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Remote Surgical Education in Asia-Pacific<br />
over Research and Education Network<br />
Chairman of Medical WG, APAN,<br />
Telemedicine Development<br />
Center of Asia,<br />
Dept of Surgery 1,<br />
Kyushu University Hospital,<br />
Fukuoka, Japan<br />
Shuji Shimizu, MD, PhD<br />
http://www.apan.net/wg/medical.html<br />
http://www.aqua.med.kyushu-u.ac.jp<br />
shimizu@med.kyushu-u.ac.jp<br />
2009.6.8@ <strong>TNC2009</strong>, Malaga, Spain
Today’s menu<br />
Medical situation<br />
•<br />
Activities<br />
•<br />
‣ Korea-Japan<br />
‣ Worldwide<br />
• Directions to go<br />
‣ Further expansion<br />
‣ Technological development
Gallstones<br />
Black<br />
stones<br />
Cholesterol stones<br />
Mixed<br />
stones<br />
Bilirubin stones
Key hole operation: New surgery<br />
Open<br />
Endoscopic
Remote Education: Convenient and Useful!<br />
Saving time, travel fee, and for continuous exposure<br />
But, NOT popular in surgery yet<br />
Why not<br />
1) Poor-quality images, due to compression<br />
2) Cost for special video-conferencing system<br />
3) Doctors are not familiar with technology, or<br />
do not know engineers to help them.
Situations changed in 2002: K-J Project<br />
Hanyang U<br />
Korea Advanced Research<br />
Network (KOREN)<br />
•Education<br />
•Culture<br />
•Business<br />
•Medicine<br />
Korea-Japan Cable<br />
Network (KJCN)<br />
QGPOP<br />
Kyushu Univ<br />
Bandwidth 2G<br />
Big Broadband Network
Actual Point 1: bandwidth Big Broadband in each Network network<br />
30<br />
25<br />
20<br />
15<br />
10<br />
Mbps<br />
Image quality<br />
is the key!<br />
• Still pictures<br />
• Compressed, degraded<br />
30<br />
• Original quality<br />
• Minimal delay<br />
D: Digital<br />
V: Video<br />
T: Transport<br />
S: System<br />
5<br />
0<br />
0.4<br />
ISDN<br />
DVTS<br />
Digital Video<br />
Internet
Point 2: Cheap & simple equipment<br />
Surgical instrument<br />
DV Camcoder<br />
DVTS PC<br />
Internet<br />
IEEE1394<br />
UTP(Ethernet)<br />
>30Mbps<br />
Microphone<br />
Audio<br />
• DVTS: free but powerful software<br />
• No special teleconferencing equipments<br />
BROADBAND network is essential!
Today’s menu<br />
Medical situation<br />
•<br />
Activities<br />
•<br />
‣ Korea-Japan<br />
‣ Worldwide<br />
• Directions to go<br />
‣ Further expansion<br />
‣ Technological development
[1] Endoscopic Surgery: casual setting<br />
OR<br />
Surgical movie<br />
Aug 1, 2003<br />
• Lap. distal gastrectomy<br />
• Security software used<br />
Kyushu Univ., Japan<br />
NCC, Korea
[2] Live surgery in a big congress<br />
2006.4.13<br />
From Korea to Japan
[3] Telementoring for neurosurgery<br />
2003.11.25<br />
Hanyang U Kyushu U
[4] Live Surgery for Medical Students<br />
2008.5<br />
Bundang H<br />
Kyushu U
[5] Interventional Cardiology<br />
2008.6
Today’s menu<br />
Medical situation<br />
•<br />
Activities<br />
•<br />
‣ Korea-Japan<br />
‣ Worldwide<br />
• Directions to go<br />
‣ Further expansion<br />
‣ Technological development
[6] The First Multi-station Demo<br />
with<br />
2006.1.25<br />
security<br />
APAN-Tokyo<br />
2005. 1<br />
• Kyushu<br />
• Tokyo<br />
• Seoul<br />
• Taipei
[7] Perfect connection to India for live surgery<br />
Seoul, KR<br />
Mumbai, IN 2008.4.28<br />
Fukuoka, JP<br />
Tata Memorial Hosp.<br />
In Mumbai, India
[8] Live demonstration around Pacific rim<br />
Beijing<br />
Seoul<br />
Fukuoka<br />
Hawaii U<br />
UC Irvine, CA<br />
Recent<br />
Video<br />
Robotic surgery and GI<br />
endoscopy for gastric cancer<br />
Sydney<br />
Jan 24, 2008
2007.12<br />
[9] Connection<br />
to Europe<br />
Germany<br />
France<br />
Belgium<br />
Czech<br />
Italy<br />
Spain
20 countries<br />
Beijing<br />
Shanghai<br />
Sapporo<br />
Tokyo<br />
94 institutions 2005.6<br />
Fukuoka Yokohama 2005.11<br />
16/KR<br />
Hong<br />
California 5/CN<br />
2006.7<br />
Taipei<br />
Kong 2004.12<br />
5/TW 2007.1<br />
2007.1 Hanoi<br />
Taichung 4/TH Hawaii<br />
Bangkok HaLong 2005.11<br />
2004.1<br />
1/SG<br />
2005.1 2006.6<br />
2007.1<br />
Manila<br />
4/VN<br />
Philippine U<br />
Kuala Lumper<br />
Ho Chi Min<br />
Cho Rai Hosp 2007.3<br />
Cairnes 1/MY<br />
2007.1<br />
2004.7<br />
New Dehli<br />
SirGanga Ram Hospital<br />
Mumbai<br />
Tata MH<br />
Before 2005<br />
2006 - 2007<br />
After 2008<br />
Singapore<br />
2005.11<br />
2004.10<br />
NUS<br />
EU<br />
Bandung<br />
ITB<br />
2003.2<br />
2006.7<br />
