title: Transcontinental telesurgical nephrectomy using the da Vinci robot in a porcine model.
abstract: OBJECTIVE
  Robotic telesurgery has been demonstrated over long distances and offers theoretical benefits to urologic training and the care of patients in remote regions. The multiple arms and three-dimensional vision of the da Vinci robotic system provide a platform conducive to long-distance telementoring and telesurgery. Whereas prior telesurgical efforts have used dedicated lines for information transmission, the public Internet offers a less expensive alternative. It was the intent of this study to test the validity of using the da Vinci system in urologic telesurgery, and to conduct telerobotic nephrectomies using the public Internet.
  
  
  METHODS
  We performed four right nephrectomies in porcine models using the da Vinci robotic system. Telementoring and telesurgical approaches were used, with resident surgeons operating a console adjacent to the swine, while attending surgeons simultaneously operated a second console at distances of 1300 and 2400 miles from the operating room.
  
  
  RESULTS
  All four procedures and both telementoring and telesurgical models were successful. Round-trip delays from 450 to 900 ms were demonstrated. Blood loss was minimal, and there were no intraoperative complications.
  
  
  CONCLUSIONS
  This study represents the first use of the da Vinci Surgical System in urologic telesurgery and the first successful telesurgical nephrectomy in an animal model.
authors.affiliation: Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA. joseph.sterbis@na.amedd.army.mil
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Sterbis
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hanly
authors.forename: Barry C
authors.initials: BC
authors.lastname: Herman
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marohn
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Broderick
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Shih
authors.forename: Brett
authors.initials: B
authors.lastname: Harnett
authors.forename: Charles
authors.initials: C
authors.lastname: Doarn
authors.forename: Noah S
authors.initials: NS
authors.lastname: Schenkman
mesh_terms: D000818:Animals; D004867:Equipment Design; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D013552:Swine; D017216:Telemedicine