Possibilities and challenges of telesurgical interventions

摘要

Traditional telemedicine makes it possible to provide diagnosis, advice, monitoring and other medical services, for example, using audio-visual communication technologies, despite physical distance. Telemedicine is an important part of medical health care, especially in rural areas. Telemedicine is an important tool for the further development of care. Against this background, new areas of application for telemedicine are constantly being developed. Telemedicine also plays an important role in the digitalisation strategy for the health care sector. An evolving branch of telemedicine is telesurgery. The concept of distance between surgeons and their patients is not new. It was first explored in the 1970s by the US National Aeronautics and Space Administration (NASA), which was interested in treating astronauts in space. Especially for missions on the International Space Station (ISS) or planned manned Mars missions, it will be essential to provide the crew with medical expertise remotely via telemedicine and telesurgery. The development of robotic surgery as we know it today was based on the idea of telemedicine. The idea was that a trained surgeon could perform remote operations in trouble spots without having to be there in person. One example is Mobile Advanced Surgical Hospital (MASH): a system for providing care to wounded soldiers directly in a vehicle equipped with surgical robots using remote control. Another example of the need for telemedicine and telesurgery is the case of Jerri Lin Nielsen. She was an American doctor who self-treated her newly diagnosed breast cancer while stationed at the Amundsen-Scott South Pole Station in Antarctica until she could be safely evacuated. Nielsen had conference calls with medical personnel in the United States and had to operate on herself to obtain tissue samples for analysis. A military aircraft was later sent to the pole to drop equipment and medicine für chemotherapy.[1] At the same time, robotic surgery allowed the surgeon to operate with greater dexterity, improved accuracy and greater access to difficult areas of the body. Significant advances in telecommunications and robotic surgery led to the idea that telerobotic surgery being considered a viable option.[2] This led to the development of robotic surgery, in which the surgeon is usually in the same room as the patient, rather than next to them. The requirements for true telesurgery, where the surgeon may be thousands of kilometers away, are a major challenge. On the one hand, there is the need to ensure that qualified surgeons are available on site in case the operation needs to be modified or technical problems arise that make further telesurgical control impossible. The Lindbergh operation was the first complete telesurgery performed by a team of French surgeons in New York on a patient in Strasbourg. The operation was successfully performed on September 7, 2001 by Professor Jacques Marescaux and his team from Institute for Research on Cancer of the Digestive System (IRCAD). It was the first time in the history of medicine that a technical solution was able to reduce the time delay in remote transmissions that this type of procedure became possible.[3] Telesurgery refers to surgical procedures performed using technology, which has the potential to transform the global healthcare landscape by improving the quality of surgery, particularly in resource-limited settings and rural areas. The technology requires advanced communications and surgical robotics, allowing surgeons to perform procedures from remote or safe locations while ensuring high quality surgical outcomes and patient safety. It improves access to surgical services, reduces travel time and costs, and makes professional care available to a wider population. A core element of telesurgery is a stable network connection with high data transfer speed. This results in a large number of different parameters that need to be adapted as much as possible to the individua