The world's first obesity surgery performed by a surgeon at a distance

Background: In recent years, laparoscopic procedures have gained popularity . The laparoscopic technique is, however, more difficult than the conventio nal approach, especially in obese patients. The purpose of this article is to demonstrate a solution to these difficulties. Method: On September 16, 1998, a laparoscopic gastric banding procedure was performed by a surgeon while he was actually sitting at a distance from hi s patient. The surgeon's assistant was scrubbed and gowned and stood at the patient's side. The surgeon manipulated handles that were connected to a c omputer in command of robotic arms mounted on the operating table near the patient. The robotic arms contained surgical tools with articulated tips, w ell inside the abdominal cavity. The system constituted a master-slave cons truction called Mona (Intuitive Surgical, Mountain View, CA). The entire pr ocedure (adjustable silicone gastric banding) was performed solely by this system without any other intervention. Results: The entire procedure lasted 90 minutes. The blood loss was 25 mL. The patient left the hospital on the second postoperative day. Conclusion: This procedure demonstrates that tele-surgical procedures are f easible, can be performed safely even in obese patients, and improve the su rgeon's comfort by restoring ergonomically acceptable conditions, by increa sing the number of degrees of freedom, and by recreating the eye-hand conne ction lost in videoendoscopic procedures.