Over the past half-decade, 5G has become ubiquitous. That’s clear enough if you examine the statistics, with 5G subscriptions set to soar globally over the years ahead. During the third quarter of 2023, to give one example, 163 million global 5G subscriptions were added – pushing the total to 1.4 billion, even as users are forecasted to exceed 5.3 billion in 2029. As Ericsson’s 2024 ‘Mobility Report’ notes, that’ll encompass a full 58% of all mobile subscriptions on earth. 5G is equally reaching emerging markets in APAC and Latin America. As GSMA Intelligence predicts, there will be four 5G networks in India by the end of 2025, accounting for 145 million additional users, while 5G adoption in sub-Saharan Africa is set to rise from below 1% in 2023 to 16% by 2030.

Beyond the raw numbers, meanwhile, 5G is already being put to good use – especially in the medical space. Over a couple of days in early 2024, this ultra-low latency technology helped facilitate a remarkable transcontinental telesurgery spanning 10,000km. A surgeon in Orlando, Florida, was able to connect robots via Dubai, United Arab Emirates, to dissect a non-human model in Shanghai, China – all in a staggering feat combining robotic surgeon skills and 5G technology.

Housing swathes of experts under a single roof at the Nicholson Center, the operation was performed live in situ by Dr Vipul Patel, medical director at Florida Hospital Global Robotics Institute, showcasing the immense power of telesurgery to over 200 surgeons, telcos, robotics companies and other experts.

“In the last two decades innovations in robotics and telecom technology have evolved significantly, making low latency telesurgery technically viable,” explained Patel, who specialises in prostate cancer. “My team recently visited China and Japan and were able to successfully demonstrate telesurgery up to 2,500km.”

Clearly, then, the event marked a historic breakthrough at the intersection of medical innovation and mobile technology, potentially redefining the future of surgical procedures in an industry that has hitherto been slow to change. In practice, meanwhile, the Florida experiment could soon lead to shorter treatment waitlists for oversubscribed health services, saving time and effort that could have life-saving impacts.

While implementing the technology is costly, it also has the potential to lessen fatigue and increase efficiency. Image Credit: MAD.vertise/ www.Shutterstock.com

Not that any of this can simply happen overnight. Rather, to truly succeed, 5G requires a collaborative ecosystem, one encompassing technological research, regulation, funding, medical expertise and policymakers committing to the innovation.

The wonders of 5G

The impressively low latency of 5G – the time taken for data to travel across the network – played a significant role in February’s digital breakthrough in Orlando. Telesurgery requires reliability of the highest standard, with the potential for outages significantly impacting the outcome of procedures. 5G, for its part, promises almost real-time communication between surgeons and the robotic instruments, enabling highly skilled and sought-after surgeons to perform intricate and life-saving surgeries without needing to be in the same operating room as a patient.

“The latency we achieved was between 300ms and 400ms in round-trip time,” explains Mischa Dohler, VP of emerging technology at Ericsson. “It’s not ideal; the surgeon needs about 100ms round-trip time to not even notice that it’s a remote operation. Anything above 200ms, they need to adapt. But nobody’s going to operate over 10,000km. We wanted to say that we could do this over 10,000km, to prove that it’s possible.”

Whatever its technical sophistication, there are plenty of practical reasons to be enthused by the science too. By untethering care from physical space, 5G makes surgery available to those who might not otherwise have access due to geographical location or socioeconomic status. It could also relieve waiting, enabling remote capabilities to perform surgeries across regions and time zones.

“Stroke and heart are the first two use cases,” says Dohler, “as about half a million Americans will have a stroke every year, yet only 10% receive the necessary care in time, so there’s a huge cost to the families and to the healthcare system. If we can democratise that and have a highly skilled surgeon in New York able to reach the north-east of the US, for example, we think there’s a real case there.”

$590bn
The projected global growth of the 5G infrastructure market by 2032, from $34.22bn in 2024, at a CAGR of 42.7%.
Fortune Business Insights

Not that patients are the only ones to benefit. While implementing the technology is costly, it also has the potential to lessen fatigue and increase efficiency, while minimising the need for surgeons as well as patients to travel, offering a better worklife balance and potentially reducing burnout rates.

