On September 7, 2001, a 68-year-old woman in Strasbourg, France, had her gall bladder removed by-surgeons operating, via computer from New York. It was the first complete telesurgery procedure performed by surgeons nearly 4 000 miles away from their patient.

In New York, Marescaux teamed up with surgeon Michel Gagner to perform the historic long-distance operation. A high-speed fiber-optic service provided by France Telecom made the connection between New York and Strasbourg. The two surgeons controlled the instruments using an advanced robotic surgical system, designed by Computer Motion Inc. that enabled the procedure to be minimally invasive. The patient was released from the hospital after about 48 hours and regained normal activity the following week.

The high-speed fiber-optic connection between New York and France made it possible to overcome a key obstacle to telesurgery time delay. It was crucial that a continuous time delay of less than 200 milliseconds be maintained throughout the operation, between the surgeon's movements in New York and the return video (from Strasbourg) on his screen. The delay problem includes video coding decoding and signal transmission time.

France Telecom's engineers achieved an average time delay of 150 milliseconds. "I felt as comfortable operating on my patient as if I had been in the room," says Marescaux.

The successful collaboration(among medicine, advanced technology, and telecommunications is likely to have enormous implications for patient care and doctor training. Highly skilled surgeons may soon regularly perform especially difficult operations through long-distance procedures. The computer systems used to control surgical movement can also lead to a breakthrough in teaching surgical techniques to a new generation of physicians. More surgeons-in-training will have the opportunity to observe their teachers in action in telesurgery operating rooms around the world.

Marescaux describes the success of the remotely performed surgical procedure as the beginning of a "third revolution" in surgery within the last decade. The first was the arrival of minimally invasive surgery, enabling procedures to be performed with guidance by a camera, meaning that the abdomen and thorax do not have to be opened. The second was the introduction of computer-assisted surgery, where complicated software algorithms enhance the safety of the surgeon's movements during a procedure, making them more accurate, while introducing the concept of distance between the surgeon and the patient. It was thus natural to imagine that this distance, currently several meters in the operating room, could potentially be up to several thousand kilometers.