Live surgery from Japan to South Africa: High-quality image transmission over a high-speed academic network

Quality preservation during the transmission of medical moving images is challenging owing to image compression in the limited bandwidth of the Internet. Satellite transmission does not solve this problem because of the high cost involved, hindering the advancement of practical telemedicine. We developed a new, affordable and usable system, and applied it to the live transmission of surgery from Japan to South Africa. The digital video transport system (DVTS), which is free software that transforms digital video signals directly to Internet Protocol, and academic networks dedicated to research and education purposes were used with bandwidth of 30 Mbps. The cipher program IPsec was used to protect patient privacy. Laparoscopic rectal surgery was transmitted live from Kyushu University Hospital in Japan, to the University of Cape Town in South Africa, as well as Cho Ray Hospital in Vietnam, over a period of 2 hours. Interactive discussion was held among the three sites with the transmission of clear, high-resolution, and smooth surgical images. This project is an important milestone achieved in South Africa indicating its feasibility for developing nations with National Research and Education Networks and provides a base for its domestic and international expansion.