Telesurgery

This topic deserves a separate discussion, although it involves many different technologies, techniques, and educational concepts. From the earliest time of using the miniaturized cameras of the laparoscope, the transmittal of these images to remote locations (telesurgery) has been a fundamentally important part of the "laparoscopic revolution" (Figure 13.1). This permitted many individuals to see, witness, and learn about new methods of performing surgery. For the first time, many surgeons could witness an expert throughout a complex operation, potentiating the learning experience of surgery.

The topic of telementoring deserves some mention. The possibility of an expert surgeon to observe, and render advice/teach actively during an operation which is some distance away from this expert, is likely to become an important part of the future of surgery (Figure 13.2). The possibilities of using such expert instruction from a distance means that new ideas and technologies could be quickly disseminated without the need for "on-site" instructions or labs, and it could also form a means of getting rapid operating room teleconsultations in remote areas, if the need arose, from a centralized source of expertise.

Telesurgery
Figure 13.1. Telesurgery, now widely practiced, will expand in the future to permit more widespread dissemination of new ideas and technology.

A further source of expert help will combine telementoring with some of the emerging aspects of robotics, telepresence, and miniaturization of instruments. This means that the expert surgeon will be capable of entering the operating room as a "robotic" surgeon and performing surgical actions, assisting the team there (Figure 13.3). Even our uses of robotics will change, because robots may be expected to enter the body on their own, identify body structures, and make decisions with or without human directions (Figure 13.4). This scenario will challenge both our technological as well as ethical frontiers, and it is one that we must prepare for, because there is no doubt, at least among the editors of this book, that this will occur.

Telementoring
Figure 13.2. Telementoring, which involves direct instruction of a laparoscopic mentor interacting with a surgical team in real time, will expand the use of new methods and technologies.
Figure 13.3. Robotic-assisted surgery will permit surgical experts to DIRECTLY perform surgeries in remote locations, with the assistance of a local team.

Figure 13.4. A Minute robots themselves, under the guidance of surgical experts, may be expected to actively enter the scene of surgery in the future. B Robots may also actively enter the scene of surgery to make complex decisions about cases on their own. This could be particularly important in battlefield situations, where actual surgeons would be directing the robots from a "safe" location.

Figure 13.4. A Minute robots themselves, under the guidance of surgical experts, may be expected to actively enter the scene of surgery in the future. B Robots may also actively enter the scene of surgery to make complex decisions about cases on their own. This could be particularly important in battlefield situations, where actual surgeons would be directing the robots from a "safe" location.

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