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Doctors on Call

While research into tele-surgery helped to jump-start robotics in the operating room, distant operations have remained an elusive application. However, it may eventually prove to be one of the most significant uses of robotic surgery.

With either da Vinci or ZEUS, a surgeon seated across the room from the patient could as readily be operating from another room down the hall or from an office across town. Without having to spend hours traveling and prepping for each surgery, a specialist could perform procedures in several different operating rooms scattered throughout a region on the same day. At least that’s the theory. In practice, there are limits, including ones caused by what can be a disorienting lag time between a surgeon’s hand motions and the robotic arms’ actions. Due to transmission delays over longer distances, the maximum effective range seems to be about 30 miles by wireless communication and 200 miles via a cable connection. The unreliability of network communication infrastructures presents even more of an obstacle-at least for now.

At NYU Medical Center one morning this August, surgeon Stephen Colvin is operating on the heart of a 56-year-old woman to repair a damaged mitral valve. The physician is working by hand with endoscopic instruments, while invoking robotic help to position the scope that is relaying the close-up view to a video monitor hanging above the patient. “AESOP!” he says. There’s a trill of acknowledgment from the machine. “Move back. Up. Up.” The scope moves to the proper orientation.

In the hallway outside the operating room, Grossi leads an audiovisual team televising the operation via satellite uplink to a medical conference in Montana. Eventually, interns and doctors at remote teaching venues could experience the actual surgical motions of their world-class colleagues on force-feedback-equipped simulators. At the moment, however, maintaining video communications is a difficult enough challenge. At the operation’s most critical phase, the TV signal is lost on the downlink in Montana. (A burst of radiation from a microwave oven on the conference’s premises apparently knocked out today’s lesson.)

While tele-surgery may not yet be ready for prime time, it’s only a temporary setback. Next time, the physicians will use broadband telephone lines to secure a steady transmission link. And soon they expect to televise a complete robotically assisted surgery. In such increments, tele-mentoring and tele-surgery will advance-further accelerating development of computer-enhanced procedures. It will take significant improvements in communications networks, but in perhaps the not too distant future, an accident victim on a rural highway in Nebraska, or a heart patient in an isolated village in France, could have remote access to care by the finest world-class surgeons at major medical facilities.

With the enabling technology for robotic surgery already making an impact in the operating room, it’s just a matter of time before a surgical star “phoning in” a complicated procedure is a routine event in the operating room.

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Tagged: Biomedicine

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