title: Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.
abstract: OBJECTIVE
  To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology.
  
  
  BACKGROUND
  Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances.
  
  
  METHODS
  To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service).
  
  
  RESULTS
  The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery.
  
  
  CONCLUSIONS
  Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.
authors.affiliation: IRCAD-EITS (European Institute of Telesurgery), Louis Pasteur University, Strasbourg, France. jacques.marescaux@ircad.u-strasbg.fr
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
authors.forename: Joel
authors.initials: J
authors.lastname: Leroy
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
authors.forename: Michelle
authors.initials: M
authors.lastname: Smith
authors.forename: Michel
authors.initials: M
authors.lastname: Vix
authors.forename: Michele
authors.initials: M
authors.lastname: Simone
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D003195:Computer Communication Networks; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D009518:New York; D012371:Robotics / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome