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Surgeons Perform First Telesurgery

Surgeons no longer have to be in the operating room, or even on the same continent, to perform surgery. A team of American and French doctors recently operated on a patient by remote control.

Two surgeons in New York City successfully removed the gallbladder of a patient 6,000 kilometers away in the French city of Strasbourg. The pioneering surgeons were Dr. Michel Gagner, chief of the Department of Laparoscopic Surgery at Mount Sinai Medical Center in New York, and Dr. Jacques Marescaux, Chairman of the Department of Surgery at the University of Strasbourg in France.

Using telecommunications technology, the surgeons guided a three-armed robot. Two of the robotic arms cut tiny incisions into the patient's abdomen, while the third arm inserted a mini-camera into her abdominal cavity, to examine internal areas of her body and to guide the surgery.

The technique, known as laparoscopy has been used for the past ten years to perform common medical procedures.

But this time, the surgeons viewed the internal organs of a patient on a computer screen thousands of miles away from the operating room. Meanwhile, in the Strasbourg operating room, other doctors stood by as a contingency medical team.

One of the most important issues that the experts had to address was a time lag in the transmission of signals from the surgeon's control board to the operating room in France and back a problem known as latency.

Dr. Marescaux says that such a delayed response could jeopardize the procedure. "When you give the order," he said, "it has to go by cable - a transatlantic cable - to Strasbourg. The order has to be analyzed and translated to a gesture. That means grasping [the organs] and after that you have to be sure that you have really well grasped the organ. That means that you have to sit back to see on your video what has happened. And for that you cannot have a very long delay. The technical problem was that until now the delay for a long distance like that was around five or six hundred milliseconds."

Medical engineers were able to solve the problem, resulting in a delay of less than .150 millisecond. So, the movements of the surgeons in New York were synchronized with the movements of the robot in Strasbourg.

The next challenge was the telemanipulation of the surgical instruments. For the robotic arm to move one centimeter, the surgeon had to move his instrument one millimeter.

Dr. Marescaux says that since the gallbladder telesurgery was a success, surgeons will attempt an open-heart remote control operation. He said, "Robotic-assisted surgery has really a fantastic application for cardiac surgery and especially for coronary bypass surgery. I think it will be the next application to show that a complex operation can also be done by remote surgery."

Although most people would prefer to have a human surgeon perform the operation, Dr. Marescaux says that telesurgery can save lives, especially at remote disaster sites and battlefields, and in developing countries that have few surgeons.

But, he adds, portable surgeries will work best when the connection between the operating console and the surgical robot is done through a low altitude satellite. "If you do the application during war," he said, "you should not rely on a cable. A good example would be to be connected between Washington and Afghanistan. It is impossible to have a direct cable between these two countries. So, you need to work through satellite. When these kinds of satellites are accessible, you have solved the problem of delay and you can operate on a ship for example, in an isolated country, in space for the future etc."

Also, Dr. Marescaux says that automated surgeries are more precise, allowing for more complicated surgical procedures.