Tags: First | Trans-Oceanic | Robot-Aided | Surgery

First Trans-Oceanic, Robot-Aided Surgery

Wednesday, 19 September 2001 12:00 AM

"This is the first time we've been able to operate at such long distances," said Michel Gagner, one of the two surgeons involved and chief of laparoscopic surgery at Mount Sinai Medical Center in New York. "Such a complex task as surgery from 4,000 miles away done completely via robotics -- it's never been performed before."

The lead surgeon, Jacques Marescaux, president and founder of the European Institute of Telesurgery, worked with Gagner on the Sept. 7 trans-oceanic procedure -- dubbed "Operation Lindbergh" after famed trans-Atlantic aviator Charles Lindbergh. Their control console at Mount Sinai was linked to a robot at Louis Pasteur University in Strasbourg, France via high-speed fiber-optic connections running in cables under the sea. "The total delay was less than one-fifth of a second -- it took 80 milliseconds for the signal to go and 80 to come back," Gagner said in an interview with United Press International. This 160-millisecond gap -- roughly half the time it takes to blink -- beat the estimated safe lag time by 40 milliseconds.

"Still, even a fifth of a second is noticeable," Gagner said. "We had to operate slower, to be more careful."

The surgeons relied on high-quality images provided by their high-speed link to compensate for the delay.

"The detail was so great, our vision was as good as if we were in my own operating room," Gagner told UPI. "With the high-resolution images, you could tolerate this delay."

The procedure took roughly 45 minutes, no longer than similar operations. Two surgeons in Strasbourg who set up the robot stood by to intervene if necessary for safety reasons. A team of some 40 computer engineers and robot specialists helped set up the telesurgery system. "For them, they told it was like magic--nobody else was in the room, yet here this surgery went on," Gagner said.

The patient, who was specially briefed on all the details of the operation and gave her consent, was released after a two-day rest period. Removal of the gall bladder is a common procedure, one that roughly a half-million Americans go through annually.

The first telesurgery operation took place in 1996. Telesurgery pioneer Richard Satava at Yale University in New Haven, Conn., explained the technique was originally devised to work from an armored vehicle in the battlefield.

"We had previously thought that the distance to safely perform this kind of surgery was about 200 miles," Satava commented. "They were able to demonstrate what we hadn't thought possible." The medical scientists were confident telesurgery could eventually help regions where surgical expertise is scarce, such as Third World countries. Gagner added telesurgery one day also may aid remote areas such as Antarctica or space stations and train surgeons in procedures they might not normally see.

There are a number of legal and technical obstacles telesurgery will have to overcome if it is to become widespread. International law has not yet caught up with the issues of liability in case something goes wrong and the recognition of medical credentials across state and national lines. So far Gagner said physicians have relied on the Geneva Convention, which says a case falls under the rules of the country in which the patient is treated.

Satava noted the key limitation to long-distance telesurgery at this time is expense. Until the Internet becomes very high bandwidth, such thousand-mile procedures will only be available via institutions that can afford the very high cost. "This kind of connection is very expensive, likely in the thousands of dollars per hour," he explained.

However, Satava told UPI it is realistic to expect costs to come down in future. "It's going to take time, at least a generation, for it to go into local hospitals," Gagner said. "It's a bit like the installation of the automobile -- it took 25 years before it became affordable." The researchers will publish their results in a future issue of the journal Nature.

Copyright 2001 by United Press International. All rights reserved.

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This is the first time we've been able to operate at such long distances, said Michel Gagner, one of the two surgeons involved and chief of laparoscopic surgery at Mount Sinai Medical Center in New York. Such a complex task as surgery from 4,000 miles away done completely...
Wednesday, 19 September 2001 12:00 AM
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