A woman in France had her gall bladder removed by surgeons working in New York in a groundbreaking procedure that used remote-controlled robots. The world's first trans-oceanic human operation lasted less than an hour and the 68-year-old has made a full recovery.
The successful operation proved that doctors could "eliminate geographical constraints and make surgical expertise available throughout the world" according to the team who publish their findings this morning in the journal, Nature.
The group included specialists from the European Institute of Telesurgery at Louis Pasteur University, Strasbourg; Mount Sinai Medical Centre, New York and the department of electrical and computer engineering at the University of California, Santa Barbara.
They tested their systems by carrying out similar gall bladder removals in six pigs. The work showed that telesurgery, surgery over distances, could work and was safe, the authors claimed.
Until this test, telesurgery was limited to distances of no more than a few hundred kilometres, the authors noted, because of the time lag caused while the video images moved along the telecommunications lines.
The delays, even though no more than a fraction of a second, were considered too great for safety. They could slow a surgeon's response to, say, a bleeding artery.
The team first measured the telecommunications delay and then artificially increased it until the surgeons considered the delay was dangerous. They found that a half a second delay was unacceptable but that a third of a second delay or less was acceptable in terms of safety.
The first tests were over distances of about 1,000km round trip between Paris and Strasbourg. They then moved on to the New York/Strasbourg connection, a round trip distance for the video signals of about 14,000km.
The robot devices and related computer software were built by a California company, Computer Motion. The "surgeon side" controls in New York were held and manipulated by the doctors. Their movements were copied and sent across to the "patient side" robots, which interpreted the signals and then imitated the movements.
The signals were sent over a high-speed terrestrial fibre-optic link, which relayed the information through dedicated connections.
The team had set a signal delay limit of 330 thousandths of a second but found that the actual delay was only about 155 thousandths of a second.
The pig operations lasted on average about 54 minutes, with the quickest just 27 minutes and the slowest 78 minutes. The surgeons gave scores for the quality of image, the impact of the time lag, the co-ordination of the cauterising tool and overall safety. They rated all of these at 8.5 out of 10 or higher, which encouraged them to use the equipment on a human patient.
The team received patient approval and hospital ethical committee agreement and used the same equipment as used with the pig operations. Two surgeons in New York controlled the robots and a third monitored the video link. Two surgeons in Strasbourg set up the robot system and served as back-up either to inactivate the robots or complete the surgery if necessary.
In the event, the back-up wasn't necessary. The woman's gall bladder was removed in 54 minutes without any complications, the authors reported. "The post-operative period was uneventful and the patient was discharged 48 hours later."
The system could make high-quality surgical expertise available anywhere, the team said.