Telesurgery

Telesurgery is a medical technology that allows a surgeon to operate from long distance; hence it is also known as remote surgery. This is clearly relevant to global health, as a surgeon from one country could feasibly operate on a patient many thousands of miles away in a different country. A large country with relatively few surgeons, such as Canada, will greatly benefit from this technology as well. Since the first telesurgery case did not occur until 2001, the 21st century and beyond will witness remarkable advancements in the field.

The technologies that built up to the possibility of telesurgery were laparoscopy and computer-assisted surgery. In laparoscopy, available since the 1980s, a long, small-diameter cylindrical apparatus is inserted into the anatomical area of interest, usually the abdomen. Through that thin tube, a surgeon can insert a small camera that transmits the image of the surgical field onto a television screen. A surgeon can also perform a surprising number of procedures through that small opening, including cholecystectomies, Fallopian tubal ligation, and even hysterectomies. In computer-assisted surgery, developed in the 1990s, robotic arms that actually perform the procedure are controlled by a surgeon who sits several feet away from the surgical field. The advantages of computer-assisted surgery include the elimination of normal tremor of a surgeon's hands, excellent three-dimen-sional visualization and magnification, and reduction of a surgeon's fatigability.

The first true telesurgical case, known as Operation Lindbergh, was successfully completed on September 7, 2001. The patient was located in Strasbourg, France while the surgeon operated 4,300 miles away in New York City, United States. A laparoscopic cholecystectomy (gallbladder removal) was performed without complications. The most remarkable aspect of Operation Lindbergh was the minimal trans-Atlantic time delay of just 0.135 second.

Telesurgery has opened unlimited possibilities in the treatment of surgical patients and the training of surgical specialists. Training of new surgeons by any world expert is now more feasible. Other potential applications of telesurgery include assisting surgeons and treating patients in rural areas, developing countries, war zones, and even outer space. The implications of helping soldiers on the battlefield are particularly intriguing and being worked [Page 1652]on by the United States’ Defense Advanced Research Projects Agency (DARPA), while aerospace surgery is a project of the National Aeronautics and Space Administration (NASA). Both projects hope to be in use by the year 2010. Some disadvantages to telesurgery requiring improvement include the issues of time delay and reducing the size of the equipment needed.

Developments in telesurgery continue at a rapid pace in several different medical fields, including otorhinolaryngology, urology, gynecology, and gastroenterology. Urologists can perform prostatectomies (removal of the prostate gland for conditions such as prostate cancer) via telesurgery, and gynecologists can remove uterine fibroids. Gastroenterologists are performing telesurgical procedures to correct gastroesophageal reflux disease (GERD). Research is progressing toward integrating telesurgery into other surgical fields, too. One day, telesurgery may be a very viable option to any patient requiring any surgical intervention.