Telematics and telemanipulation in surgery

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Abstract
Telematics applications are of big interest for research in various fields of medicine. In diagnosis, teleconsulting techniques for the remote interpretation of radiologic or histologic images is already clinical practice in several centres. In therapeutic areas, such as all surgical disciplines, telemedicine also has relevance, but is not yet as widespread as on the diagnostic side. Three levels of telematic applications in surgery can be distinguished: teleconsulting, teleassistance and telemanipulation. Whereas the first is solely based on intra-operative video-conferencing and bilateral audio-visual communications, the two other levels include remote guidance of an endoscope or even surgical instruments, by a remote expert. In surgery most telematic applications are still experimental and further technical progress is required. We estimate that teleconsulting techniques will enter the clinical routine of centres relatively soon, whereas teleassistance and telemanipulation technologies will not result in clinical breakthroughs within the next few years.

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