Remote Telesurgical Mentoring: Feasibility and Efficacy.

We report our experience in performing telesurgically-mentored procedures from Baltimore, MD to Thailand, Austria, Italy and Singapore. We additionally report on a case of remote robotic manipulation using a robot designed for Percutaneous Access of the Kidney (PAKY). Telementoring was performed using a video teleconferencing platform including audio, video, real-time video telestration and remote control of the AESOP robotic arm that manipulates the laparoscopic camera. The international telementoring was achieved over 3- ISDN lines (384 Kilobytes/sec). The robotic arm and PAKY robot were controlled over a separate analog POTS line. Telecommunications links were successfully established to these remote locations that ranged in distance from approximately 4,500-11,000 miles. There was no perceptible impact of time delay on the surgical procedures. All procedures were successfully completed without additional complications. Multiple laparoscopic surgeries to include varicocelectomy (4), nephrectomy (4), adrenalectomy (1) and cholecystectomies (2) were demonstrated. Remote robotic percutaneous access to the kidney was successfully conducted within fifteen minutes from Baltimore, Maryland to Rome, Italy.