Remote operative urology using a surgical telemanipulator system: preliminary observations

A prototype surgical telemanipulator system was evaluated to determine the feasibility of remotely performing operative urology.

Surgeons operated remotely on anesthetized swine (n = 4), using a four degree-of-freedom teleoperator system. A stereoscopic video display of the remote surgical field guided tissue manipulation, which was performed using standard instrument tips attached to robotic arms. Nephrectomies, cystotomy closures, and ureteral anastomoses were performed by surgeons linked only by electronic cables to the remote operative field (5 m away). Flexible fiberoptic endoscopy was performed remotely, as well, using a simulated ureter in an ex vivo testing apparatus. The endoscope was positioned and manipulated remotely, and was maneuvered through a 25-cm-long tube.

All procedures were completed successfully, demonstrating the capability to remotely incise, dissect, suture, and ligate tissues. Operative times were prolonged; however, the surgical telemanipulator was precise and accurate. Surgeons guided a flexible fiberoptic endoscope by remote observation and manipulation through 5-mm-diameter simulated ureters. There were no operative complications.

Telesurgical manipulation is feasible in a controlled, experimental environment. All critical tasks performed by surgeons can be completed remotely, although performance must be improved substantially before telemanipulators enter the clinical armamentarium. Major hurdles remain in identifying clinical needs, improving performance and safety, and developing telecommunications capabilities that will enable telesurgical systems to achieve regulatory approval and acceptance.