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Special Report

Remote Surgery

By Sharon Kay

A patient is prepped for surgery. The anesthesiologist asks him to count backward from 10 -- he fades out at 5. Everyone in the operating room is wearing scrubs and a mask, but one critical person is missing -- the surgeon. Not only is the surgeon absent from the operating theater; he's not even in the same hospital, or on the same continent! He's actually performing surgery from thousands of miles away in a room with dimmed lights, multiple television monitors, a surgical console, and a computer that connects him via a high-speed fiber-optic link to robotic arms in the operating room. It's called telesurgery -- a technology with far-reaching implications.

Telesurgery provides people in remote regions with access to expert medical care. Though still experimental, the hope is that in time patients won't need to travel great distances or live in cities with the best medical care in order to receive the best, most advanced treatment. "What we have done is to show that surgery is possible at long distances -- it could be hundreds of kilometers, it could be thousands of kilometers. It's very much like the Internet was a couple of decades ago. It really is a network for medical and surgical care," explains Dr. Mehran Anvari, founding Director of the Centre for Minimal Access Surgery (CMAS), in Ontario, Canada.

Telesurgery made international news on September 7, 2001, when the first transatlantic surgical procedure took place between New York City and Strasbourg, France at a distance of nearly 4,000 miles. Dubbed "Operation Lindbergh" after Charles Lindbergh's first solo nonstop flight across the Atlantic, the surgery was a landmark in experimental long distance telesurgery. "We can now extend the reach of the surgeon so that an expert can intervene any place in the world," said Dr. Jacques Marescaux, who led the surgery from New York. The patient, in Strasbourg, was a 68 year-old woman requiring a minimally invasive gall bladder operation. Fiber optics played a crucial role in all aspects of the procedure. With only a miniscule delay, the surgeon's actions in New York were transmitted over fiber to the robotic surgical instruments in Strasbourg, while an endoscopic camera, which acted as the surgeon's eyes, transmitted images from inside the patient's body to the surgeon's monitor thousands of miles away. Conversations between doctors, a videoconference link between both rooms, and continuous data exchanged between PCs on either end were all transmitted over fiber.

The challenge of communicating this vast amount of information at great speed and with such a high degree of sensitivity prompted France Telecom Group, the bandwidth provider, to commit exclusive "end-to-end" local as well as transatlantic fiber access for just this purpose. The distance and minimal delay -- averaging 150 milliseconds in each direction -- was a breakthrough for the telecommunications provider and for telesurgery.

Two and a half years later, Dr. Anvari, a leading Canadian laparoscopic surgeon, has performed multiple long distance surgical procedures between St. Joseph's Hospital in Hamilton, Ontario, and North Bay General Hospital, a rural community hospital 400 kilometers away. "This technology allows me to feel as if I'm in the operating room in North Bay performing a standard surgery. It allows us to connect teaching hospitals to smaller community hospitals to allow the surgeons in these communities to perform technically advanced procedures with confidence and with assistance and support from experts," says Dr. Anvari. He is dedicated to mentoring from a distance, and to teaching the technique, which requires acclimating to the feeling of performing robotic surgery with a delay -- even one as small as 20 milliseconds.


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data, data everywhere

The evolution of communications technology has dramatically increased the amount of information transmitted around the world. Take Martin Luther King's 1963 "I Have a Dream" speech, which was filmed in black and white and ran 16 minutes and 14 seconds. Imagine it was transmitted by telegraph, or radio, or shot in color or hi-definition. How much information would each medium require?

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