Teleconferencing bridges two oceans and shrinks the surgical world.
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Biomedical subjects
Publications and source records attributed to R M Satava.
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Virtual reality (VR) has provided a new methodology for interacting with information. Since telemedicine is principally involved with transmitting medical information, VR has the potential to enhance the telemedicine experience. The two principle ways in which VR can be applied are as an interface, which enables a more intuitive manner of interacting with information, and as an environment that enhances the feeling of presence during the interaction. Since there are no current clinical applications of VR in the telemedicine experience, this report reviews concepts and experiences with the potential to enhance the delivery of telemedicine.
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BACKGROUND: Although flexible endoscopy is only 25 years old, a new technology may soon be used to provide the same view of internal organs without inserting an instrument. This is virtual endoscopy. METHODS: By acquiring patient specific high resolution digital images with a helical CT scan or MRI, individual organs can be graphically isolated or "segmented" into fully interactive 3-D reconstructions on a computer monitor. Applying sophisticated flight-tracking programs from military pilots, the organs can be "flown through", giving a view identical to endoscopy. CONCLUSIONS: In the future we will fly through data instead of inserting endoscopic instruments for gastrointestinal endoscopic diagnosis.
Although flexible endoscopy is only 25 years old, a new technology may soon be used to provide the same view of internal organs without inserting an instrument. This is virtual endoscopy. By acquiring patient-specific high-resolution digital images with a helical CT scan or MRI, individual organs can be graphically isolated or "segmented" into fully interactive 3-D reconstructions on a computer monitor. Applying sophisticated flight-tracking programs from military pilots, the organs can be "flown through," giving a view identical to endoscopy. In the future we will fly through data instead of inserting endoscopic instruments for gastrointestinal endoscopic diagnosis.
We are seeing the emergence of medical applications for virtual reality (VR). These include telepresence surgery, three-dimensional (3-D) visualization of anatomy for medical education, VR surgical simulators, and virtual prototyping of surgical equipment and operating rooms. Today, approximately 90% of the knowledge a physician requires can be obtained through electronic means, such as diagnostic sensors and imaging modalities, directly seeing the patient with a video camera for medical consultation, or using electronic medical records. In addition, with telepresence, a therapy can be effected electronically, regardless of the physical location of the patient. Therefore, it makes sense to send the electronic information or manipulation, rather than sending the patient or blood samples, to obtain tests or to produce a cure. In that these applications are mediated through the computer interface, they are the embodiment of VR as the major force for change in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site are a 3-D camera system and responsive manipulators with sensory input. At the workstation are a 3-D monitor and dexterous handles with force feedback. The next generation in medical education can learn anatomy from a new perspective by "flying" inside and around the organs, using sophisticated computer systems and 3-D visualization. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using this, students and surgeons can practice surgical procedures with virtual scalpels and clamps. To support these advanced technologies, the operating room and hospital of the future will first be designed and tested in virtual reality, allowing multiple iterations of equipment and surgical rooms before they are actually built. Insofar as all these technologies are based on digital information, they are the building blocks for the digital physician of the 21st century.
Medical applications for virtual reality (VR) are just beginning to emerge. These include VR surgical simulators, telepresence surgery, complex medical database visualization, and rehabilitation. These applications are mediated through the computer interface and as such are the embodiment of VR as an integral part of the paradigm shift in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and remote worksite. At the remote site there is a 3-D camera system and responsive manipulators with sensory input. At the workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using a helmet mounted display and DataGlove, a person can learn anatomy from a new perspective by 'flying' inside and around the organs, or can practice surgical procedures with a scalpel and clamps. Database visualization creates 3-D images of complex medical data for new perspectives in analysis. Rehabilitation medicine permits impaired individuals to explore worlds not otherwise available to them, allows accurate assessment and therapy for their disabilities, and helps architects understand their critical needs in public or personal space. And to support these advanced technologies, the operating room and hospital of the future will be first designed and tested in virtual reality, bringing together the full power of the digital physician.
The profound changes brought about by technology in the past few decades are leading to a total revolution in medicine. The advanced technologies of telepresence and virtual reality are but two of the manifestations emerging from our new information age; now all of medicine can be empowered because of this digital technology. The leading edge is on the digital battlefield, where an entire new concept in military medicine is evolving. Using remote sensors, intelligent systems, telepresence surgery and virtual reality surgical simulations, combat casualty care is prepared for the 21st century.
