Telemedicine in surgery

Background: Telemedicine is influencing surgical training, allows mentoring, proctoring and teleconferencing, and is increasingly being applied to carry out remote surgical procedures. A systematic review of the telemedicine systems available, along with a critical appraisal of their application, potential and limitations in the surgical field, has been undertaken. Method: Medline, Ovid and internet searches were carried out using the keywords 'telesurgery', 'telepresence surgery' and 'telemedicine and surgery', along with hand searches of the two peer-reviewed telesurgery journals. Results: Telementoring and teleconferencing have been used widely for surgical teaching and training. Two clinical telesurgery systems are currently available and have been trialled in patients undergoing a variety of operations including cholecystectomy, coronary artery bypass, prostatectomy and gastroplasty. Most studies have reported successful outcomes but with prolonged operating times. In 2002 the first long-distance telesurgery procedure was successfully performed. Conclusion: Telemedicine has huge potential to alter surgical practice but improvements are required in telesurgical technology with respect to tactile feedback, instrumentation, telecommunication speed and availability. Issues of liability, legislation, cost and benefit require clarification. The future of telemedicine in surgery may lie in facilitating complex minimally invasive techniques.