One use case where robotic aided surgery proved to be highly beneficial is Robotic Aided Kidney Transplant (RAKT) for obese recipients (see 
). In general, transplant surgery in obese recipients is technically very demanding and require larger right lower quadrant incision, often associated to more wound related morbidity in terms of surgical site infections (SSI), more pain, longer convalescence and postoperative recovery, which explains why obese patients are frequently denied access to transplantation. But epidemiological data indicate that 20-50% of patients on dialysis for end-stage renal disease (ESRD) are obese, advocating for minimally invasive surgery as opposed to open surgery. Unfortunately, conventional minimally invasive surgery using laparoscopic instruments manipulated by a surgeon is not suitable for the safe execution of a kidney transplant in morbidly obese patients due to the high complexity of the procedure. In fact, current laparoscopic cameras present only a two-dimensional view and laparoscopic instruments have a limited degree of freedom which results in loss of depth perception, lower natural hand-eye coordination and dexterity. On the other hand, robotic surgery provides a three-dimensional view and utilizes articulated instruments, which allows the surgeon to work with greater ease, with more intuitive movements during the execution of complex procedures.
In a series of RAKT performed in obese patients between June 2009 and December 2011 (see 
), 0% developed surgical site wound infection versus 28,6% patients in a control group that underwent an open kidney transplant procedure.
There are concerns that are usually raised related to robotic surgery:
Learning curve which leads to few experienced surgeons
Procedure duration impacting return on investment for hospitals and potentially affecting patient status after surgery
Medical costs that are significantly higher for the robotic surgical technique compared to the open technique
In our use-case, the higher costs have to be balanced against the cost of keeping obese renal failure patients on dialysis, which is quite expansive as well.
As to the point related to procedure duration, the question is indeed whether surgeons are able to complete the procedure with same or equivalent duration as an open surgery, so as to keep the warm ischemia time (time a tissue remains at body or ambient temperature after blood supply has been interrupted), which is one of the main reason for graft failure, as low as possible. Therefore, with the idea that the whole transplant procedure shall be completed in the shortest possible time, requirements on latencies introduced by the teleoperation system, that are discussed in clause 220.127.116.11.2
, need to be considered here so that surgeons can make more natural movements, do not slow down their hand speed and do not make pauses every now and then.
Typical RAKT duration is close to four hours, this allows us to estimate targeted communication service availability figure for the successful transmission of images within latency constraints discussed above. In fact, considering that any late received image translates immediately into a wrong estimated distance and may result in serious injury to the patient, we want this event to not happen during at least the duration of the procedure, a safe margin would be to consider five hours of correctness in a row. Note that in this use case, a total of 240 images per second are exchanged over 5G communication service (120 images per second in each direction).
In addition, having two consecutive errors in any direction shall be negligible as it may result in incorrect commands sent the actuators, and, in addition to represent a serious risk of injury for the patient, may damage the system. Considering that the probability of having two consecutive errors shall be p2 < (1000 messages x 2 directions x 2 radio segments x 3600 seconds x 5 hours)-1 = 1.39 x 10-8, this gives a suitable p = 0.0001 for the message error rate.