ATM technology now enables operations to be performed over huge distances. The introduction of robotic and computer technology into surgical operations allows dexterity to be increased1,2,3 and surgical procedures to be carried out from a distance (telesurgery)4. But until now, the distance feasible for remote telesurgery was considered to be limited to a few hundred miles1 by the time lag of existing telecommunication lines. Here we show that robot-assisted remote telesurgery can be safely carried out across transoceanic distances. The ability to perform complex surgical manipulations from remote locations will eliminate geographical constraints and make surgical expertise available throughout the world, improving patient treatment and surgical training.

Transatlantic robot-assisted telesurgery

One of the emerging issues in m-Health is how best to exploit the mobile communications technologies that are now almost globally available. The challenge is to produce a system to transmit a patient's biomedical signals directly to a hospital for monitoring or diagnosis, using an unmodified mobile telephone. The paper focuses on the design of a processor, which samples signals from sensors on the patient. It then transmits digital data over a Bluetooth link to a mobile telephone that uses the General Packet Radio Service. The modular design adopted is intended to provide a "future-proofed" system, whose functionality may be upgraded by modifying the software.

Bluetooth telemedicine Processor for multichannel biomedical signal transmission via mobile cellular networks

Principles of Clinical Medicine for Space Flight

“......Health care is primarily about people-to-people interactions. It is about understanding, diagnosis, physical contact, communication, and, ultimately, providing care. By bringing people together, telecommunication technologies have the potential to improve both the quality of and access to health care in the remotest areas of the developing world. Telemedicine offers solutions for emergency medical assistance, long-distance consultation, administration and logistics, supervision and quality assurance, and education and training for healthcare professionals and providers.

http://idl-bnc.idrc.ca/dspace/bitstream/10625/37334/1/IDL-37334.pdf

Telehealth in the Developing World

We have developed a low-bandwidth, Internet-based telerehabilitation system to provide outpatient rehabilitation to patients who have undergone total knee arthroplasty. The preliminary efficacy of this treatment programme in terms of both physical and functional objective outcome measures was assessed on 21 patients. Subjects receiving a six-week rehabilitation programme were randomized to the telerehabilitation system or the usual face-to-face method. The physical and functional improvements in the telerehabilitation group were similar to those in the control group. There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements. The telerehabilitation programme was well received by patients. The results of this study provide evidence for the efficacy of low-bandwidth telerehabilitation consultations.

Low-bandwidth telerehabilitation for patients who have undergone total knee replacement: preliminary results

Background: Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. Study Design: Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. Results: Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. Conclusions: Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by limiting travel, expanding services to patients, and increased patient quality assurance.

Brett Harnett

Papers

Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.