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Special Report

Remote Surgery

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The total quantity of information transmitted per second for the average telesurgery procedure between Hamilton and North Bay is equivalent to 94 simultaneous phone calls. A recent stomach operation performed by Dr. Anvari lasted 90 minutes. Unlike the dedicated fiber access line used between Strasbourg and New York in 2001, Bell Canada, which supplies the fiber-optic bandwidth and telecommunications infrastructure for Dr. Anvari's procedures, shares the same fiber with other clients performing business transactions, emails, and MPEG downloads. Though the data and images are transmitted through standard Internet channels, the hospitals maintain a Virtual Private Network (VPN) to guarantee ongoing access to bandwidth and a secure link during the operation. "The ability to transmit data over a shared network reduces costs and provides clients with greater access," explains Dan Zhang, an engineer with Bell Canada. While the procedure is still experimental and expensive, Zhang believes that once it has become more widespread, the cost will drop until it rivals the costs of transporting patients to big hospitals for traditional surgery.

With a vast fiber-optic network and some 10 million Canadians living in rural and sparsely populated areas, the potential for bringing care and mentoring to these communities is a strong motivation for telesurgery advocates like Dr. Anvari. And for emergency procedures, the system could allow surgeons to provide immediate care to patients who might not survive a long-distance journey to a bigger hospital. Though long-distance robotic surgery is not yet approved by the US Food and Drug Administration (FDA), few critics argue with its potential for serving remote populations. Early studies of robotic telesurgical techniques indicate that such surgery offers less risk of infection, shorter hospital stays, and less pain and scarring compared to traditional surgery. The cost of the three part robotic system including surgeon console, computer controller, and interactive robotic arms is nearly one million US dollars. Current initiatives receive government and private funding.

In addition to direct fiber-optic communication for telesurgery, Bell Canada is also researching a combination of fiber-optic and satellite technology with future implications for telesurgery in war zones. And, the Canadian Space Agency (CSA) and NASA are even consulting with Dr. Anvari and Bell to explore the potential for telesurgery on the International Space Station and for future long distance space travel initiatives.

Though patients may take comfort from the touch of a surgeon's hand and a surgeon's presence, there may be more and more circumstances in the future when they will defer to the long distance touch of an expert -- especially in remote and underserved parts of the world where access to surgeons and specialists is difficult or impossible. Though some critics worry about the potential legal implications of telesurgery, robotics and telecommunications will increasingly play a role in the operating room. University of Washington surgeon, Dr. Richard Satava, predicts that in the next 40-50 years surgery will be completely automated. The surgeon will manage an information system complete with robotics. One thing is clear says Satava, "The future of technology -- and medicine in general -- is not in blood and guts, but in bits and bytes."

Sharon Kay is the INNOVATION series Science Editor. She is also a freelance science writer and producer in New York City. Her work has appeared on public television, in the American Museum of Natural History, and in THE BOSTON GLOBE.

Dr. Mehran Anvari performs telesurgery on a patient hundreds of miles away.
Dr. Mehran Anvari performs telesurgery on a patient hundreds of miles away.
Univarsity of Washington surgeon, Dr. Richard Satava, predicts that in the next 40 - 50 years, surgery will be completely automated.

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