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Medscape
15-05-2025
- Health
- Medscape
Doc: ‘I Forgot I Was 7000 Miles Away' During Surgical First
On a cold Wednesday morning in January, Ruben Olivares, MD, sat down at a computer workstation in Cleveland to perform surgery on a man with prostate cancer. Olivares, a urologist at Cleveland Clinic, Cleveland, directed a robot to send high-intensity, focused ultrasound waves to the tumor. But this time, the patient was not in a nearby operating room, or in the same building — or even the same country. Instead, the man was in a facility more than 7000 miles away, at Cleveland Clinic's hospital in Abu Dhabi. Ruben Olivares, MD, a urologist in the Glickman Urological Institute at Cleveland Clinic in Ohio, worked remotely with Waleed A. Hassen, MD, the chair of urology at Cleveland Clinic, Abu Dhabi, who managed the on-site procedure in which a man with prostate cancer underwent high-intensity focused ultrasound therapy to ablate his tumor. In what is believed to be the world's first remotely-conducted, transcontinental robotic-assisted focal therapy for prostate cancer, Waleed Hassen, MD, MBA, department chair of urology for the Abu Dhabi hospital, sat near the patient to launch the software program and transferred to Olivares control of the robotic arm used to deliver the therapy. 'During the procedure, I forgot I was 7000 miles away,' Olivares told Medscape Medical News . 'I did a case in a regular fashion and, with all the people interested, I started doing teaching and educated everyone. The case was seamless,' thanks in part to an imperceptible video lag of less than 120 milliseconds, he added. The patient, expected to have a life expectancy of at least 10 more years, is now cancer-free, Olivares said. The procedure was intended to serve as proof that this type of remote surgery was possible using a regular landline. The achievement was the result of 2 years of planning, Olivares said, including testing the equipment and finding an appropriate patient who was agreeable. Olivares traveled to the Abu Dhabi location in 2023; he has since established a tumor board for which colleagues at Cleveland Clinic's various locations — including outposts in Florida, Canada, Nevada, and the United Arab Emirates — send him MRIs, biopsies, and other test results, and they discuss who is an appropriate candidate for focused ultrasound for prostate cancer. Olivares and his colleagues incorporate MRI images and a robotic platform that scans the prostate in real-time to determine exactly where to aim the ultrasound to ablate the tumor while sparing nearby healthy tissue. If a patient moves, Olivares can adjust the robotic arm accordingly. 'The future looks very promising,' Olivares said. 'We have to be able to offer new alternatives, new ways to solve all problems, regardless of where the patient lives.' He foresees a time when he could help guide physicians performing the procedure elsewhere while staying connected in real time: 'If a problem happens, I can take over and do the case from here.' Accelerating Adoption Teleinterventions between physical locations have occurred since the 1990s, but the field is gaining momentum, said Louis Kavoussi, MD, MBA, chairman of urology and director of Teleintervention at Northwell Health in New Hyde Park, New York. The first widely known telesurgery occurred in 2001, when surgeons at Mount Sinai Medical Center in New York City performed a remote, robotic gallbladder removal on a patient in Strasbourg, France. While successful, the procedure, supported by French Telecom, was determined to be too expensive for the transatlantic cable to be done on any regular basis, and garnered little interest, he said. With recent advances in technology, surgeons in China, Japan, and India have been performing robotic urological telesurgeries in remote locations, said Vipul Patel, MD, medical director of the Global Robotics Institute at AdventHealth in Celebration, Florida, and director of Urologic Oncology at the AdventHealth Cancer Institute. 'There's just a huge interest' in the technology, Patel said. 'All the societies, all the countries, all the robotic companies — I think we're starting to realize that we can truly help healthcare equity globally with telesurgery, and everyone's just jumping on board now.' Patel said the COVID-19 pandemic gave the field an important push. 'Patients could be seen virtually for medical issues but not for surgery. Telesurgery was born out of the need to treat patients remotely,' he said. A small number of medical schools, including Duke University, Durham, North Carolina, and McMaster University in Hamilton, Ontario, Canada, have started training programs in telesurgery. In 2023, Patel and colleagues from AdventHealth traveled to China, Japan, and India to see their equipment and work with companies there to develop telesurgery applications. As part of the visit, they were given licenses to operate in China, where Patel performed five robotic prostatectomies on patients located up to 5000 km (about 3106 miles) away to test the capabilities, with surgical colleagues at the patients' bedsides in case the equipment malfunctioned or another problem arose. The surgeons present locally never had to intervene. 