title: Is telesurgery a new reality? Our experience with laparoscopic and percutaneous procedures.
abstract: BACKGROUND
  Minimally invasive surgery offers many advantages, but its correct practice is associated with a steep learning curve. Telesurgery allows a surgeon at a remote site to guide and teach surgeons at a primary site by utilizing robotic devices, telecommunications, and video technology, thereby reducing complications.
  
  
  METHODS
  From September 1998 to July 2000, 17 procedures were telementored between two sites 9230 km apart: a primary operating room at the Policlinico Casilino "Tor Vergata" University of Rome and a remote site at the Johns Hopkins Medical Institutions in Baltimore. Of these procedures, 14 were laparoscopic cases: 8 spermatic vein ligations, 2 retroperitoneal renal biopsies, 3 simple nephrectomies, and 1 pyeloplasty. Three procedures were carried out to obtain percutaneous renal access. All procedures were performed with the help of two robots: the first robot, AESOP, for the orientation of the laparoscope, and the second one, PAKY, to perform the percutaneous renal access. In addition to the robotic device, the system provided four ISDN lines, a PC with dedicated software to manage the connection, audio and video connections, an external video camera with a panoramic view of the operating room, and remote control of the electrocautery and the Telestrator.
  
  
  RESULTS
  All the procedures were accomplished with an uneventful postoperative course. Ten operative cases were telementored successfully. In five cases, it was not possible to establish a connection to the remote site, and two procedures were converted to open surgery because of intraoperative complications. The time delay of the image transmission was <1 second.
  
  
  CONCLUSIONS
  This preliminary experience has demonstrated the feasibility of international telementoring. It could provide education to surgeons and decrease the likelihood of complications attributable to inexperience with new techniques.
authors.affiliation: Department of Urology Tor Vergata University of Rome, Italy. pierluigi_bove@hotmail.com
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Bove
authors.forename: Dan
authors.initials: D
authors.lastname: Stoianovici
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Alexandru
authors.initials: A
authors.lastname: Patriciu
authors.forename: Nicola
authors.initials: N
authors.lastname: Grassi
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D006801:Humans; D010535:Laparoscopy; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous; D019114:Remote Consultation; D012371:Robotics; D017216:Telemedicine; D013519:Urogenital Surgical Procedures