Telepresence and micropresence

Telepresence, micropresence, and telerobotics hold promise for allowing expert physicians
to assist clinicians and surgeons at remote locations. Telepresence allows a physician to
have access to a distant location through static or full-perspective views of a patient. Highfidelity
telepresence allows a remote location or scene to be inspected from different
perspectives via a procedure of moving distant cameras in concert with the head and gaze
positions of a local observer. Telerobotics allows the telepresent clinician to interact with a
distant patient. Simple forms of telepresence and telerobotics have already become popular
in pathology diagnosis. In telepathology, a surgical pathologist has instant access to a
microscope and a slide of a patient’s biopsy at a distant site. Telepathology systems that
communicate via satellite and over the telephone lines have been developed. Several
groups, including teams at NASA, and within the SRI International bioengineering group,
have developed interesting demonstration technologies that display the effectiveness of
telerobotics for exploring and manipulating objects at a distance. Some telepresence
projects demonstrate strides in developing force-feedback techniques, which allow a user to
feel the texture, elasticity, or weight of distant objects and structures.

We have been investigating a derivative of telepresence, called micropresence, at the Palo
Alto Laboratory. Micropresence can enable physicians to explore and to perform
procedures on compact, complex regions of a patient’s anatomy, while minimizing the
extent of surgical incisions. Micropresence involves the positioning of one or more small
CCD television cameras and associated camera-control systems in hard-to-reach or
compact areas of a patient’s anatomy. Such cameras have the ability to image and enlarge
complex anatomic regions of interest, as well to identify the exact position of teleoperated
microsurgery tools. Micropresence could allow surgeons to explore small or hidden areas
from different perspectives, and to perform surgical procedures in these areas as if the
regions of interest were expanded greatly, or even made to surround a physician. In
essence, a surgeon would be endowed with the ability to explore complex regions, and
maneuver tele-operated tools as if he or she were reduced in size, and could step into these

We focused, in particular, on technologies that can help physicians make more effective use
of computers that offer assistance with decision making. There is great opportunity for
enhancing future healthcare delivery by integrating medical-informatics software with
evolving human—computer interaction technologies.



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