Is Telesurgery a New Reality? Our Experience with Laparoscopic and Percutaneous Procedures

Abstract

Background: Minimally invasive surgery offers many advantages, but its correct practice is associated with a steep learning curve. Telesurgery allows a surgeon at a remote site to guide and teach surgeons at a primary site by utilizing robotic devices, telecommunications, and video technology, thereby reducing complications.Patients and Methods: From September 1998 to July 2000, 17 procedures were telementored between two sites 9230 km apart: a primary operating room at the Policlinico Casilino "Tor Vergata" University of Rome and a remote site at the Johns Hopkins Medical Institutions in Baltimore. Of these procedures, 14 were laparoscopic cases: 8 spermatic vein ligations, 2 retroperitoneal renal biopsies, 3 simple nephrectomies, and 1 pyeloplasty. Three procedures were carried out to obtain percutaneous renal access. All procedures were performed with the help of two robots: the first robot, AESOP, for the orientation of the laparoscope, and the second one, PAKY, to perform the percutaneous renal access. In addition to the robotic device, the system provided four ISDN lines, a PC with dedicated software to manage the connection, audio and video connections, an external video camera with a panoramic view of the operating room, and remote control of the electrocautery and the Telestrator.Results: All the procedures were accomplished with an uneventful postoperative course. Ten operative cases were telementored successfully. In five cases, it was not possible to establish a connection to the remote site, and two procedures were converted to open surgery because of intraoperative complications. The time delay of the image transmission was ,1 second. Conclusion:This preliminary experience has demonstrated the feasibility of international telementoring. It could provide education to surgeons and decrease the likelihood of complications attributable to inexperience with new techniques.

Robotic pyeloplasty using internet protocol and satellite network‐based telesurgery

“…In a study involving transcontinental telementoring, 5/17 of cases failed to achieve site-to-site connection, which was attributed to international telephone line overload (13). The use of protected private networks permitted completion of 100% of our complex operative tasks in our experiments.…”

“…Other investigators using ISDN found that network traffic severely limited their ability to perform simpler tasks involving telementoring and adjustment of laparoscope positioning (13). In a study involving transcontinental telementoring, 5/17 of cases failed to achieve site-to-site connection, which was attributed to international telephone line overload (13).…”

Video Communication in Telemedicine

“…The remote surgeon controlled the laparoscope via an Automated Endoscopic System for Optimal Positioning (AESOP 3000, Intuitive Surgical, Inc., Sunnyvale, CA). This group has now carried out telesurgical telementoring in more than 17 cases using AESOP or the Percutaneous Access to the Kidney robot (PAKY, Johns Hopkins University, Baltimore, MD) (Bove et al, 2003).…”

Telerobotic-assisted laparoscopic operation performed at a remote site: initial experience

“…This technological development gave an impulse to many other telerobotic procedures, allowing the urologists to accomplish even more complex surgeries, such as spermatic vein ligation, renal biopsy, percutaneous renal access, nephrectomy and pyeloplasty (2). Coming along with such worldwide technological advance, the feasibility of telerobotic surgery at our institution was tested and it is herein reported as an original report from our local academic environment.…”