Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Los Angeles, California.
Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Los Angeles, California.
J Urol. 2018 Feb;199(2):355-369. doi: 10.1016/j.juro.2017.06.082. Epub 2017 Jun 26.
Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications.
Two paired investigators screened PubMed, Scopus and Web of Science databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance." We categorized and included studies of level of interaction between proctors and trainees. Research design, special equipment, telecommunication network bandwidth and research outcomes of each study were ascertained and analyzed.
Of 65 identified reports 38 peer-reviewed studies qualified for inclusion. Series were categorized into 4 advancing levels, ie verbal guidance, guidance with telestration, guidance with tele-assist and telesurgery. More advanced levels of surgical telementoring provide more effective and experiential teaching but are associated with increased telecommunication network bandwidth requirements and expenses. Concerns regarding patient safety and legal, financial, economic and ethical issues remain to be reconciled.
Telementoring and telesurgery in minimally invasive surgery are becoming more practical and cost effective in facilitating teaching of advanced surgical skills worldwide and delivery of surgical care to underserved areas, yet many challenges remain. Maturity of these modalities depends on financial incentives, favorable legislation and collaboration with cybersecurity experts to ensure safety and cost-effectiveness.
远程医疗和微创手术的交叉领域存在巨大的兴趣和需求。机器人技术为手术远程指导和远程手术提供了理想的环境，因为它具有内窥镜光学和机械仪器运动。我们回顾了远程医疗在内窥镜和微创手术中的现状、当前挑战和未来前景，重点关注泌尿科的应用。
两名配对的调查人员使用“远程医疗”、“微创外科手术”、“机器人外科手术”、“教育”和“距离”等关键词，在 1995 年至 2016 年间在 PubMed、Scopus 和 Web of Science 数据库中筛选出所有全文英文文章。我们对主任和学员之间的互动水平进行了分类和研究。确定并分析了每个研究的研究设计、特殊设备、远程通信网络带宽和研究结果。
在 65 份已确定的报告中，有 38 份经过同行评审的研究符合纳入标准。系列分为 4 个先进水平，即口头指导、带远程描记术的指导、带远程协助的指导和远程手术。更先进的手术远程指导提供了更有效和经验性的教学，但与增加远程通信网络带宽要求和费用有关。关于患者安全以及法律、财务、经济和伦理问题仍有待解决。
在微创外科手术中，远程指导和远程手术在促进全球先进手术技能的教学和向服务不足地区提供手术护理方面变得更加实用和具有成本效益，但仍存在许多挑战。这些模式的成熟取决于财政激励、有利的立法以及与网络安全专家的合作，以确保安全性和成本效益。
