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Technology Insight: telementoring and telesurgery in urology

Nature Clinical Practice Urology volume 3, pages 611–617 (2006)Cite this article

Abstract

The rapid expansion of the field of minimally invasive surgery has been accompanied by a number of controversies. These novel surgical techniques offer benefits to the patient with regard to length of hospital stay, return to full activity, and cosmesis; also, they are often more cost-effective than open procedures. On the other hand, they are technically demanding, have a significant learning curve, and can be associated with high initial complication rates unless performed by experienced endoscopic surgeons. Telemedicine, which uses real-time video and information transfer, offers the potential to increase the availability of minimally invasive surgery through video-assisted surgery and through remote instruction. At present, remote communities, especially those within developed countries, can most immediately benefit from telesurgical approaches. Enthusiasm must be tempered by the issues of cost, security, surgeon liability and availability of the technology itself which have yet to be fully resolved. In this Review, the field of telemedicine, focusing specifically on telementoring and telesurgery, and its relevance to urology are discussed. From early experimental work to current clinical usage, the advantages of and problems in this evolving field are explored.

Key Points

  • Telemedicine has the potential to make a significant impact on urologic surgery and medicine in general

  • International telementoring has already been used successfully for urologic surgery

  • Telemedicine has not been taken up as quickly as predicted, despite initial enthusiasm, because of financial, technical and ethical issues

  • Telesurgery has yet to fully overcome the problems of security, liability and the potential issue of confidentiality

  • The formation of an international committee that would address these issues and coordinate global telemedical activity might aid further progress in this field

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Figure 1: The three subdivisions of telemedicine.
Figure 2: PAKY-RCM robot during a randomized, controlled trial of telerobotics.

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Authors and Affiliations

  1. Specialist Registrar in Urology, Department of Urology, Guy's & St Thomas' NHS Foundation Trust and Guy's, King's and St Thomas' School of Medicine, King's College, London, UK

    Ben Challacombe

  2. Consultant Urological Surgeon and Honorary Senior Lecturer, in the Department of Urology, Guy's & St Thomas' NHS Foundation Trust and Guy's, King's and St Thomas' School of Medicine, King's College, London, UK

    Prokar Dasgupta

  3. Professor of Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA

    Louis Kavoussi

  4. Postdoctoral Fellow, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA

    Alexandru Patriciu

  5. Professor of Urology, at the Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA

    Dan Stoianovici

Authors
  1. Ben Challacombe
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  2. Louis Kavoussi
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  3. Alexandru Patriciu
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  4. Dan Stoianovici
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  5. Prokar Dasgupta
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Corresponding author

Correspondence to Prokar Dasgupta.

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The authors declare no competing financial interests.

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Challacombe, B., Kavoussi, L., Patriciu, A. et al. Technology Insight: telementoring and telesurgery in urology. Nat Rev Urol 3, 611–617 (2006). https://doi.org/10.1038/ncpuro0626

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