| Tele-medicine is an emerging field in its infancy. It will have tremendous growth, changing our lives, due to its unique property that it not only allows “Expert Care” to be available to rural areas, but also to inner-cities when and where such “Expert” intervention is meaningful. Furthermore, with the introduction of Robotic Surgery and its growth during the past decade, Tele-Robotic Surgery would benefit from the same concept.
Power of Telecommunication
Combining benefits and power of Telecommunication
with Medical services, brings about Tele-Medicine. While presence of the physician
next to the patient can have its own healing merits,
nevertheless it is impossible to have competent
and expert medical practitioners to be present
wherever their expertise is needed. Furthermore,
as in the case of videoconferencing and web conferencing
reducing costs by minimizing the need for travel,
tele-medicine can also benefit the population
that otherwise will not have access to the expert
medical care. Today
tele-diagnostics
are a reality as they save costs, and provide immediate, round-a-clock
service. For example, the MRI of an emergency
room patient in New York at 11:00 p.m. is
sent electronically to a competent radiologist
oversees (where it is morning!) and results can
be delivered within the hour. Another powerful example is by providing tele-care to prison inmates, where it would be challenging at best to either transport the prisoner to the medical facility or to bring the doctor to the prison environment.
There are numerous applications
of tele-medicine. Here are a few:
- Tele-dermatology
- Tele-radiology
- Tele-consultation
- Tele-checkup
- …
- Tele-Surgery
Tele-Surgery
Tele-surgery is one of the
more demanding fields of tele-medicine. In this
case an expert surgeon will participate in a surgical
case without being in the operating room. Even though
the surgeon outside of the operating room
could be the only surgeon performing the operation, as demonstrated on September 7, 2001
(See the video), the reality is that tele-surgery is a viable and valuable
option where the less-experienced surgeons in the
operating room and next to their patients will be
assisted by the expert surgeon who could be hundreds
of miles away as demonstrated on 2/28/2003 (See the video). This has lots of benefits: 1- Best
outcome for the patient, 2- Local surgeon learns
while being assisted/taught by the expert surgeon,
3- Reduced costs as no one travels. 4- Discomfort
and expenses for patients and their family is reduced as they do not have to travel to the expert surgeon for the operation.
These are the true values of tele-surgery that can be
realized today and in the future.
Despite these advantages, there are challenges that need to be overcome:
- Regulatory process in the U.S. to allow such delivery of care can be one of the main reasons preventing its adoption today (FDA allowed the one time operation on 9/7/2001. Canada's regulatory body is more forward looking and allowed the system to be used on a regular basis.
- Current reimbursement process has no provisions to pay the expert surgeon
outside of the operating room, performing the
operation?
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Technical information on Proof of concept 09/07/2001
The trans-atlantic operation was code-named Lindbergh in honor of the first trans-atlantic solo flight by Charles Lindbergh. Surgeon console was in NY and the patient and the robotic
arms were in Strasbourg, France. The robot was Zeus® Tele-Susrgery system developed by Dr. Ghodoussi while at Computer Motion Inc. and France Telecom provided the highest quality, private ATM network.
On that day Drs. Jacques Marescaux (the principal surgeon) and Dr. Michel Gagner operated from NY on the 68 year old French patient in Strassbourg, France.
Pertinent Data
The communications transport was a DS3 ATM Virtual Private Link set for 10 Mbps. Of this bandwidth, 7 Mbps was dedicated to the endoscopic video set at guaranteed delivery. Another 2 Mbps was provisioned for the video conferencing system showing the external view of the OR table (patient and robot positioning). Remaining bandwidth was set for the Zeus® robot data/control also set for guaranteed delivery. The transmission delay was 39 msec in each direction and the FORE systems' CODEC used 38 msec to encode and 38 msec to decode the endoscopic video in MPEG2 (DVD quality) format. For more information.
Technical information on Canada Tele-Surgeries which started on 02/28/2003 Due to the success of the Operation Lindbergh and success of the Zeus® system in Canada, health Canada approved the use of Zeus® Tele-Surgery within Canada for an extended study. The Surgeon console was in Hamilton, ON and the patient and the robotic
arms were in North Bay, ON - 250 miles away. The robot was the sameZeus® Tele-Susrgery system developed by Dr. Ghodoussi's team at Computer Motion Inc. and Bell Canada provided the telecommunication link.
Starting on Feb. 28, 2003 Dr. Mehran Anvari (the world-renown surgeon) operated from Hamilton, assisted and guided Dr. Craig McKinley in his operating room in North Bay, performing a Lap. Nissen Fundoplication procedure. Two such operations were performed back to back that day. Over 20 tele-surgery procedures (Nissen, Hernia, Bowel Resection …) were performed.
Pertinent Data
The communications transport was an MPLS public Link set for 7 Mbps. Of this bandwidth, 4 Mbp was dedicated to the endoscopic video set at Highest priority. Another 2 Mbps was provisioned for the video conferencing system showing the external view of the OR table (patient and robot positioning). Remaining bandwidth was set for the Zeus® robot data/control also set for Highest priority. The transmission delay was 15 msec RT and the CODEC used 120 msec to encode and decode the endoscopic video in MPEG2 (DVD quality) format. For more information.
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