Telesurgical presence and consultation for open surgery.

When telemedicine emerged in the late 1950s, the innovative and sophisticated technology used at the time was quite expensive. Historically, the use of telemedicine applications was limited to institutions that either had funding through government-sponsored grants or could afford the cost of the technologic tools. This hindered the broad use and expansion of telemedicine. Today, the use of this technologic method is still cost-dependent; however, the advent of the Internet as well as a broader expansion of telecommunication to remote areas make the concept of globalization more feasible. In recent years, several groups have experimented with less expensive telecommunication resources that are capable of handling less bandwidth, while nonetheless establishing safe and effective telemedicine applications. Access to specialized medical attention by those in remote areas has traditionally limited adequate patient care. The feasibility and effectiveness of mobile health care delivery to remote areas has been demonstrated. However, the sense of remoteness and isolation in certain medical scenarios could limit the potential of this service. Laparoscopic tools make it possible to share the surgical visual field with the rest of the surgical team, with the benefit of superior optics. Endoscopic visualization techniques recently applied to open surgery facilitate surgical performance and add a new tool to the armamentarium of today’s surgeon. Transmission of such visualization techniques, especially with current compression software, may be severely limited by motion artifacts resulting from both intentional and inadvertent human manipulation. While small movements within the visual field may have no adverse effects, moving the entire field causes severe pixelation of the transmitted images. Stabilization of the camera to eliminate motion artifacts allows compression of laparoscopic images with the H.323 protocol for Internet transmission, with