'It was the same as if the patient was in our home OR [operating room],' Patel said. 'It was amazing that we could operate at such distances, and it was if the patient was in the room with us.' Patel's training facility in Florida is now connected to robotic systems in Brazil, Kuwait, Angola, China, and Morocco to teach and coach surgeons through telesurgeries in those countries. 'The global implications in terms of humanitarian healthcare equity are massive,' said Patel, who gave a plenary talk on telesurgery for the American Urological Association (AUA) 2025 Annual Meeting in Las Vegas last month. 'If we could teach remotely from here to underserved areas of the world, we could actually advance healthcare. Obviously, it helps patient care as well, But I think first, if you could teach remotely, you can help so many more people.' Conquering Lag Some hurdles still to be worked through are determining how far apart surgeons can be from the patient to perform operations safely, achieving a lag of < 155 milliseconds in some areas, and ensuring secure connections that cannot be breached. Still, telesurgeries could become more mainstream in the United States and other areas within 2-5 years, Patel and Kavoussi said. Legal and patient care issues also must be worked out, he said. Patel is executive director of the Society for Robotic Surgery, where he is working on guidelines for telesurgeries to ensure the patient is protected and clinicians conduct procedures in an ethical, orderly manner. Device manufacturers are working on designs for 'several hundred' new robots with different capacities, Kavoussi said. For example, some could be employed in telestroke programs where experts in one hospital can use them remotely to guide a wire through a patient's body to the site of a clot for the delivery of clot-busting drugs or devices to remove a blockage, in any emergency room. 'This is something that's coming,' he said. 'This is just the tip of the iceberg is what we're beginning to see now.' Kavoussi is on the board of Sovato. Olivares and Patel reported no relevant financial conflicts of interest.
Zawya
16-04-2025
- Health
- Zawya
Cleveland Clinic Abu Dhabi collaborates with Cleveland Clinic in the U.S.
This groundbreaking procedure marks the first of its kind in the world and within the Cleveland Clinic health system The innovative surgery enabled real-time collaboration between Dr. Ruben Olivares Cleveland Clinic Urologist, supporting remotely from Ohio, and Dr. Waleed A. Hassen, Department Chair of Urology at Cleveland Clinic Abu Dhabi, who managed the on-site surgical execution Abu Dhabi, United Arab Emirates: Cleveland Clinic Abu Dhabi, part of the M42 group, has achieved a historic milestone in global healthcare. In collaboration with experts from Cleveland Clinic in the U.S., the team performed the world's first remotely conducted transcontinental robotic-assisted focal therapy for prostate cancer. Focal therapy is a non-invasive treatment that precisely targets a specific section of the prostate using ultrasound beams, eliminating the need for major surgery or radiation. The Focal-One system enhances this approach with a robotic arm that ensures precise and controlled ultrasound delivery. The innovative surgery enabled real-time collaboration between Dr. Ruben Olivares, Urologist in the Glickman Urological Institute at Cleveland Clinic, supporting remotely from Ohio, and Dr. Waleed A. Hassen, Department Chair of Urology, at Cleveland Clinic Abu Dhabi, who managed the on-site procedural execution. Lasting approximately one hour, the remote procedure was completed successfully without complications, demonstrating the transformative potential of advanced technology in expanding access to specialized care. Remote procedure, powered by cutting-edge technology and robust communication networks, offers unparalleled access to specialized surgical expertise, even in remote or underserved regions. By combining local and global expertise, it addresses critical gaps in healthcare equity and training while enabling minimally invasive treatment options, such as focal therapy for prostate cancer. However, widespread access to such advanced procedures remains a significant challenge in many parts of the world. Commenting on the milestone, Hasan Jasem Al Nowais, Chairman of Cleveland Clinic Abu Dhabi, said: 'This innovative remote procedure is a remarkable feat that presents the possibility to manage complex care needs across borders and close global health inequities. We were delighted to have partnered with our colleagues in the U.S. to set a new standard for transcontinental healthcare.' H.E. Dr. Noura Al Ghaithi, Undersecretary of the Department of Health – Abu Dhabi (DoH), said: "Abu Dhabi is rapidly evolving towards establishing one of the world's most intelligent and efficient healthcare systems. Our progress is powered by advanced infrastructure and innovation-driven regulatory frameworks, which enhance healthcare quality and