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Zhang F, Zhu X, Gao J, Wu B, Liu P, Shao P, Xu M, Pawlik TM, Martin EW, Xu RX. Coaxial projective imaging system for surgical navigation and telementoring. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-9. [PMID: 31650743 PMCID: PMC7000882 DOI: 10.1117/1.jbo.24.10.105002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/10/2019] [Indexed: 05/13/2023]
Abstract
A coaxial projective imaging (CPI) module acquires surgical scene images from the local site of surgery, transfers them wirelessly to the remote site, and projects instructive annotations to the surgical field. At the remote site, the surgical scene images are displayed, and the instructive annotations from a surgical specialist are wirelessly transferred back to the local site in order to guide the surgical intervention by a less experienced surgeon. The CPI module achieves seamless imaging of the surgical field and accurate projection of the instructive annotations, by a coaxial optical path design that couples the imaging arm with the projection arm and by a color correction algorithm that recovers the true color of the surgical scene. Our benchtop study of tele-guided intervention verifies that the proposed system has a positional accuracy of better than 1 mm at a working distance ranging from 300 to 500 mm. Our in vivo study of cricothyrotomy in a rabbit model proves the concept of tele-mentored surgical navigation. This is the first report of tele-guided surgery based on CPI. The proposed technique can be potentially used for surgical training and for telementored surgery in resource-limited settings.
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Affiliation(s)
- Fan Zhang
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Xiang Zhu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Jian Gao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Bingxuan Wu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Peng Liu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
- Address all correspondence to Peng Liu, E-mail: ; Ronald X. Xu, E-mail:
| | - Pengfei Shao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Min Xu
- Sino-Medic, Hefei, Anhui, China
| | - Timothy M. Pawlik
- The Ohio State University, Department of Surgery, Columbus, Ohio, United States
| | - Edward W. Martin
- The Ohio State University, Department of Surgery, Columbus, Ohio, United States
| | - Ronald X. Xu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- The Ohio State University, Department of Biomedical Engineering, Columbus, Ohio, United States
- Address all correspondence to Peng Liu, E-mail: ; Ronald X. Xu, E-mail:
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Glenn IC, Bruns NE, Hayek D, Hughes T, Ponsky TA. Rural surgeons would embrace surgical telementoring for help with difficult cases and acquisition of new skills. Surg Endosc 2016; 31:1264-1268. [PMID: 27444835 DOI: 10.1007/s00464-016-5104-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical telementoring, consisting of an expert surgeon guiding a less experienced surgeon through advanced or novel cases from a remote location, is an evolving technology which has potential to become an integral part of surgical practice. This study sought to apprise the attitudes of rural general surgeons toward the possible benefits and applications of surgical telementoring in their practices. METHODS A survey assessing demographics and attitudes toward telementoring was e-mailed to members of the American College of Surgeons (ACS) Advisory Council for Rural Surgery and posted to the ACS website in areas targeting rural surgeons. A link to a webpage with a description of surgical telementoring and brief demonstrative video were included with the survey. RESULTS There were 159 respondents, with 82.3 % of them practicing in communities smaller than 50,000 people. Overall, 78.6 % felt that telementoring would be useful to their practice, and 69.8 % thought it would benefit their hospitals. There was no correlation between years of practice and perceived usefulness of surgical telementoring. When asked the single most useful, or primary, application of surgical telementoring there was a split between learning new techniques (46.5 %) and intraoperative assistance with unexpected findings (39.0 %). When asked to select all applications in which they would be interested in using telementoring from a list of possible uses, surgeons most frequently selected: intraoperative consultation for unexpected findings (67.7 %), trauma consultation (32.9 %), and laparoscopic colectomy (32.9 %). CONCLUSIONS Surgical telementoring is on the verge of widespread use but industry and surgical societies remain ambivalent about supporting its implementation due to concerns over lack of interest. This study demonstrates interest among rural surgeons. While there are differing opinions regarding compensation of the telementoring, the most common, single interest in the use of surgical telementoring was for learning new techniques or skill sets.
