How would you feel if the surgeon performing an endoscopic procedure on you was naked… and on another continent? Sounds good, right?

Well, that may happen soon, thanks to telepresence surgery.

Drs. Mehran Anvari and Timothy Broderick both gave lectures at SAGES 2008 as part of the “Changing Faces of Robots and MIS” panel, in which they separately discussed the merits of performing operations hundreds of miles away from patients.

Dr. Anvari explained that in Canada, where he practices, many people live in rural areas where surgeons have limited skills in laparoscopy. Using remote-controlled robotic arms, however, he’s able to perform surgeries from his own practice, which not only helps patients but also teaches new skills to the rural surgeons. Dr. Anvari performed his first remote case, a lap Nissen, in February 2003 on a patient 400 km away. As of 2005, his team has performed 22 cases in this manner, which have included Nissens, colon resections, and inguinal hernia repairs.

Dr. Broderick, meanwhile, spoke about the importance of telepresence surgery for combat and deep space exploration. (And read George W. Bush’s lips: we are going to Mars.) He explained that there are some unique issues, however, that arise in these situations. First, when someone is in an unstable environment such as a war zone or an airplane, there is a lot of unexpected movement. To compensate, robots can have an “inertial monitoring unit” that dampens hand movement when you hit a bump. The second issue is that other planets have different gravities. Mars’ gravity, for example, is one-third that of Earth. Thus, if you are working at different gravitational pulls, the robot needs to somehow compensate.

Both physicians mentioned that one of the main drawbacks of remote telepresence surgery is the delay — which, according to Dr. Anvari, is typically about 150 milliseconds — between what the robot does and what the surgeon sees. (Probably it would be a little longer for surgeries on Mars.) Dr. Broderick even said that, when working on a soldier in a war zone, the signals have to be bounced off of SUAVs (small, unmanned air vehicles, in other words, flying drones) because a satellite would introduce unacceptable delays. Dr. Anvari, however, insists that short delays are typically not a problem because the brain can compensate for up to a 300msec delay.

Although I think telepresence surgery is an amazing advancement that will extend higher standards of care to medical centers out in the middle of nowhere, I can’t help but wonder how quickly surgeons could respond if something were to go wrong during a case on the other side of the globe. And even though the whole system is designed to compensate for deficiencies of onsite surgeons, those surgeons still need to be skilled enough to salvage an error, or a robot malfunction.

Fortunately for me, I plan to continue living in a big city (on Earth, Dr. Broderick) where there will always be a surgeon willing to work on me in person.