Anvari Mehran, McKinley Craig, Stein Harvey
Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
Ann Surg. 2005 Mar;241(3):460-4. doi: 10.1097/01.sla.0000154456.69815.ee.
To establish a telerobotic surgical service between a teaching hospital and a rural hospital for provision of telerobotic surgery and assistance to aid rural surgeons in providing a variety of advanced laparoscopic surgery to their community patients.
The above service was established between St. Joseph's Hospital in Hamilton and North Bay General Hospital 400 km north of Hamilton on February 28, 2003. The service uses an IP-VPN (15 Mbps of bandwidth) commercially available network to connect the robotic console in Hamilton with 3 arms of the Zeus-TS surgical system in North Bay.
To date, 21 telerobotic laparoscopic surgeries have taken place between North Bay and Hamilton, including 13 fundoplications, 3 sigmoid resections, 2 right hemicolectomies, 1 anterior resection, and 2 inguinal hernia repairs. The 2 surgeons were able to operate together using the same surgical footprint and interchange roles seamlessly when desired. There have been no serious intraoperative complications and no cases have had to be converted to open surgeries. The mean hospital stays were equivalent to mean laparoscopic LOS in the tertiary institution.
Telerobotic remote surgery is now in routine use, providing high-quality laparoscopic surgical services to patients in a rural community and providing a superior degree of collaboration between surgeons in teaching hospitals and rural hospitals. Further refinement of the robotic and telecommunication technology should ensure its wider application in the near future.
在一家教学医院和一家乡村医院之间建立远程机器人手术服务，以提供远程机器人手术及协助，帮助乡村外科医生为其社区患者开展各种先进的腹腔镜手术。
上述服务于2003年2月28日在汉密尔顿的圣约瑟夫医院与位于汉密尔顿以北400公里处的北湾综合医院之间建立。该服务使用一个商用的IP-VPN（带宽为15 Mbps）网络，将汉密尔顿的机器人控制台与北湾的宙斯-TS手术系统的3个操作臂相连。
截至目前，北湾和汉密尔顿之间已进行了21例远程机器人腹腔镜手术，包括13例胃底折叠术、3例乙状结肠切除术、2例右半结肠切除术、1例前切除术和2例腹股沟疝修补术。两位外科医生能够使用相同的手术空间共同操作，并在需要时无缝互换角色。术中未出现严重并发症，也没有病例需要转为开放手术。平均住院时间与三级医疗机构腹腔镜手术的平均住院时间相当。
远程机器人手术现已常规使用，为乡村社区的患者提供高质量的腹腔镜手术服务，并在教学医院和乡村医院的外科医生之间提供了高度的协作。机器人和电信技术的进一步完善应能确保其在不久的将来得到更广泛的应用。
