Originally Published MPMN November 2001

EDITOR'S PAGE

A New French Connection Lifts Barriers to Long-Distance Surgery

We all know what happened September 11. It's a date we won't soon forget. But on September 7, New York was the setting for another momentous event that did not receive the media attention it deserved. It's understandable that Operation Lindbergh got short shrift, but it's unfortunate nonetheless, because it represents a milestone in medical technology.

The outcome of Operation Lindbergh was the successful removal of a patient's gall bladder. That would be extraordinarily mundane were it not for the fact that the surgeon performed the procedure in New York City on a patient who was several thousand miles away in Strasbourg, France. Professor Jacques Marescaux, MD, of the European Institute of Telesurgery, assisted by New York–based physician Michel Gagner, controlled a robotic surgical system developed by Computer Motion Inc. by means of an end-to-end high-speed fiber-optic connection deployed by a subsidiary of France Telecom. The world's first telesurgical procedure was described by Computer Motion chairman and CEO Robert W. Duggan as an incipient step toward the "convergence of technology and medical science that will treat patients with less pain and faster recovery" regardless of their location.

Robotic surgery has made tremendous strides in recent years. Computer Motion announced on October 8 that its Socrates Robotic Telecollaboration system has been granted regulatory clearance by FDA. (Interestingly, the agency was forced to introduce a new category—Robotic Telemedicine Devices—to its medical device classification protocol to accommodate the system.) The da Vinci surgical robot, developed by Intuitive Surgical Inc., also was recently approved for clinical use by FDA, and several other systems are currently undergoing clinical studies. Elements of the Zeus Robotic Surgical system that was used in Operation Lindbergh have been cleared by FDA for use on patients, but it has yet to receive the agency's blessing for remote applications. The system has been granted the CE mark, however, clearing it for commercial distribution within the European Union.

But it is the advent of the telecommuting surgeon and long-distance surgery that is the truly novel aspect of Operation Lindbergh. In the past, telesurgical efforts have been thwarted by inadequate data transmission speeds: the surgeon needs to view the results of his actions in as close to real time as possible. By linking all of the equipment used in Operation Lindbergh over a high-bandwidth fiber-optic service transmitting 10 Mb/sec across the Atlantic Ocean, Equant North America achieved an average 150-millisecond delay. The time that elapsed between the surgeon's command to the robot and the visualization of his action on the monitor was for all intents and purposes imperceptible to the human eye. This achievement is all the more remarkable considering that this delay encompasses coding and decoding of the video image as well as signal transmission time.

"The demonstration of the feasibility of a transatlantic procedure is a richly symbolic milestone," commented Marescaux. "It lays the foundation for the globalization of surgical procedures, making it possible to imagine that a surgeon could perform an operation on a patient anywhere in the world."

Norbert Sparrow

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