The authors' institute has established that precise surgical procedures can be carried out with Telepresence. Within this decade, Telepresence surgery may become an established component of a new, technologically enhanced mode of cost-effective health care delivery. Because of the substantial medical and financial benefit that Telepresence will bring to laparoscopic and other minimally invasive procedures, its first routine use is expected to be within the individual hospital and surgical center. Telepresence surgical procedures have been demonstrated over distances of 160 meters, and the authors are working toward demonstrating animal surgeries over a much greater distance by using microwave and fiber-optic links. Mobile Telepresence surgical equipment may prove especially effective for trauma care in combat and in civilian disasters. Because the stereographic images and the motions and forces can be readily scaled, microsurgeries of all kinds can be made easier with this technology. Arthroscopic procedures, especially difficult surgery on joints such as the wrist and shoulder, are good Telepresence candidates. In neurosurgery, excision of pituitary adenomas could benefit from the increased dexterity and tactile sensitivity of Telepresence. Eventually, neurosurgery under real-time magnetic resonance imaging could be performed by a Telepresence surgeon operating on a three dimensional reconstruction that is immediately updated to show the actual tissue changes caused by the telemanipulated instruments. >
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