Surgeons perform successful near real time telesurgery from New York on patient in France

Paris 19 September 2001On 7 September, Operation Lindbergh, a complete telesurgical intervention, has been carried out by a team of French surgeons located in New York on a patient in Strasbourg, France. A 68 year-old woman in the Strasbourg Civil Hospital in Eastern France became the first patient in history to receive a complete laparoscopic cholecystectomy or gall bladder removal, performed by surgeons nearly 4000 miles away. This technical solution, implemented by the French Institute for Research into Cancer of the Digestive System (IRCAD), the European Institute of Telesurgery (EITS), France Telecom, and surgical robotic system developer Computer Motion has proved capable of reducing the time delay inherent to long distance transmissions, thus making this type of procedure possible.

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This world first is a truly remarkable medical and technical feat, involving a minimally invasive surgery, performed using telecommunications solutions based on high-speed services and sophisticated surgical robotics. Operating from a France Telecom/Equant centre in Manhattan and in collaboration with Mount Sinai Medical Center in New York, Professor Jacques Marescaux, M.D. of the European Institute of Telesurgery, Dr. Michel Gagner of New York, and a team from the IRCAD Institute performed the procedure in 45 minutes. From New York, the surgeons controlled the arms of the Zeus Robotic Surgical System, designed by Computer Motion, to operate on the patient. The link between the robotic system and the surgeons was provided by a high-speed fiberoptic service deployed thanks to the combined efforts of several France Telecom group entities.

Commenting on the operation, Professor Marescaux stated: "I believe that this demonstration of the feasibility of a completely safe remotely performed surgical procedure, and notably the first trans-Atlantic operation, ushers in the third revolution we have seen in the field of surgery in the past ten years. The first was the arrival of minimally invasive surgery, enabling procedures to be performed with guidance by a camera, meaning that the abdomen and thorax do not have to be opened. The second was the introduction of computer-assisted surgery, where artificial intelligence enhances the safety of the surgeon's movements during a procedure, rendering them more accurate, while introducing the concept of distance between the surgeon and the patient. It was a natural extrapolation to imagine that this distance, currently several meters in the operating room, could potentially be up to several thousand kilometers."

The France Telecom group provided an end-to-end high speed fiberoptic service which enabled the surgeons to work with virtually no time delay between the instant they manipulated the Zeus robot controls in New York, and saw the result on the patient in France. Despite a distance of about 7000 kilometers, it was imperative that a constant time delay of less than 200 milliseconds could be maintained between the surgeons' movements and the return video image displayed on the screen. This is especially challenging since the time delay includes video coding/decoding and signal transmission time. France Telecom's high-speed service linked with the solutions developed by France Telecom R&D engineers made it possible to achieve an average time delay of 150 milliseconds. This represents a decisive breakthrough for telesurgery, that previously was strongly limited due to the time delay problem.

For France Telecom, meeting this daunting challenge meant indeed guaranteeing the quality, reliability and security of the transmission speeds. Drawing on its expertise in end-to-end high-speed services, France Telecom linked all the parts of the equipment including video camera, robotic system, video conference, and telephone, by a transatlantic high-bandwidth fiberoptic service of 10 megabits per second. The participants believe that this demonstration has the potential to interest medical professionals across the world in the newest applications of interventional telemedicine. The teams hope that future applications will have the potential for bringing dramatic changes to the delivery of patient care.

The combination of robotics systems and unique computer software used to perform the world's first completely telesurgical procedure is the result of the efforts of the internal research and development engineering staff at Computer Motion. The company recently introduced the Socrates Tellecollaborative System, and new Microwrist Technology for the Zeus Surgical Robotic System. Operation Lindbergh has provided an invaluable real world test environment for the challenges associated with tele-enabled surgery and real time collaboration. In several research trials with Socrates announced by the company in March of 2001, surgeons reported positive results in significantly augmenting the learning experience between mentoring and training surgeons.

The success of the demonstration on a human patient marks this moment in history as the first successful collaboration of its kind between medicine, advanced technology, and telecommunications. Future explorations into the potential of telesurgery and tele-collaborative surgeon training will be measured by the benchmarks established by this event. "The demonstration of the feasibility of a trans-Atlantic procedure constitutes a richly symbolic milestone. It lays the foundations for the globalisation of surgical procedures, making it possible to imagine that a surgeon could perform an operation on a patient anywhere in the world", stated Professor Marescaux, founder and president of IRCAD and the European Institute of Telesurgery in Strasbourg.

Doctors dubbed the procedure Operation Lindbergh in honour of Charles Lindbergh and his breakthrough solo flight across the Atlantic. The medical team received clearance from ethics committees before the operation, and 80 people were on hand, some in New York, some in Strasbourg, in case things went wrong. The experts had performed the same procedure on pigs before searching for a human candidate. The patient had no complications and was released from the hospital two days later, and reported a return to normal activity the following week. Surgeons at Johns Hopkins University Medical School in Maryland have performed similar work but on a smaller scale, namely a part of a kidney operation where the surgeons were in Baltimore and the patient was in Rome.

Video and film material of the procedure and interviews with the participants of Operation Lindbergh are available at the Web site of the European Institute for Telesurgery. Please, also read the relating VMW articles: European Institute of TeleSurgery finalist in 1999 Computerworld Smithsonian Award for medicine and Tele-urology experiments to show added value of telementored robotic surgery.


Leslie Versweyveld

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