The European Institute of Tele Surgery (EITS) has been established in Strasbourg in 1993 to meet the needs of medicine as it is rapidly evolving towards the information age. Surgery experiences the same type of revolution as has the aeronautics industry. Just as laparoscopy, or minimally invasive surgery, coined by surgeons as the "second French Revolution", has revolutionized surgery, the developments in information technology can be applied to revolutionize surgical training. The original concept of the EITS founders was to group together an international pool of practising surgeons, fundamental researchers, computer scientists and industrial partners, all working together towards the same goal of improving patient care in a digital world. To focus the international attention on nearly six fruitful years of hard work, the CWSA organization has selected EITS as one of five finalists in the medical category.
The overall organization of EITS' innovative school of surgery for videoscopic techniques, is federated around three major research projects. The MASTER project or Minimal Access Surgery by Telecommunications and Robotics, together with its sub-programme HESSOS, which refers to Hepatic Surgery Simulation and Operative Strategy, is devoted to the concept of the operating room of the third millennium. This programme was launched in 1994 and implements telerobotics and virtual reality. The TESUS programme or Telesurgical Staff started in 1995 and focuses on the tele-transmission of medical information. Its applications include multi-site videoconferencing. Thirdly, the WeBS-Surg programme or World Electronic Book of Surgery initiated in 1997 and develops a multimedia, continuous surgical education system on the Internet.
The EITS experimental Operating Room is composed of 17 surgical tables, equipped with high quality surgical material, comparable to the best that is available in human surgery. These tables have been designed to enable the surgeon to operate without being distracted by the technological aspects of the equipment. Each surgeon has two screens facing his operative table. The first screen is linked to the operative camera and displays the actual surgical procedure that is performed, as in a conventional OP room organization. The second screen is the "teaching screen". The 17 operative screens and the 17 teaching screens are linked to a central switchboard, controlled by the expert surgical mentor present in the experimental laboratory or from a remote site, who conducts the experimental procedure. This represents a unique, real-time image based teaching system for local use. It can also be used between any medical centre in the world linked to an ATM transmission system, enabling tele-companionship.
In fact, EITS has followed two main directions in developing new applications for minimal invasive surgery and by improving teaching methods, dedicated to this new technique. This has led to the creation of a unique, multi-media teaching system. The EITS training school is fully operational. Between June 1994 and December 1998, over 3.800 surgeons were trained in laparoscopic techniques by a team of 500 international experts in the EITS purpose-built facilities. Although the majority of the surgeon trainees, some 89 %, were European, 11% came from North America and Asia. Among the European trainees, 15 % were from Eastern European countries. Over the same period, over 400 nurses were trained in the EITS nursing courses. Training seminars for anaesthesiologists, who aimed to clearly define the technical aspects and potential complication of laparoscopic surgery in anaesthesiology, were also regularly offered.
The HESSOS project has made possible a 3-D volumic reconstruction of a virtual liver on the basis of patient data. This reconstruction is the new base for teaching and tele-teaching. The 3-D reconstruction of the liver, using the slide image data from the Visible Human project is, at the present time, the most highly developed model in the world concerning this organ. In addition, EITS has demonstrated the ability to move from the total body data set of the Visible Human to a specific organ reconstruction. Using novel mathematical simplifications, a palpable, deformable organ has been created and a model has been constructed which allows for the insertion of tumour masses. This model is certainly the first that can authorize pre-operative surgical planning on an individual patient's specific hepatic data. This represents true, real-time surgical virtual reality. The implications are considerable, because this type of concept has real potential for providing more effective, less expensive and safer surgical education.
Tele-transmissions are frequently used during theoretical training sessions. Their applications were developed through a telematic application project, TESUS, with a 2-year starting budget of about $2.5 million, which at its origin involved medical centres from five different European countries and the two industrial partners, Alcatel Business Systems and France Telecom Europe. The TESUS project has developed the use of standard means of communication, such as multi-site videoconferencing through ISDN lines at a rate of 384 kbt/s. A multi-conference bridge and CODEC transmission system were purchased to allow for total autonomy for the EITS centre. The project's main innovation is the international communication network it has created, allowing for multi-disciplinary exchange of medical information (X-rays, films, images, MRI) between surgical teams of different cultures. This method allows to standardize exchanges of know-how and medical opinions on different subjects.
The creation of a transatlantic virtual university has been another aspect of surgical training, but the idea to initiate a real Virtual University, consisting in a unique multimedia system available all over the world, was initiated via a third original project set up with the support of the European Community. This WeBS-Surg project, with an initial 2-year budget of about $5 million, becomes fully available on the Internet in 1999. The technological revolution imposed on surgeons by the advent of laparoscopic surgery has urged the need for an appropriate, rapid and pedagogical response in the framework of Continuous Medical Training. At the heart of the project is the "World Virtual Encyclopedia" of laparoscopic operating techniques, including all the multimedia applications required for an interactive and entertaining presentation. Other parts include regularly updated articles, practical data, and a surgeon discussion forum.
The EITS projects have laid the grounds for standardizing the medical offer presented to the patient on an international level. Hospitals will be motivated to join the best expert networks. The EITS is a non-profit, private institution, built on university hospital grounds. This type of structure has never before existed in France, nor in Europe. The development of a experimental surgical laboratory is unique in the world. The applications developed in the Institute are used on a regular basis by all of the surgeons and nurses participating to the courses. The annual functioning costs of the EITS amount to $4 million, of which 85% are financed by private funding. The winning projects for the Computerworld Smithsonian Award in each category will be announced at a gala dinner on June 7th at the National Building Museum in Washington DC.