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Affiliation(s)
- Ian C Glenn
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Nicholas E Bruns
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Danial Hayek
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | | | - Todd A Ponsky
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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Xiao Y, Schimpff S, Mackenzie C, Merrell R, Entin E, Voigt R, Jarrell B. Video Technology to Advance Safety in the Operating Room and Perioperative Environment. Surg Innov 2016; 14:52-61. [PMID: 17442881 DOI: 10.1177/1553350607299777] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Video is a powerful medium and is underused for patient safety in several areas: education, real-time consultation, process improvement, research, and workflow coordination. We illustrate this point through an overview of uses of video in health care by the authors and others in several institutions. These uses were in the context of team work training, operating room coordination, technical skills of invasive procedures, process improvement, telementoring, and multimedia video records. Also described are several key issues associated with the use of video, such as ethics and legal concerns. Technology advances and new methods will make video an important tool for improving patient safety.
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Affiliation(s)
- Yan Xiao
- University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Askari A, Khodaie M, Bahaadinbeigy K. The 60 most highly cited articles published in the Journal of Telemedicine and Telecare and Telemedicine Journal and E-health. J Telemed Telecare 2014; 20:35-43. [DOI: 10.1177/1357633x13519899] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Summary We analysed the most highly cited articles in two specialist telemedicine journals, the Journal of Telemedicine and Telecare (JTT) and Telemedicine Journal and E-health (TJEH). Articles were extracted from the Science Citation Index Expanded in September 2012. A total of 1810 articles were listed for the JTT and 1550 for TJEH. In the JTT, the mean number of citations was 43 (SD 13); in TJEH the mean number of citations was 30 (SD 11). The average number of citations for the JTT was significantly higher than for TJEH ( P < 0.001). In each journal, the 60 articles which had the most citations were identified as highly cited publications (HCPs). The 60 HCPs in the JTT originated from 16 countries; the 60 HCPs in TJEH originated from 10 countries. Considering both journals together, the majority of HCPs came from the US, UK, Australia and Canada. In the JTT, the mean number of authors for each HCP was 4.6 (SD = 3.1); in TJEH, the mean number of authors for each HCP was 4.5 (SD = 2.3). There was no difference between the two journals ( P = 0.84) and the characteristics of the HCPs published in the JTT and TJEH were broadly similar. Although HCPs are not a direct method of measuring quality, they are an indicator of the scientific impact of the articles.
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Affiliation(s)
- Azam Askari
- Medical Informatics Research Centre, Institute of Futures Studies in Health, Kerman University of Medical Science, Kerman, Iran
| | - Mahdieh Khodaie
- Medical Informatics Research Centre, Institute of Futures Studies in Health, Kerman University of Medical Science, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Research Center for Modelling in Health, Institute of Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Hahm JS, Lee HL, Choi HS, Shimizu S. Telemedicine system using a high-speed network: past, present, and future. Gut Liver 2009; 3:247-51. [PMID: 20431756 PMCID: PMC2852732 DOI: 10.5009/gnl.2009.3.4.247] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/06/2009] [Indexed: 11/12/2022] Open
Abstract
There is no doubt that telecommunication saves a great deal of time and expense when exchanging information, and recent technological advances have increased its popularity in business and educational applications. Telemedicine is a rapidly developing application of clinical medicine in which medical information is transferred via the Internet or another communication network for the purpose of consultations, and sometimes also for remote medical procedures or examinations. A telemedicine system can also be applied to medical education. Many doctors and medical students could benefit from telementoring and tele-education based on videoconferencing systems. However, telemedicine in general has not yet become popular in clinical practice or medical education. In our university, we have used a telemedicine system to educate doctors and medical students since 2003. Since our first telemedical conference with Kyushu University Hospital on February 12, 2003 when we have regularly performed telemedical conferences. Here we introduce a general methodology for telemedicine, our experiences of medical conferencing using telemedicine, and future possible directions.
