title: Establishment of the world's first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community.
abstract: OBJECTIVE
  To establish a telerobotic surgical service between a teaching hospital and a rural hospital for provision of telerobotic surgery and assistance to aid rural surgeons in providing a variety of advanced laparoscopic surgery to their community patients.
  
  
  BACKGROUND
  The above service was established between St. Joseph's Hospital in Hamilton and North Bay General Hospital 400 km north of Hamilton on February 28, 2003. The service uses an IP-VPN (15 Mbps of bandwidth) commercially available network to connect the robotic console in Hamilton with 3 arms of the Zeus-TS surgical system in North Bay.
  
  
  RESULTS
  To date, 21 telerobotic laparoscopic surgeries have taken place between North Bay and Hamilton, including 13 fundoplications, 3 sigmoid resections, 2 right hemicolectomies, 1 anterior resection, and 2 inguinal hernia repairs. The 2 surgeons were able to operate together using the same surgical footprint and interchange roles seamlessly when desired. There have been no serious intraoperative complications and no cases have had to be converted to open surgeries. The mean hospital stays were equivalent to mean laparoscopic LOS in the tertiary institution.
  
  
  CONCLUSIONS
  Telerobotic remote surgery is now in routine use, providing high-quality laparoscopic surgical services to patients in a rural community and providing a superior degree of collaboration between surgeons in teaching hospitals and rural hospitals. Further refinement of the robotic and telecommunication technology should ensure its wider application in the near future.
authors.affiliation: Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada. anvari@mcmaster.ca
authors.forename: Mehran
authors.initials: M
authors.lastname: Anvari
authors.forename: Craig
authors.initials: C
authors.lastname: McKinley
authors.forename: Harvey
authors.initials: H
authors.lastname: Stein
mesh_terms: D003195:Computer Communication Networks; D013505:Digestive System Surgical Procedures; D006780:Hospitals, Rural; D006784:Hospitals, Teaching; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D009864:Ontario; D012371:Robotics
references.citation: J Endourol. 2000 Mar;14(2):133-8
references.pmid: 10772504
references.citation: Telemed J. 1999 Summer;5(2):129-37
references.pmid: 10908425
references.citation: Surg Endosc. 2002 Oct;16(10):1389-402
references.pmid: 12140630
references.citation: Ann Surg. 2002 Apr;235(4):487-92
references.pmid: 11923603
references.citation: Urol Clin North Am. 2001 Feb;28(1):177-88
references.pmid: 11277063