Urological Telementoring

Trials have been reported of the use of telementoring in urological procedures. In 1994, Kavoussi and coworkers reported that cholecystectomy, bladder suspension, and valix ligation were successfully performed using the AESOP robotic arm controlled by an experienced surgeon at a remote site (Fig. 2) [47]. Since then, Kavoussi's group has tried to extend the distance between the remote site and the primary operating site. The remote-site surgeon, located in a control room over 1000 feet away from the operating room, supervised an inexperienced surgeon. Data were transferred via fiberoptic and copper wire links. The remote surgeon was capable of simultaneously viewing internal and external images of the primary operating room and could control the laparoscope and draw an overlay video sketch on the video image generated by the internal camera [48, 49]. This overlay sketch appeared on the internal operative video monitor at the primary site. They developed a system that connected a central site (Johns Hopkins Hospital) and an operating site (the Bayview Campus of the Johns Hopkins Medical Institute, approximately 3.5 miles apart) via a single T1 (1.54Mbs) point-to-point communication link. The system provided a real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to elec-trocautery for tissue cutting or hemostasis [50].

The group at Johns Hopkins subsequently attempted telementoring surgery over international and intercontinental distances. The telementoring remote site in Baltimore (USA) was connected to operating sites in Innsbruck (Austria),

Remote site

Telestration Video

Robotic camera control Electrocautery control

Primary site

Fig. 2. The illustrated telementoring system developed at the Johns Hopkins School of Medicine

Audio

Video (operating room and laparoscopic image)

Remote site

Telestration Video

Robotic camera control Electrocautery control

Primary site

Fig. 2. The illustrated telementoring system developed at the Johns Hopkins School of Medicine

Bangkok (Thailand), Singapore, Rome (Italy), and Munich (Germany) [27, 51-56]. The first transcontinental telementoring involved a laparoscopic adrenalectomy performed between Baltimore and Innsbruck. Recently, a laparoscopic bilateral varicocelectomy and a percutaneous renal access for a percutaneous nephrolithotripsy were performed with telementoring assistance between Baltimore and Sao Paulo and Recife (Brazil) [57]. Four ISDN lines, each line carrying 128 kbps, were used for data transfer between the primary operating site and the remote site. AESOP was applied for laparoscopic varicocelectomy, and PAKY was used for percutaneous renal access. The remote surgeon was capable of making notes and drawings over the full-motion video monitor. Furthermore, the two surgical robots, AESOP and PAKY, were controlled by the remote surgeon. Both surgeries were successfully completed. In 2003, Ushiyama and coworkers reported the performance of laparoscopic adrenalectomy under tele-mentoring guidance. They used a fiberoptic cable for data transfer between the primary site and the remote site about 100 m away [25]. Telementoring trials at the Johns Hopkins Medical Institute are summarized in Table 3.

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