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Affiliation(s)
- Joon Soo Hahm
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
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Shimizu S, Nakashima N, Okamura K, Tanaka M. One Hundred Case Studies of Asia-Pacific Telemedicine Using a Digital Video Transport System over a Research and Education Network. Telemed J E Health 2009; 15:112-7. [DOI: 10.1089/tmj.2008.0067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuji Shimizu
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Nakashima
- Department of Medical Informatics, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Okamura
- Computing and Communications Center, Kyushu University, Fukuoka, Japan
| | - Masao Tanaka
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan. Department of Surgery and Oncology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Huang KJ, Qiu ZJ, Fu CY, Shimizu S, Okamura K. Uncompressed video image transmission of laparoscopic or endoscopic surgery for telemedicine. Telemed J E Health 2008; 14:479-85. [PMID: 18578684 DOI: 10.1089/tmj.2007.0088] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traditional narrowband telemedicine cannot provide quality dynamic images. We conducted videoconferences of laparoscopic and endoscopic operations via an uncompressed video transmission technique. A superfast broadband Internet link was set up between Shanghai in the People's Republic of China and Fukuoka in Japan. Uncompressed dynamic video images of laparoscopic and endoscopic operations were transmitted by a digital video transfer system (DVTS). Seven teleconferences were conducted between June 2005 and June 2007. Of the 7 teleconferences, 5 were live surgical demonstrations and 3 were recorded video teleconsultations. Smoothness of the motion picture, sharpness of images, and clarity of sound were benefited by this form of telemedicine based upon DVTS. Telemedicine based upon DVTS is a superior choice for laparoscopic and endoscopic skill training across the borders.
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Affiliation(s)
- Ke-Jian Huang
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai First Peoples Hospital, Shanghai, PR China.
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Boanca C, Rafiq A, Tamariz F, Lavrentyev V, Onisor D, Flerov E, Popescu I, Merrell RC. Remote video management for intraoperative consultation and surgical telepresence. Telemed J E Health 2008; 13:603-7. [PMID: 17999622 DOI: 10.1089/tmj.2006.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration.
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Affiliation(s)
- Cosmin Boanca
- Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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Anvari M. Telesurgery: remote knowledge translation in clinical surgery. World J Surg 2007; 31:1545-50. [PMID: 17534550 DOI: 10.1007/s00268-007-9076-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 03/08/2007] [Indexed: 12/24/2022]
Abstract
Dissemination of new surgical knowledge, skills, and techniques across the wide spectrum of practicing surgeons in the community is often difficult and slow. This is even more problematic in countries such as Canada, where geographic distances separate a large portion of community surgeons from the large teaching centers. As an example, the penetration of advanced minimally invasive techniques in Canada has been severely hampered by the inability to provide adequate training opportunities and support for community surgeons, many of whom live in remote regions of the country. In an attempt to overcome the barriers that exist, the Centre for Minimal Access Surgery (CMAS) at McMaster University has been using broadband Internet and telecommunication systems to provide distance training and mentoring to community surgeons living in remote northern communities of Canada. This article describes our experience with telementoring and robot-assisted remote telepresence surgery and assisting, between a teaching hospital in Hamilton and two community hospitals in northern Ontario and Quebec.
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Affiliation(s)
- Mehran Anvari
- McMaster University, 8th Floor, Mary Grace Wing, 50 Charlton Ave. E, L8N 4A6, Hamilton, Ontario, Canada.
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Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M. Telementoring: an important enabling tool for the community surgeon. Surg Innov 2006; 12:327-31. [PMID: 16424953 DOI: 10.1177/155335060501200407] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study evaluated the efficacy of telementoring as an enabling tool for community general surgeons to perform advanced laparoscopic surgical procedures. We present a series of 19 patients who underwent advanced laparoscopic surgical procedures in two community hospitals, between November 2002 and July 2003, by four community surgeons with no formal advanced laparoscopic training. Each surgeon was telementored by an expert surgeon from a tertiary care hospital. Telementoring was achieved with real-time two-way audio-video communications over Internet Protocol or Integrated Services Digital Network lines with bandwidths from 385 kbps to 1.2 mbps. The procedures included 10 bowel resections, 5 Nissen fundoplications, 2 splenectomies, 1 reversal of a Hartmann procedure, and 1 ventral hernia repair. Two of the 19 procedures (11%) were converted to open. There were no intraoperative complications and two postoperative complications (11%). The primary surgeon considered telementoring useful in all cases (median score, 4 of 5). The mentor was also comfortable with the quality of the laparoscopic surgery performed (median score, 4 of 5). Telecommunication bandwidth for audio and video transmission was found to be a critical factor in the quality of telementoring process. Telementoring is safe and feasible. It allows community surgeons with no formal advanced laparoscopic training to benefit from expert intraoperative advice during the performance of advanced laparoscopic procedures. It may also reduce health-care costs by avoiding the need to refer and transfer patients to tertiary care centers.