Collaborative ecosystem

The Orlando experiment was the summation of 40 years of innovation and collaboration in the medical field. In the 1980s, Rick Savata realised that utilising high-precision instruments, despite slowing down an operation, could demonstrate much greater control and less blood loss for patients – so much so that they could be released from hospitals sooner. Ten years on, in 1995, Fred Moll founded Intuitive Surgical, which drove activity in Silicon Valley, bringing robotic surgery to the world stage.

30
The number of countries new 5G networks were expected to be deployed in during 2023, with the number of 5G connections anticipated to be doubled by 2025.
GSMA

Then, in the early 2000s, Jacques Marescaux aspired to democratise robotic surgery and conducted the first telesurgery using fibre. Mischa Dohler aimed to build on this with the idea of harnessing 5G technology for robotic surgery. After collaborating with surgeons at King’s College London and confirming the feasibility of the idea, they built the first demo with Ericsson. Between 2012 and 2022, the proportion of surgical procedures in the US carried out using robotic technology rose from 0% to 22%.

Beyond 5G itself, meanwhile, developing the technology’s infrastructure and collaborative ecosystem has been vital for advancing transcontinental surgeries. To make sure the mechanisms are viable, 5G has two requirements: so-called ‘slicing’ architecture (the ability to isolate traffic), and more spectrum (the invisible radio frequencies that wireless signals travel over).

Dohler says operators must upgrade 5G networks to standalone (SA) from non-standalone (NSA) for better control over the traffic as the SA 5G network consumes less energy and offers more capacity than NSA. Implementing slicing architecture, which dynamically optimises allocation and prioritisation of radio resources across different slices for guaranteed performance, will help fully isolate hospital traffic, especially surgical traffic, from all other traffic, ensuring the teleoperation capability isn’t congested. Such an upgrade is crucial for future FDA approval and the readiness of robotic surgery companies.

59%
The percentage of 5G subscriptions in North America at the end of 2023, the highest penetration globally.
Ericsson

At the same time, Dohler argues that medical regulators around the world need to recognise 5G as a significant and real use case. 5G will require considerably more spectrum, particularly in the midband, known as frequency range 1 (FR1) and FR3, says Dohler.

38%
The percentage of thyroid cancer treatment performed by robotic surgery, with prostate cancer treatment at 27.8%.
Strategic Market Research

“This spectrum allows for efficient data transmission and good coverage, which is crucial for the business case as it’s not feasible for operators to deploy a base station every 100m,” says Dohler. “We need to be practical. Mid-band spectrum is of paramount importance and regulators must ensure sufficient spectrum allocation. Everyone has a role to play in this.”

Navigating new ground

Another crucial element of this approach is acknowledging the regulatory requirement of redundancy. In practice, that means having multiple connectivity systems in place, in case of a fibre or 5G outage. Using 5G in conjunction with fibre cables can help ensure reliable connectivity during surgeries, an essential factor during lifealtering surgeries.

“5G will not be used alone,” stresses Dohler. It will always be in combination with fibre.”

Typically, fibre connections have about 99.999% reliability, which means there’s an outage of less than an hour per year, but it’s still much longer than the 100ms round-trip time needed for a telesurgical system, making it unacceptable, says Dohler. “To ensure continuous connectivity, a dual system with 5G can be brought in, or 5G can be used as the primary system and fibre as the back-up.”

In some remote hospitals, for instance, only 5G fixed wireless may be available. Elsewhere, fibre may be the only option. By having two redundant systems up and running, at any rate, technicians can ensure reliable connectivity.

At the same time, there are plenty of signs that doctors are hoping to take advantage of more stable systems over the years ahead. In 2021, 644,000 robotic surgeries took place in the US, a figure that is set to hit almost a million by 2028. Digital laparoscopy and telesurgery are typically used to address soft-tissue procedures such as colorectal and gynaecological surgery. As the technology becomes more widely adopted and developed, at any rate, it has the potential to jump in complexity – and, like the Florida experiment, perform life-saving surgeries remotely.