Rafiq Azhar, Moore James A, Zhao Xiaoming, Doarn Charles R, Merrell Ronald C
Medical Informatics and Technology Applications Consortium, Department of Surgery, Virginia Commonwealth University, Richmond 23298, USA.
Ann Surg. 2004 Apr;239(4):567-73. doi: 10.1097/01.sla.0000118749.24645.45.
To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities.
Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy.
Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses.
Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience.
The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of surgical fields was documented.
为了实现对身处遥远地点的学生进行实时或同步的外科手术会诊与教学，我们报告了利用现有硬件和互联网功能成功整合机器人技术、视频电话会议及内部网络传输的情况。
使用诸如腹腔镜的闭合耦合装置（CCD）这类高分辨率视频成像摄像头对外科手术视野进行精确可视化，有助于确保对手术进行清晰的视觉观察，并与远处的实习生和/或会诊医生分享手术过程。先前的工作已成功应用光学和技术进步在腹腔镜检查中实现精确可视化。
对15例患者的25次甲状腺切除术探查进行实时双向音频和视频数据监测与传输。远程的外科实习生（n = 4）和医学生（n = 3）在每次手术过程中确认了7个不同的解剖标志。该研究使用了苏格拉底系统（计算机运动公司[CMI]，加利福尼亚州戈利塔），这是一个包含远程标注白板的交互式远程指导系统，与AESOP机器人手臂和赫耳墨斯语音命令系统（CMI）配合使用。使用一个10毫米的平板腹腔镜望远镜来捕捉手术光学视野。当语音、远程标注工具或标记确认每个解剖标志时，通过调查反馈评估图像的分辨率、色度（光的位置和强度）和亮度等参数。
大多数相关解剖标志的确认率超过90%，远程观众能够看到这些标志。
本研究中的数据支持了通过手术视野的视觉传输对远程观众进行指导和会诊的可行性，而手术视野原本是很难共享的。此外，还记录了将技术协议验证为机器人器械教学工具和手术视野计算机成像教学工具的情况。