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Affiliation(s)
- Herawaty Sebajang
- North Bay District Hospital, North Bay, McMaster University, Hamilton, Ontario, Canada
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Cone SW, Gehr L, Hummel R, Merrell RC. Remote Anesthetic Monitoring Using Satellite Telecommunications and the Internet. Anesth Analg 2006; 102:1463-7. [PMID: 16632827 DOI: 10.1213/01.ane.0000204303.21165.a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Remote collaboration for anesthesia requires considerable sharing of physiologic data, audio, and images on a consistent data platform. A low-bandwidth connection between Ecuador and the United States supported effective joint management of operative plan, airway, intraoperative decisions, and recovery. Transmission with a 64-Kbps InMarSat satellite telephone (Thrane & Thrane, Denmark) connection from hospitals in Macas and Sucúa, Ecuador, to Richmond, Virginia, included preoperative patient evaluations, video of endotracheal intubations, electrocardiogram waveforms, pulse oximetry measurements, arterial blood pressure readings, capnography readings, and auscultation of breath sounds.
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Affiliation(s)
- Stephen W Cone
- Medical Informatics and Technology Applications Consortium, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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Thiyagarajan CA, Clarke M. A systematic review of technical evaluation in telemedicine systems. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:6320-6323. [PMID: 17946758 DOI: 10.1109/iembs.2006.260377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We conducted a systematic review of the literature to critically analyse the evaluation and assessment frameworks that have been applied to telemedicine systems. Subjective methods were predominantly used for technical evaluation (59 %), e.g. Likert scale. Those including objective measurements (41%) were restricted to simple metrics such as network time delays. Only three papers included a rigorous standards based objective approach. Our investigation has been unable to determine a definitive standards-based telemedicine evaluation framework that exists in the literature that may be applied systematically to assess and compare telemedicine systems. We conclude that work needs to be done to address this deficiency. We have therefore developed a framework that has been used to evaluate videoconferencing systems telemedicine applications. Our method seeks to be simple to allow relatively inexperienced users to make measurements, is objective and repeatable, is standards based, is inexpensive and requires little specialist equipment. We use the EIA 1956 broadcast test card to assess resolution, grey scale and for astigmatism. Colour discrimination is assessed with the TE 106 and Ishihara 24 colour scale chart. Network protocol analysis software is used to assess network performance (throughput, delay, jitter, packet loss).
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Affiliation(s)
- C A Thiyagarajan
- Dept. of Inf. Syst. & Comput., Brunel Univ., Uxbridge, Middlesex, UK
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Allaf M, Patriciu A, Mazilu D, Kavoussi L, Stoianovici D. Overview and fundamentals of urologic robot-integrated systems. Urol Clin North Am 2005; 31:671-82, vii. [PMID: 15474594 DOI: 10.1016/j.ucl.2004.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Advances in technology have revolutionized urology. Minimally invasive tools now form the core of the urologist's armamentarium. Laparoscopic surgery has become the favored approach for treating many complicated urologic ailments. Surgical robots represent the next evolutionary step in the fruitful man-machine partnership. The introduction of robotic technology in urology changes how urologists learn, teach, plan, and operate. As technology evolves, robots not only will improve performance in minimally invasive procedures, but also enhance other procedures or enable new kinds of operations.
