Technology insight: telementoring and telesurgery in urology

The rapid expansion of the field of minimally invasive surgery has been accompanied by a number of controversies. These novel surgical techniques offer benefits to the patient with regard to length of hospital stay, return to full activity, and cosmesis; also, they are often more cost-effective than open procedures. On the other hand, they are technically demanding, have a significant learning curve, and can be associated with high initial complication rates unless performed by experienced endoscopic surgeons. Telemedicine, which uses real-time video and information transfer, offers the potential to increase the availability of minimally invasive surgery through video-assisted surgery and through remote instruction. At present, remote communities, especially those within developed countries, can most immediately benefit from telesurgical approaches. Enthusiasm must be tempered by the issues of cost, security, surgeon liability and availability of the technology itself which have yet to be fully resolved. In this Review, the field of telemedicine, focusing specifically on telementoring and telesurgery, and its relevance to urology are discussed. From early experimental work to current clinical usage, the advantages of and problems in this evolving field are explored.