Robotica (1995) volume 13, pp 397-400. © 1995 Cambridge University Press Telerobotic surgery project for laparoscopy Alberto Rovetta, Remo Sala, Xia Wen, Francesca Cosmi, Arianna Togno and Santo Milanesi Telerobotics Laboratory, Department of Mechanical Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan (Italy) (Received in Final Form: August 1,1994) SUMMARY This paper deals with the first transatlantic experiment of robotic telesurgery. A robot in Milan (Italy) performed an operation on a model of a pig, and the surgeon controller was in JPL, Pasadena (USA). By means of two communication satellites and of an optical fibre network, the robot performed a biopsy and a preliminary cut for a laparoscopic mini-invasive surgery operation. KEYWORDS: Telesurgery; Laparoscopy; Robot; Pig. 1. DESCRIPTION OF THE EXPERIMENT The system consists of three parts: a "master" part, in Los Angeles, where a surgeon works on images coming from Milano, Italy, and may send signals for the robot control by means of satellites and optical fibre networks; a "slave" part, in Milan, where the robot performs the surgery operation on the model of the pig (the liver was real, the body was a model) under remote control; a "telecommunication system" with satellites and optical fibre networks, working at 2Mbits (Figure 1 and Figure 2). When the message from the Telerobotics Laboratory of the Politecnico di Milano is declared "green", then transmission of the signal from Los Angeles is authorised, making two journeys over the USA and the Atlantic Ocean to reach the computers in Milan. The signal route from the Jet Propulsion Laboratory in Pasadena follows the NASA-reserved Transponder 13 channel to the first satellite, Satcom F2, geostationary at a height of 40,000 km above the USA. In Pasadena the operation of the link is controlled and directed by Antal Bejczy, Director of the Robotics Division. The signal goes down close to Washington, is amplified and then sent across the Atlantic to the Intelstat satellite, in geostationary orbit 40,000 km above the Atlantic Ocean. The satellite retransmits the signal down to the Fucino station in Italy, where it is sent on to the Telerobotics Laboratory in Milan. The signal permits the operation to be performed on the model of a pig set up beneath the robot. 1 " 3 The surgery is performed by the robot. The end effector of the robot is provided with a surgical instrument, which it grips firmly. The robot approaches the model of the pig, touches it, makes the incision with the scalpel, cuts precisely for the preset length, raises the scalpel and moves back after the intervention. There is one basic difference compared to the normal operating theatre for a robotic operation: the chief surgeon is not in Milan beside the model of a pig but 14,000 km away in the NASA Jet Propulsion Laboratory in Los Angeles. This first experiment in telerobotic surgery was carried out on 7 July 1993, at 20.34 hours Milan time (11.34 a.m. Los Angeles time). The surgical acts were controlled from the Teleconference Room in the JPL by Professor Licinio Angelini, chief surgeon at the Policlinico Umberto I, Roma. The teleconference room is well known as the venue for the presentation of the latest space explorations. By examining the images of the model of the pig sent from the Telerobotics Laboratory in Milan which are displayed on a wide screen, the surgeon in Los Angeles checked the echograph of the pig's liver, decided the point of penetration and the depth of penetration of the biopsy needle and sent the commands to the robot. The second surgeon in Milan inserted the trocar and then the optical fibre camera into the abdomen of the model of a pig. At this point, the liver of the pig was seen in all its striking colours, in both Milan and Los Angeles (Figure 3). The robot now came into action again to insert the surgical instrument. It brought the scalpel to a position a few centimetres away from the first incision and descended, controlled by the surgeon. In Milan, the robot moved obediently and with precision, with a delay of about" 1.1 seconds between the decision of the surgeon in Los Angeles and the start of the movement. 4 " 6 The biopsy needle descended and perforated the artificial silicon skin which covers the real pig's liver. Guided by the ecograph, it penetrated the liver under the control of a surgeon. 2. SURGICAL ASPECTS During the experiment, an echograph was used to examine the pig's liver and a high resolution monitor was used to display the images taken by the microcamera inserted in the abdomen for the laparoscopy. While the biopsy was being concluded, the condition of the robot and the biopsy needle were checked. The penetration force signal appears on the monitor and was checked by the operators, which is helpful for operation quality and for emergency control. 7 " 10 When the needle emerged, the material was aspirated under the guidance of the surgeons. After the conclusion of the biopsy the surgeon on the