title: Telementoring between Brazil and the United States: initial experience.
abstract: OBJECTIVE
  To assess the safety and feasibility of transcontinental telementored and telepresence surgery, we report on two procedures carried out with participation by surgeons in Baltimore in the United States and São Paulo and Recife in Brazil.
  
  
  METHODS
  Over a period of 3 months, a laparoscopic bilateral varicocelectomy and a percutaneous renal access for a percutaneous nephrolithotomy were performed. The mentoring surgeon (LRK) was the same for both procedures. He used a 650-MHz personal computer fitted with a Z360 video COder/ DECoder (CODEC) and a Z208 communication board (Zydacron Corp, Manchester, NH) that comprise the core of the telesurgical station. In the first case, a surgical robot, AESOP 3000 (Computer Motion Inc.), was attached to a laparoscope, and the remote surgeon drove the robot via a controller on the remote computer. In the second case, another robot (Percutaneous Access to the Kidney; PAKY) was used for percutaneous needle placement into the renal collecting system.
  
  
  RESULTS
  The two procedures were completed successfully. In the first case, the operative time was 25 minutes, with minimal estimated blood loss. The patient was discharged home the next day. At 3-month follow-up, there was no scrotal pain or varicocele. In the second case, access to the urinary tract was achieved with the first needle pass, and percutaneous nephrolithotomy was uneventful. Blood loss was minimal, and the patient was discharged home on the second postoperative day. At 3-month follow-up, the patient was free of urinary stones and of symptoms.
  
  
  CONCLUSIONS
  The first transcontinental telementored and telepresence urologic surgical procedures have been reported previously. The success observed with the novel surgical techniques has motivated great interest. The cases reported here demonstrate that several types of procedures can be mentored safely and effectively with telemedicine technology.
authors.affiliation: Division of Urology, University of Campinas-Unicamp, São Paulo, Brazil. nrnetto@uol.com.br
authors.forename: Nelson
authors.initials: N
authors.lastname: Rodrigues Netto
authors.forename: Anuar I
authors.initials: AI
authors.lastname: Mitre
authors.forename: Salvador Vilar C
authors.initials: SV
authors.lastname: Lima
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Fugita
authors.forename: Marcelo Lopes
authors.initials: ML
authors.lastname: Lima
authors.forename: Dan
authors.initials: D
authors.lastname: Stoianovici
authors.forename: Alexandru
authors.initials: A
authors.lastname: Patriciu
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000293:Adolescent; D001938:Brazil; D005240:Feasibility Studies; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008328:Man-Machine Systems; D008611:Mentors; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D014646:Varicocele / Q000601:surgery