Tuesday, October 2, 2001

First transatlantic surgery

On September 7, French and American surgeons performed the first-ever surgery across the Atlantic Ocean. Sitting in a New York hospital, they removed the gall bladder of a 68-year-old French woman, using a computerized surgical robot connected to a transatlantic fiber optic link. “It was a bit difficult to explain to my patient in Strasbourg that I was going to New York to operate on her,” said professor Jacques Marescaux of the University of Strasbourg.

Jacques Marescaux and Michael Gagner of New York’s Mount Sinai Hospital belong to an elite group of surgeons that are pioneering a new type of medicine – robot surgery. They use sophisticated robots to perform more efficient operations, which in principle can be done from anywhere in the world, hence the name telesurgery. ”In the future, using satellite clinics, we will be able to operate on patients in poor countries, onboard ships at sea, remote islands, the Antarctica, and even in a space station – anywhere where there is a lack of experienced experts,” says Dr. Gagner.

Before this operation, few experts thought it was possible to perform surgery over more than a few hundred kilometers, because of the time delay when electronic signals travel between the surgeon’s workstation, and his robotic counterpart. This was a real problem during trial operations on pigs, but was later solved when France Telecom provided the scientists with a dedicated fiber optic connection.

The entire operation took 54 minutes, of which 16 was used to prepare the patient in Strasbourg. Drs. Gagner and Marceaux took turns in directing the robot using two thin, pen-shaped controls. A third surgeon was at hand in Strasbourg ready to take over in case anything went wrong, but did not need to take action.

With telesurgery, the patient can leave the hospital in only two days, and has a good chance of recovering faster than after traditional surgery, since the robot’s incisions are smaller, and there is less bleeding. Authorities in the EU and Canada have already cleared these kind of robotic systems for human surgery, while the more conservative American authorities are still evaluating them. There are also a number of legal aspects that may slow down the introduction of robot surgeons. Who bears the responsibility if anything goes wrong? The manufacturer of the robot, or the doctor? And from which country?

“(Telesurgery) is a new science where robots act as the new interface between the doctor and patient,” says Dr. Gagner, who intends to start a professional association of robot surgeons. Asked whether he has any doubts about the use of robots surgery, he says that he hopes that there will always be a doctor standing behind the controls.

Hans Sandberg

Hubble Telescope Images