Transcontinental Robot-Assisted Remote Telesurgery: Feasibility and Potential Applications

IRCAD-EITS (European Institute of Telesurgery), Louis Pasteur University, Strasbourg, France.
Annals of Surgery (Impact Factor: 8.33). 05/2002; 235(4):487-92. DOI: 10.1097/00000658-200204000-00005
Source: PubMed


To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology.
Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances.
To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service).
The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery.
Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.

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Available from: Michel Vix, Dec 19, 2013
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    • "A telemedicine study was conducted over intercontinental cities even in the 1990's, and the first human telesurgery consultation was performed in 1996 [30]. In 2001, a telesurgery of Laparoscopic cholecystectory was demonstrated between New York (USA) and Strasbourg (France), with a network delay of 200ms and a constant delay of 155ms over a 10Mbps network (3Mbps guaranteed minimum bandwidth ), achieving no packet loss in the application level and the overall subjective quality measured as 9.5 points (0:worst; 10:best) [31]. With these on-going studies, several commercialized surgical robotic systems were also developed. "
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    • "They can filter out high-frequency signals and surgical tremor [1], or scale down clinician's movements to enhance her accuracy [2]. Moreover, they may also enable expert clinicians to train or assist other colleagues from a distance, or even directly enable operations from a remote location [3]. Teleoperated robotic systems also improve the ergonomics of the operating theatre, since the master interface can be always positioned in a way convenient for the clinician to control [4]. "
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    • "For example, telemedicine technology was used for distance medical consultation (Perednia and Allen, 1995); telepresence technology enables the physician to use a robot to 'walk around' intensive care units to monitor and interact with patients (Vespa, 2005a); surgeries can also be performed remotely (Cadiere et al. 1999). In 2001, the world's first transcontinental surgery was successfully performed (Marescaux et al., 2002). This laparoscopic cholecystectomy surgery was performed in Strasbourg, France, with the surgeon in New York, USA. "
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