ELEMEDICINE IN SURGER

GUIDES PROF. Q. M RAHAMAN

ASST. PROF. S.S
ROYCHOWDHURY
PRESENTED BY DR. IPSEET MISHRA

WHAT IS TELEMEDICINE?
The delivery of healthcare services, where distance is a critical factor,
by all healthcare professionals using information and communication
technologies for the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries, research and
evaluation, and for the continuing education of healthcare providers,
all in the interests of advancing the health of individuals and their
communities

FOUR INHERENT ELEMENTS OF TELEMEDICINE

:
1. Provide clinical support
2. Overcome geographical barriers and connecting users who are
not in same physical location
3. Involves use of various type of Information and Communication
technology
4. Improve health outcomes

TYPES OF TELECOMMUNICATIONS APPLICATIONS :

1. ASYNCHRONOUS ( Store and Forward technique): exchange of prerecorded data between individuals at different times
2. SYNCHRONOUS ( Real-time): simultaneous presence of involved
individuals for immediate exchange of information

ROLE OF TELEMEDICINE IN SURGERY:

1.
2.
3.
4.
5.

Telesurgery
Telementoring
Telestration
Tele-education Conference/ CME / Workshops
Tele- health care Tele-consultation /Tele follow-up/ Pre-referral screening

TELESURGERY
- Remote surgery performed by a surgeon at a site distant from the patient

- Used synonymously with ROBOTIC SURGERY where the surgeon is at the Da Vinci
console.

TELEMENTORING
- Educational technique of mentoring through telecommunication
- For remotely placed surgeons for expert advice of centrally placed experienced
surgeons in complicated surgeries / new surgical techniques intra-operatively
- In diagnosis, pre-operative planning and post-operative care for a mentors
expert inputs.

TELESTRATION
- Illustrative technique that allows expert surgeon to use a drawing tablet to use
marks on the local surgeons video monitor

TELE-EDUCATION
- Real-time video conferencing and Interactive video sessions
- Live transmission of CMEs, symposia, workshops or seminars

TELE HEALTHCARE
- Involves pre-operative screening and consultation by exchanging patients
clinical records, diagnostic reports and radiological images followed by video
conferencing
- Important for patient care for those who live at remote places and are not
able to come physically.
- Same principle applies for Tele-follow-up for remotely placed post-operative patients.

BENEFITS OF TELEMEDICINE IN SURGERY

The first telesurgery system was developed by Green et al in 1992 at Stanford
Research institute, California, USA that was Improved as Da Vinci telesurgery system.
The first successful telerobotic surgery was laparoscopic cholecystectomy performed
over a patient in Strasbourg, France by a surgeon sitting at New york using Zeus robotic
surgery.
Davies was first to show application of robotic surgery for TRUS at Imperial College of
London in 2001. Later many robotic systems like PACKY, AESOP, EndoAssist, Da vinci
and Zeus systems were developed for urological surgeries.
In Thoracic surgeries, robotics assistance has been useful in VATS and Brachytherapy
catheter placement for lung cancer.

 Surgical gastroenterology has telemedicine applications in robotic assisted Heller

myotomy, anti-reflux surgery , image transmission system in split liver transplantation
and colonic surgeries ( Sebajang et al, 2006 and Schlachta et al , 2010).
Telementoring has been successfully tried in various endocrine surgeries like
thyroidectomy ( Rafique et al, 2004) and adrenalectomy ( Ushyama et al , 2003 and
Bruschi et al ).
Di Valentino telementored endovascular repair of abdominal aortic aneurysms in
vascular surgery.
Telementoring was assessed by Mendez et al in Neurosurgical procedures like
Craniotomy for brain tumors and AVMs, Carotid endarterectomy and Lumbar
laminectomy.

BARRIERS IN TELEMEDICINE TECHNOLOGY ADOPTION SYSTEMS:

1. Resistance in adopting services that differ from traditional or indigenous approaches.
2. Linguistic and cultural differences between patients and service providers.
3. Lack of uniform international legal framework to allow health professionals to deliver
services in different jurisdictions.
4. Technological barriers with potential of malfunction and software or hardware failure.
5. Underutilization in undeveloped countries due to high cost of robotic unit or high
speed internet.

THRUST AREAS OF ISRO IN TELEMEDICINE PROJECT

IN INDIA
Remote/Rural Hospitals and Specialty Hospitals
Continuing Medical Education (CME)
Mobile Telemedicine Units
Disaster Management Support (DMS)
Integrating with Village Resource Centres (VRC) / information
kiosks for multiple services

ACHIEVEMENTS OF ISRO IN TELEMEDICINE IN INDIA :

Telemedicine was made by ISRO in the form of a Telemedicine Pilot Project in 2001,
linking Apollo Hospital at Chennai with the Apollo Rural Hospital at Aragonda village in
the Chittor district of Andhra Pradesh.
Later in March 2002,the Karnataka Telemedicine project linked the Narayana
Hrudayalaya, a super specialty hospital for cardiac care at Bangalore with the district
hospital,Chamarajanagar and the Vivekananda Memorial Trust Hospital at Saragur in
south Karnataka.
Many Remote areas like Kargil and Leh in the North, offshore islands of Andaman and
Nicobar and Lakshwadeep, as well as some of the interior parts of Orissa, Karnataka,
Kerala, Chattisgarh, J&K, North-eastern states of India and some tribal districts in
certain other states have access to specialty healthcare from some of the major
specialty hospitals in the country today.

ACHIEVEMENTS OF ISRO IN TELEMEDICINE IN INDIA :

The ISROs Telemedicine facilities at three Hospitals GB Pant Hospital, INHS
Dhanvantari at Port Blair, Andaman Island and Bishop Richardson Hospital at Car
Nicobar along with ISRO Gramasat Network at 8 Islands was effectively used during
post Tsunami disaster relief work for the benefit of the remote population of Andaman
and Nicobar Islands.
Presently, ISROs Telemedicine Network stretches to around 100 Hospitals all over the
country with 78 Remote/Rural/District Hospitals/Health Centers connected to 22
Specialty Hospitals located in the major cities.
Encouraged by the steady growth of its Telemedicine programme, ISRO has also
envisioned the development of HEALTHSAT, an exclusive satellite for meeting the
healthcare and medical education needs of the country at large.

OTHER SUCCESSFUL TELEMEDICINE PROJECTS IN INDIA :

At SGPGIMS, Lucknow, an experienced surgeon telementored a performing surgeon at
Kochi in a reoperative parathyroid surgery for primary hyperparathyroidism.
Pradeep et al trained remote surgeons via 70 telemedicine sessions between 2001 and
2005
with surgical treatment planning, tele-consultation and tele-conferences.
Mishra et al conducted a pilot study in India on post-operative care through tele-follow
up for patients undergoing thyroidectomy and parathyroidectomy using questionnaire
method.

THANK YOU