vulnerable to potential cyber breaches, and why blockchain technology could be the solution. 

In the world of telesurgery, network latency could pose a serious issue – disrupting surgical procedures and potentially putting patients’ lives at risk. Wider use of telesurgery systems and their enhanced accessibility also makes them more vulnerable to potential cyber breaches. Blockchain technology can provide the solution for these and other application issues by securing telesurgery systems, while still allowing them to be accessed by surgeons from multiple sites.

Telesurgery involves the use of automated or robotic systems, which allow surgeons to operate on patients remotely, without the need to be present with them in the operating theatre. Despite becoming more prevalent, particularly in areas such as gastrointestinal surgery, network latency remains a significant problem and a barrier to their wider take up. It is easy to understand why - when playing a video game, network latency might be an inconvenience, but when performing an operation, it could have catastrophic consequences.

Solving the network latency issue

The emergence of next generation networks and 5G technology has led to surgical robots becoming much more common in the operating room. 5G technology provides a more reliable and faster internet connection, making telesurgery systems more reliable, with less concern of a drop in network speed during operations. While 5G’s low latency network infrastructure has solved some important connection-related issues, other problems have become more prominent. For example, the fact that many more surgeons are now using these systems, from more locations, has brought security, privacy, and interoperability issues to the fore.

A much-cited research paper published by scientists at the University of Washington first highlighted the risk of potential cyberattacks in 2015. The research demonstrated that it is possible for a malicious third party to hack into a telesurgery system and compromise the remote connection that is established with a surgeon during an operation. The system could become jammed as a result, preventing it from working. This raised concerns about telesurgery at a critical time. Ever since then, innovators of these automated systems have been exploring ways to improve security.

Blockchain to the rescue

Extensively used in the banking sector to secure online transactions and to facilitate the buying and selling of cryptocurrencies, blockchain technology uses a distributed and decentralised system, which is secure by design.

Applying this technology to telesurgery systems can bring several benefits. For example, traditional telesurgery systems are centralised, which makes it difficult for multiple surgeons using different systems to share patient data, without an intermediary being involved. As well as potentially causing delays to surgical procedures, the use of an intermediary is an unnecessary security risk. Due to its decentralised functionality, blockchain or distributed ledger technology eliminates the need for an intermediary and enhances the system’s overall security.

Using ‘smart contracts’ to validate a surgeon’s identity

The use of blockchain technology in telesurgery can also help to verify a surgeon’s identity using a ‘smart contract’. A smart contract is a self-executing programme, which is stored on a blockchain, requiring the user to meet certain pre-determined criteria before using the system. This process means it is possible to check the validity of a surgeon’s identity, qualification, and experience before giving them control of a surgical robot.

While many researchers have recognised the benefits that blockchain can bring to telesurgery systems, some further problems remain unresolved and further research and development activity is needed in this area to find a solution. For example, while the problem of network latency has largely been resolved by 5G technology, the consensus mechanism required by blockchain technology to facilitate use of an automated system can still take time. For example, Bitcoin’s ‘proof of work’ consensus mechanism takes an average of 10 minutes to add a new block to the blockchain, which seems a long time when we consider how this might delay the start of an operation. Although there are other faster consensus mechanisms such as ‘proof of stake’, they each have disadvantages – for example, ‘proof of stake’ becomes vulnerable when a single party owns a huge share of the blockchain assets.

Patenting viewpoint

The use of blockchain technology in telesurgery is still in its infancy. The Gartner Hype Cycle for Blockchain 2021 shows that many of the aspects of blockchain technology considered most useful to telesurgery applications, such as authenticated provenance and zero-knowledge proofs, are still at an early stage of development. Much R&D activity seems to be taking place within academic research departments, which could mean that there is a heightened risk of early publication before patent protection is considered.

This type of early disclosure could render a technological innovation unpatentable. While many universities are switched on to the benefits that commercialisation can bring, others may not be thinking in this way, losing out financially as a result.

Currently, there doesn’t appear to be much patenting activity specifically directed to the use of blockchain in telesurgery. However, some general blockchain patents could be broad enough to cover telesurgery applications and would-be developers should consider these carefully. They should also bear in mind that some patent applications may have been filed recently, which means they won’t be published for up to 18 months and could frustrate plans to commercialise their innovation.

Innovators exploring ways to apply their blockchain technologies in telesurgery should consider their IP strategies with care. For example, it may be wise to file some patent applications early to secure broad protection and stay ahead of any potential competition.

With the pandemic affecting ways of working across the healthcare sector, the use of telesurgery systems is expected to increase and spread into new areas of practice. Blockchain technology could have an important role to play in securing these systems at the same time as enhancing efficiency and improving patient outcomes.