The cutting edge in surgery

In September 2001, a hospital in Strasbourg, France, probably broke the record for the most expensive standard surgery in history by removing the gall bladder from a 68-year-old woman for the princely sum of more than €1 million. But it was not the exorbitant cost of the operation that made the headlines in the popular and biomedical press. It was the fact that it was the first example of transatlantic telesurgery, with the patient in Strasbourg and both surgeons, Jacques Marescaux of the European Institute of Telesurgery at the University of Strasbourg and Michel Gagner of New York City’s Mount Sinai Medical Center, in New York. This was not necessarily a medical breakthrough—telesurgery has been performed successfully before—but rather a proof of principle that computer technology, robotics, fibre optics and surgical techniques have advanced sufficiently to overcome the technical problems that previously plagued the approach. Although still in its infancy, telesurgery is currently mainly used to train surgeons in endoscopic techniques and for consultations and telementoring. But in the long-term, experts expect it to be used on the battlefield, in space, in remote regions or in hospitals that lack a specialist to perform a complex operation. While few surgeons are currently pondering adding telesurgery to their skills, many are in fact moving in that direction by adopting endoscopic techniques. Indeed, it was the development of endoscopy and laparoscopic surgery— keyhole techniques where surgeons insert remote-controlled instruments through small cuts—in the early 1990s that laid the groundwork for the development of telesurgery. Since laparoscopy requires a surgeon to manipulate instruments remotely, telesurgery means nothing more than further separating the tool and the controls by space and data-transmission technology. According to Marescaux, the idea of telesurgery was born in 1993, after he had attended a lecture by a US military physician who envisioned its use on the battlefield and in space. He first collaborated with European partners, but it became clear that their current technology was not compatible with the requirements of the operating room, mainly because data transmission via satellite would be too slow. He then started working with Yulun Wang, Chief Scientific Officer of ComputerMotion in Santa Barbara, CA, and developer of the company’s Zeus robotic system, which was used for the operation in Strasbourg. Wang, who became interested in medical robotics in the early 1990s at the beginning of the laparoscopic boom, saw an opportunity to combine laparoscopy with telecommunications and robotics. He left NASA, where he was working at that time, and started developing a voiceactivated robotic system.