There must be fifty ways to leave your lover but only five suffice to get a taste of computer assisted surgical intervention in the operating room. MichaÎl Nord, a surgeon and telemedical expert from Strasbourg, guided the audience at the International Symposium on Telemedicine, organised last October at the Brussels Military Hospital, through the five high-tech gateways leading up to laparoscopic surgery. This new approach invites the surgeon to collect information through databases and guidelines in order to simulate procedures on a graphic station by using adequate patient data and by requesting interactive support from a distant expert.
In the world of telesurgery, five telematics developments have been identified enabling access to information and to operating rooms. With the concept of telemedicine, we are aiming at a double goal, according to Nord. First, the optimisation of patient care through continuous medical education and second, the containment of health care cost through instant availability and unreserved implementation of best practice standards.
To accomplish the planned mission, the initial telematical step constitutes the use of multimedia applications and training. Two European projects are focusing on the execution of these interactive scenarios involving text, 3D-animations, video, data and expert advice. The Eureka project MASTER (Minimal Access Surgery by Telecommunication and Robotics) investigates on the use of broadband ATM-networks (Asynchronous Transfer Mode) with special interest on transmission of high quality video and interactivity. The WEBS project (World Electronic Book of Surgery) is developing a continuously updated surgical database to offer guidelines and technical as well as therapeutical advice through world-leading experts.
Nord indicates the personal computer with Internet and CD-ROM access as the indispensable equipment of the modern surgeon to participate in information exchange, teleteaching and remote training, referred to as teleconcertation, the second telematical step. Another European project called TESUS (Telesurgical Staffs), is implementing an excellence network of nine laparoscopic surgery departments all over Europe with two extensions in the USA, to try and standardise surgical procedure imaging and counsel in everyday practice. Third comes telemanipulation. Here, a remote proctor can take over the current procedure from a surgeon in action by distantly manipulating the instruments.
In step four, virtual reality techniques are applied on patient data in training and preoperative environments permitting surgical procedure simulation. Nord cites the HESSOS project (HEpatic Surgery Simulation and operative Strategy) as an illustrative example since it includes elements like volumic 3D-reconstruction from the Visible Human Project; assisted preoperative simulation; real-time interactivity with instruments in a hyper-realistic context which involves bleeding; morpho-physiologic studies and preoperative use of augmented reality.
Teleaccreditation forms the final telematical step by which Nord defines the distant access to procedures in order to fulfil the time-dependent criteria of professional accreditation, supervised by European responsible organisations. The whole set of these five technological developments should guarantee a more effective and optimised health care delivery system in favour of the individual patient. The Belgian Armed Forces web site presents more detailed news on the Telemedicine Symposium.