accessibility. Cleveland Clinic Abu Dhabi's achievements mark another milestone in our journey of healthcare excellence, showcasing the sector's commitment to pioneering medical solutions and cutting-edge technologies. This success strengthens our local and global partnerships, reaffirming the Emirate's dedication to safeguarding the health and well-being of our community and beyond." Highlighting the hospital's leadership in medical innovations, Dr. Georges-Pascal Haber, CEO of Cleveland Clinic Abu Dhabi said: 'Cleveland Clinic Abu Dhabi has always been at the forefront of integrating advanced technology with world-class care. Remote procedures represent the future of healthcare, pushing the boundaries of what can be achieved in medicine. This procedure exemplifies our vision of leveraging cutting-edge technology with collaborative expertise to set new benchmarks in patient care. It is exciting to partner with our colleagues in the US to make history and transform patient outcomes on a global scale. The success of this procedure marks a new era in global surgical collaboration. We envision a future where advanced treatments are accessible to patients regardless of location, reducing health disparities and improving outcomes for everyone.' The journey to this remarkable achievement began in October 2023, when Cleveland Clinic Abu Dhabi introduced the Focal One high-intensity focused ultrasound (HIFU) therapy to patients in Abu Dhabi. Focal One represents a novel approach to treating non-metastatic prostate tumors, utilizing advanced imaging technology to precisely target cancerous cells. This method enables effective tumor treatment while minimizing the risk of side effects. Dr. Waleed A. Hassen, Department Chair of Urology at Cleveland Clinic Abu Dhabi, explains: "There are many ways to treat prostate cancer, and one of the options is focal therapy. It's a non-invasive procedure where we use a robotically controlled arm to deliver treatment. Once the treatment plan is in place, the machine delivers it precisely. This is proof of principle that we can contour the prostate, design the plan, and execute it remotely. The procedure typically takes about an hour, with the Focal-one screen visible to both the surgical team and the ultrasound team, ensuring shared expertise. Dr. Ruben Olivares, M.D., Urologist in the Glickman Urological Institute at Cleveland Clinic said: 'We are thrilled to have successfully performed the first-ever transcontinental robotic assisted focal therapy procedure for prostate cancer by working in tandem with our partners at Cleveland Clinic Abu Dhabi. Here at Cleveland Clinic, we use cutting-edge technology, but unfortunately, it's not available in many places throughout the U.S. and in the world. We look forward to expanding the adoption of the latest alternative minimally invasive options and increasing access for patients throughout the world with this first step." This milestone comes as Cleveland Clinic Abu Dhabi celebrates a decade of excellence in care, making remarkable strides in advancing healthcare through integration of technology. As the hospital continues to explore the potential of remote procedures, the implications stretch far beyond prostate cancer treatment. This success not only opens new pathways for surgical education and collaboration but also drives global accessibility to advanced care. About Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi, part of the M42 group, is a multispecialty hospital on Al Maryah Island in Abu Dhabi, UAE. Cleveland Clinic Abu Dhabi is a unique and unparalleled extension of US-based Cleveland Clinic's model of care, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population. Cleveland Clinic Abu Dhabi has the following Institutes and Departments: Heart, Vascular & Thoracic, Neurology, Digestive Disease, Eye, Respiratory, Critical Care, Oncology, Transplant, Surgical Subspecialties, Medical Subspecialties, Emergency Medicine, Anesthesiology, Pathology & Laboratory Medicine, Imaging, Quality & Patient Safety, Clinical & Nursing, Research and Education Departments. In all, more than 50 medical and surgical specialties are offered at Cleveland Clinic Abu Dhabi. The campus is also home to a stand-alone and dedicated cancer center, Fatima bint Mubarak Center. The state-of-the-art, facility provides patients with access to diagnostics and treatment options through world- class facilities across 24 clinical departments that include a range of cancer subspecialties and programs: Blood Cancers, Breast Cancers, Endocrine Cancers, Gastrointestinal Cancers, Genitourinary Cancers, Gynecological Cancers, Head and Neck Cancers, Neurological Cancers, Thoracic Cancers, Ophthalmological Cancers and Soft Tissue Cancers among others. Cleveland Clinic Abu Dhabi provides patients in the region with direct access to the world's best healthcare providers and Cleveland Clinic's unique model of care that includes state-of-the-art amenities and world- class service standards closer to home. M42 is an Abu Dhabi-based, global tech-enabled healthcare company operating at the forefront of medical advancement. Visit us at