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Human interface technology is a new science which must be understood by all surgeons in order to cope with the ever-increasing complexity of surgical practice. This science is the understanding of how humans comprehend, interact, and use the world around them. The increasing use of robotics, computers, and virtual reality depend upon this technology to create a "user-friendly" environment to be able to assimilate the massive amount of data and images and to "naturally" interact with machines and computers. Through careful implementation, more complex systems will become easier to use and enhance the surgeon--the technology must adapt to the surgeon, not the reverse.
Medical applications for virtual reality (VR) technologies are just beginning to emerge. These include VR surgical simulators, telepresence surgery, complex medical database visualization, and rehabilitation. These applications are mediated through the computer interface and embody VR as an integral part of a paradigm shift in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site there is a 3-D camera system and responsive manipulators with sensory input. At the workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using a head-mounted display and DataGlove, a person can learn anatomy from a new perspective by 'flying' inside and around the organs, or can practice surgical procedures with a scalpel and clamps. Database visualization creates 3-D images of complex medical data for new perspectives in analysis. VR applications in rehabilitation medicine permit impaired individuals to perform tasks not otherwise available to them, allow accurate assessment and therapy for their disabilities, and help architects understand their critical needs in public or personal space. And to support these advanced technologies, the operating room and hospital of the future will be first designed and tested in virtual reality, bringing together the full power of the digital physician.
OBJECTIVES: To assess the feasibility of telerobotic assisted surgery. METHODS: In a laboratory model, a cholecystectomy, splenectomy, and nephrectomy were performed by an inexperienced surgeon who was being mentored by an experienced surgeon stationed at a remote site. The remote surgeon controlled the laparoscopic camera by utilizing a telerobotic system. In patients, laparoscopic cholecystectomy, varix ligation, and bladder suspension were performed by an experienced team utilizing a robotic system controlled by an experienced surgeon from a remote site. RESULTS: In both the laboratory and clinical setting, all procedures were successfully completed without complications. CONCLUSIONS: Current technology is available to successfully allow for telerobotic assisted surgery.
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With the rapid advancement in technology, there is a revolutionary paradigm shift in the delivery of health care: physicians are now interacting with their patients via an "electronic interface." This interface will make possible the future of endoscopy and endoscopic surgery by taking advantage of the emerging technologies in robotics, micro-robotics, telepresence, and virtual reality.
The concepts of teleoperation, telerobotics, and telepresence are presented and defined. Current surgical systems, some in clinical practice and others in prototype demonstration, are used to illustrate each of these principles. The importance and impact of these technologies and their relation to other advanced technologies are illustrated to project a framework for the future of surgery.
Under the auspices of the Resident Education Committee of the Society of American Gastrointestinal Endoscopic Surgeons, 158 of 298 (53%) of surgical training program directors responded to a survey on the current status of endoscopy in residency programs. Although 100 per cent claim that gastrointestinal endoscopy is provided by their program, only 76 per cent have formal endoscopy training, usually centered around the PGY 3 level, with only 23 per cent having didactic lectures in endoscopy. Directors claim to have trained nearly all of their residents by the completion of residency, averaging 44 esophagogastroscopies, 37 colonoscopies, and 46 flexible sigmoidoscopies per resident. However, they feel only 71 per cent of trainees are able to perform esophagogastroscopies and 67 per cent to perform colonoscopies in clinical practice. Ninety-seven per cent of directors feel endoscopy is important to surgical residency training, and 87 per cent have full-time faculty doing endoscopy. Only 44 per cent have a director of endoscopy; endoscopy is supervised by surgeons exclusively in only 48 per cent. Only 35 per cent have ongoing endoscopy research. When surgeons are not performing endoscopy, 66 per cent feel that the gastrointestinal (GI) service provides adequate service or training. Gastroenterology has a monopoly in endoscopy at 28 per cent of institutions, and 67 per cent of program directors feel there would be resistance to the formation of a separate surgical endoscopy service. Surgeons work in their own surgical endoscopy suite in only 15 per cent of institutions; in a GI suite in 13 per cent; and in a combined suite in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)