NEW YORK—Researchers reported in the September 27 Nature that a surgeon on one side of the Atlantic removed the gallbladder of a patient on the other side, but the clinical usefulness of this long-distance, robot-assisted laparoscopic surgery is uncertain.
This report shows that robot-assisted laparoscopy can be stretched between remote sites, but major problems remain to be resolved, including high equipment cost, absence of tactile feedback, and incomplete availability of the high-speed, broad-bandwidth telecommunications needed to transmit images over distance without irritating and potentially dangerous time delays.
Lead author Jacques Marescaux, MD, of the Department of Digestive Surgery, University of Strasbourg, France, reported that, following six laparoscopic remote robotic cholecystectomies in pigs, the procedure was successfully carried out in a 68-year-old female patient.
Dr. Marescaux and two other surgeons directed the robotic console at the GlobalOne Building in New York City where a high-speed fiberoptic network was available.
Two surgeons with the patient in Strasbourg set up the trocar position and were on hand to stop the robot if things went awry. Coagulation was coordinated by voice between the two sites.
The total time lag was 155 ms, well below the 330 ms limit judged safe by surgeons in previous studies. Setting up the apparatus took 16 minutes, and the gallbladder was dissected in 54 minutes with no intraoperative or postoperative complications. The patient was discharged 48 hours after surgery.
"We showed that dissection of an artery, dissection of a biliary canal, and ablation of an organ can be done safely by robot-assisted laparoscopy guided by a surgeon at a remote site," Dr. Marescaux told ONI. "The time delay of 155 ms is acceptable and allows the surgeon’s brain to adapt immediately."