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Affiliation(s)
- Mohamad Allaf
- Brady Urological Institute, D0300, Bayview Medical Center, Johns Hopkins University, 5200 Eastern Avenue, Baltimore, MD 21224-2736, USA
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Rafiq A, Moore JA, Zhao X, Doarn CR, Merrell RC. Digital video capture and synchronous consultation in open surgery. Ann Surg 2004; 239:567-73. [PMID: 15024319 PMCID: PMC1356263 DOI: 10.1097/01.sla.0000118749.24645.45] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. SUMMARY BACKGROUND DATA Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. METHODS Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. RESULTS Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. CONCLUSION The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of surgical fields was documented.
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Affiliation(s)
- Azhar Rafiq
- Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond 23298, USA.
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Cone SW, Gehr L, Hummel R, Rafiq A, Doarn CR, Merrell RC. Case Report of Remote Anesthetic Monitoring Using Telemedicine. Anesth Analg 2004; 98:386-388. [PMID: 14742375 DOI: 10.1213/01.ane.0000096048.17319.b5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We report a case supporting the use of telecommunications technology from a remote location to monitor anesthetic events. Vital signs, data, and video were transmitted from surgery conducted in the remote Amazonian rainforests of Ecuador to Richmond, VA. This application of telemedicine technologies makes available expert advice from remote locations during surgical procedures. IMPLICATIONS This study validates the use of telecommunications technology from a remote location to monitor an anesthetic event. This type of work makes expert advice available during surgical procedures.
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Affiliation(s)
- Stephen W Cone
- From the Medical Informatics and Technology Applications Consortium (MITAC), Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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Wildi SM, Kim CY, Glenn TF, Mackey HA, Viator GE, Wallace MB, Hawes RH. Tele-endoscopy: a way to provide diagnostic quality for remote populations. Gastrointest Endosc 2004; 59:38-43. [PMID: 14722545 DOI: 10.1016/s0016-5107(03)02529-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Flexible endoscopy plays an important role in digestive health. However, access to endoscopy is limited in many rural areas throughout the world. Training non-physician personal to perform diagnostic endoscopy and to transmit images to a central hospital, where experienced endoscopists can review the procedures, may improve digestive health for patients in remote areas. The aim of this study was to evaluate the diagnostic quality and accuracy of upper-GI tele-endoscopy. METHODS Fifty patients scheduled for EGD underwent upper-GI tele-endoscopy. The procedures were observed simultaneously by the endoscopist and a gastroenterologist observing from a remote station connected by 4 integrated services digital network telephone lines. The interpretation of the findings by both were compared and concordance for diagnosis of major and minor lesions was analyzed. RESULTS Tele-endoscopic image quality was adequate to support diagnosis of abnormal lesions by the remote observer. Technical issues included worsening image quality caused by mild pixelation during rapid endoscope movement and rare loss of the telephone lines. The endoscopist identified 47 different major and 44 minor findings in the 50 patients. The observer missed one major lesion (columnar-lined esophagus) because of suspected inflammation and described 10 non-existing major lesions (sensitivity 98%: 95% CI[89%, 99%], specificity 80%: 95% CI[66%, 90%]). Some of the differences were because of interobserver variability. CONCLUSIONS Upper-GI tele-endoscopy by using telephone lines has good diagnostic quality and is highly sensitive with regard to major findings. The misinterpretation of certain findings (esophageal ring, gastric erosions) may be caused by interobserver variability. The data strongly suggest that endoscopist and observer see similar endoscopic views.
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Affiliation(s)
- Stephan M Wildi
- Digestive Disease Center, Medical University of South Carolina, and Department of Veterans Affairs Medical Center, Charleston, 29425, USA
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Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK. Transatlantic robot-assisted telesurgery. Nature 2001. [DOI: 10.1038/35096636 10.1038/414710a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK. Transatlantic robot-assisted telesurgery. Nature 2001; 413:379-80. [PMID: 11574874 DOI: 10.1038/35096636] [Citation(s) in RCA: 410] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J Marescaux
- IRCAD European Institute of Telesurgery, Louis Pasteur University, 1 Place de l'Hopital, 6700 Strasbourg, France.
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