Long-distance doctors: Surgeon sees Internet as next frontier

ST. LOUIS -- A St. Louis University professor envisions a network where a doctor can be called to take part in surgery over the Internet, use a laptop to position a microscope for a better view and even direct instruments remotely -- all at a location far from an operating room.

Dr. Richard Bucholz, a neurosurgeon who has already created a surgical navigational system used in precision operations, has set his sights on helping to build a better, smarter operating room.

He received patent approval two months ago related to his plans, hopes to announce his business partners within a few weeks and wants to have a clinical prototype within six to nine months of SurgON, his surgical operating network.

Surgeons and engineers working for medical innovations said it's not clear what form the operating room of the future will take or where the technologies Bucholz and others are developing will fit. But, they said, the notions aren't as far-fetched as they might seem.

"The basic principles he's expounding are completely inevitable," said Dr. Richard Satava, a University of Washington surgeon and a project manager for the Pentagon's Defense Advanced Research Projects Agency.

Satava said a Canadian doctor has performed robotic surgery hundreds of kilometers from where the surgeon, Dr. Mehran Anvari, manned computer controls. Dr. Michael Treat in New York is conducting trials of a "robotic scrub nurse" that can respond to voice commands for certain surgical instruments.

The network Bucholz is working on ideally would allow an operating room surgeon to contact a remote consultant over the Internet. If the surgeon wants to show the consultant some images or video -- say an ultrasound, to get the consultant's opinion -- the operating room doctor could forward it to the consultant using a computer.

With the operating room doctor's approval, the consultant could also be given remote access to equipment used in the surgery, to redirect the gaze of a device, or even to take part in procedures.

"Basically, what we've come up with is a way to network all the devices in the operating room so that we can have local control of all of those devices while at the same time selectively sharing that remote control with a consultant," Bucholz said.

"The very real possibility exists then that I could just be at the St. Louis Bread Company, hooked up wi-fi and have my laptop, and be able if I get a call to take over that procedure," he said.

Bucholz said the plan he is advancing has built-in firewalls, a type of security system for computer systems that would protect patients.

He said there needs to be more standardization in operating rooms, with equipment designed so it can better communicate electronically with other equipment, and said his network proposes ways to better link technologies.

And insurance issues haven't been resolved. Bucholz said that if consultants usually charge for services, they need to be licensed and have insurance in the state where the procedure is performed.

"My thoughts would be that in the early implementation of this, the consultants would not charge," Bucholz said. "The industry, to get the techniques disseminated, would pay for the consultant."

But he saw plenty of benefits to the network, as well. For one, a world-renowned surgeon might be able to virtually look over the shoulder of another doctor during the crucial phase of an operation.

And, he said, patients could heal closer to home.

"There are issues where patients do not necessarily want to travel far way to get these procedures done, and yet at the same time, they would like to have the expertise applied to their particular case," Bucholz said.