Remote surgery

Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

The Lindbergh Operation
Main article: Lindbergh Operation

One of the earliest remote surgeries was conducted on 7 September 2001 across the Atlantic Ocean, with a surgeon in New York performing a gallbladder operation on a patient 6,230 km away in Strasbourg, France. That operation, called Project Lindbergh for Charles Lindbergh’s pioneering transatlantic flight from New York to Paris, was conducted over a dedicated fiberoptic link to ensure guaranteed connectivity and minimal lag.

Applications
Since then, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopic surgeon in Hamilton, Canada, has conducted numerous remote surgeries on patients in North Bay, a city 400 kilometres from Hamilton. Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data, Dr. Anvari's has not had any connection problems during his procedures.

Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital in Toronto, Canada, the surgical room responds to the surgeon’s voice commands in order to control a variety of equipment at the surgical site, including the lighting in the operating room, the position of the operating table and the surgical tools themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.

The possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres.

Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy’s Hospital in London, England compared the success of kidney surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stones.

Unassisted robotic surgery
As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. In fact Carlo Pappone, an Italian surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention. This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.

Limitations
For now, remote surgery is not a widespread technology. Before its acceptance on a broader scale, many issues will need to be resolved. For example, established protocols and global compatibility of equipment must be developed in order for such procedures to occur in spite of communication problems such as linguistic differences. Also, there is still the need for an anaesthetist and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot.