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First trans-oceanic, robot-aided surgery NEW YORK, Sept. 19 (UPI) -- Surgeons using remote-controlled
robots announced today that they performed the world's first complete
trans-oceanic surgery, working from New York to successfully remove the
diseased gall-bladder of a 68-year-old woman in eastern France. Medical
scientists predict that in future "telesurgery" may enable expert
surgeons to treat desperate patients in Antarctica, battlefields, Third
World countries and even space stations. "This is the first time we've been able to operate at such long distances," said Michel Gagner, one of the two surgeons who operated on the patient and chief of laparoscopic surgery at Mount Sinai Medical Center in New York. "Such a complex task as surgery from 4,000 miles (7,000 kilometers) 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 trans-oceanic
Sept. 7 procedure -- dubbed "Operation Lindbergh" after famed
trans-Atlantic aviator Charles Lindbergh. Their control console from 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 roughly 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
that 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 that telesurgery
could eventually help regions where surgical expertise is scarce, such
as Third World countries. Gagner added that telesurgery may also one day
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 surgery 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 that if the patient is treated in country A, then it the case
falls under the rules of country A. Satava added that the key limitation to long-distance
telesurgery was that until the Internet becomes very high bandwidth, these
kinds of thousand-mile procedures will only be available to 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 that it's 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 Nature. |