Jakarta, UI<br />
Seoul<br />
Jilin<br />
Adelaide<br />
Flinder’s Hosp<br />
2005.11<br />
Canberra<br />
ANU<br />
2007.3<br />
Melbourne<br />
Sydney<br />
2004.7<br />
Iwate 2005.7<br />
2004.1<br />
25/JP<br />
Stanford, UC Irvine<br />
2/PH<br />
9/AU<br />
6/US<br />
Auckland<br />
Brisbane<br />
10/EU<br />
Brazil
Today’s menu<br />
Medical situation<br />
•<br />
Activities<br />
•<br />
‣ Korea-Japan<br />
‣ Worldwide<br />
• Directions to go<br />
‣ Further expansion<br />
‣ Technological development
World Gastroenterology Organization:<br />
- Endoscopic training centers -
Connection to Training Centers in Africa<br />
• Cairo,<br />
Egypt<br />
• Soweto,<br />
South Africa
Live surgery at European Meetings (1)<br />
In Switzerland<br />
in 2010<br />
Connection to<br />
the venue
Live surgery at European Meetings (2)<br />
In Norway<br />
in 2010
The first live surgery in Egypt<br />
http://www.iasgo-2010.org<br />
We need<br />
your help!<br />
IASGO2010 Secretariat Conference Organizing Bureau<br />
14 El Khalil St., of Lebanon Sq., El Mohandissen, Giza, Egypt
Today’s menu<br />
Medical situation<br />
•<br />
Activities<br />
•<br />
‣ Korea-Japan<br />
‣ Worldwide<br />
• Directions to go<br />
‣ Further expansion<br />
‣ Technological development
Problems and future directions<br />
• Multi-connection system: Quatre
Increasing demands for multi-connection<br />
0% 20% 40% 60% 80% 100%<br />
2003<br />
7<br />
2<br />
2004<br />
18<br />
2<br />
2<br />
3<br />
2005<br />
2006<br />
16<br />
16<br />
6<br />
3<br />
7<br />
4<br />
1<br />
4<br />
2007<br />
15<br />
5<br />
11<br />
3<br />
5<<br />
More and more hospitals want to join.
• Only equipment available for<br />
DVTS multi-point connection<br />
• Very powerful and useful<br />
• Support NTSC, but not PAL<br />
• Available only in Japan<br />
New technologies are essential and heavily awaited.
Live endoscopy with Communication XP<br />
•University of Puerto Rico<br />
•National Inst Health<br />
•Johns Hopkins Hospital<br />
•U Michigan School of Med<br />
•Rochester Inst Technology<br />
2008.9.18<br />
Internet2<br />
30Mbps<br />
Mid-field
Problems to be considered<br />
• Multi-connection system: Quatre<br />
• Network to hospitals; last one mile
Further requests for participation<br />
• Japan: Hiroshima U, Kobe U, Cancer Institute, Hokkaido U, TSF<br />
• Korea: Catholic U, Busan U, Taegu,<br />
• China: Ruijing H, CTEC, Beijing International Conference Center,<br />
• Thailand: PMK, Rajvithi H, Chiang Mai U, Khonkaen U, Songkhla U<br />
• Vietnam: Vietduc U, National Convention Center (Hanoi)<br />
• US: Duke U, MUSC, Columbia U, Toronto U<br />
• Brazil: U of San Paulo, Albert Einstein Hospital<br />
Network conditions<br />
are different.<br />
• Spain: Hospital Royo Villanova, Hospital de Fuenlabrada, Univ of Madrid<br />
• Italy: U of Naples, Tor Vergata University Hospital, U of Milan,<br />
• Greece: U of Athens, Athens Medical Center, Aristotle U of Thessaloniki<br />
• Others:Norway, Germany, Delhi, Egypt, S Africa, Pakistan, Bangladesh…<br />
About 100 hospitals are on the waiting list in the world.
Problems to be considered<br />
• Multi-connection system: Quatre<br />
• Network to hospitals; last one mile<br />
• Transmission of HD quality
High Definition: Uncompressed HD<br />
=>Still experimental!<br />
2007.3.23<br />
1.6G<br />
Surgery/HD<br />
Operating room/<br />
DVTS<br />
Chairman
HD transmission by JPG2000<br />
Tokyo<br />
Seattle<br />
Science<br />
Foundation<br />
Neurosurgery<br />
@APAN-NZ<br />
Venue at Queenstown
Problems to be considered<br />
• Multi-connection system: Quatre<br />
• Network to hospitals; last one mile<br />
• Transmission of HD quality<br />
• Sound quality<br />
• Security, annotation, etc.<br />
• Time difference
Conclusions<br />
1. Quality is the key in telemedicine.<br />
2. REN made the transmission of clear movies<br />
possible, which is very helpful in medicine.<br />
3. Currently, DVTS is the best solution, both<br />
in quality and cost.<br />
4. High-definition quality, which is cheap and<br />
powerful, should replace DVTS soon.<br />
5. Further technical breakthroughs are awaited.
Surgical<br />
Teleconference<br />
with DVTS<br />
St Olavs Hospital,<br />
Trondheim, NO<br />
2009.6.10 (W)<br />
13:30-14:15<br />
State-ofthe-art<br />
hospitals<br />
<strong>TNC2009</strong><br />
Malaga, ES<br />
Hospital Clinica<br />
Barcelona, ES<br />
Monaldi Hospital,<br />
Naples, IT
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