Robot-assisted remote surgery: technological advances, potential complications, and solutions.

: Technical limitations, mostly related to the issue of time delay for transmission of digitized information, had prevented the development of remote surgery intended as performance of a complete surgical procedure from long distances. To overcome the issue of time delay, tests and researches performed with the joined effort of surgeons, robotic and telecommunication engineers convinced our group that use of the high-speed terrestrial network [asynchronous transfer mode (ATM) service], rather than satellite connections, would significantly reduce the time lag for transmission of data. Using ATM technology, our group demonstrated the feasibility of performing surgery across transoceanic distances by safely carrying out a laparoscopic cholecystectomy, first on an animal model and later (September 7, 2001), on a patient. Using ATM technology, the mean time lag for transmission of data and images was 155 msec despite a total round-trip distance of 14,000 km. Teletransmission of active surgical manipulations have the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and improve surgical training worldwide. However, several limitations remain for remote surgery to become commonplace. Among these, the need to render ATM network available to hospitals, costs of technology, ethical and liability issues, and possible conflicts of jurisdictions between countries involved.