You know something revolutionary is afoot when terms like Nintendo surgeons and joystick start cropping up in a serious medical journal. Welcome to the world of "telemedicine" -- medicine practiced long-distance with the aid of telephones or computer networks. "Not in the past 100 years has such an upheaval in medicine occurred: The 'discipline of surgery' is joining the technologic revolution," wrote Dr. Richard Satava in an issue of Surgical Endoscopy last year. Satava is program manager of the Advanced Biomedical Technology Program at the government's Advanced Research Project Agency (ARPA). While the telemedicine field is just beginning to develop, insiders envision a day when a specialist could treat a patient hundreds of miles away. But, says David Dlesk, CEO of Medical Media Systems (see below), "questions like, Who's going to pay for it? and, Who's going to profit from it? still remain."

Three start-ups venturing into medicine's brave new world:

Medical Media Systems
Hanover, N.H.

"Just as computer-aided design and computer-aided manufacturing have evolved from science-fiction novelties 20 years ago to standard industry tools today, we see the same type of opportunity opening up in surgery," says David Dlesk, CEO of Medical Media Systems (MMS). Founded last September, MMS develops software and hardware tools that give surgeons a better view inside the body. Its target market: the fast-growing field of minimally invasive surgery, in which surgeons slip surgical instruments equipped with tiny video cameras into small incisions instead of making large cuts in the body. MMS integrates radiological data such as CAT scans and X rays with mathematical models to create a 3-D image of a specific patient's anatomy. "The 3-D image is then fused with the live video coming from the scope and serves as a road map to enable surgeons to quickly find areas of concern," says Dlesk. The company projects it will have fifth-year revenues between $30 million and $40 million.

Biocontrol Systems
Palo Alto, Calif.

When asked to describe his company, cofounder Anthony Lloyd uses a familiar Star Trek analogy. "We can't beam you up, but we can beam up your nervous system," he boasts. Privately funded with nearly $1 million, BioControl Systems is developing technology to computerize the signals of the human nervous system. Its primary product is a $19,800 bioelectric signal controller called the BioMuse, which Lloyd says uses electric activity in the body (such as eye motion or muscle movements) to control and operate computers. By wearing a special headband, armband, or legband that captures electrical signals, a user can manipulate objects on a screen with an eye-controlled mouse or create digital-synthesizer music by flexing a muscle. One potential future medical application: mapping the movement of a surgeon's forearms onto remote computer-controlled instruments.

Woburn, Mass.

"Ultimately, one can envision a doctor putting his or her son to bed and then plugging a surgical device into the Nintendo game to practice for tomorrow's surgery." Dr. Beth Marcus is not hallucinating; she is the founder of a start-up that specializes in bringing a sense of touch to virtual reality for the medical and entertainment markets. Exos recently completed for ARPA a prototype of a surgical simulator, which enables doctors to experience the hand motions and sensations of operating on a patient. "If you put a drape over it, you'd never know the difference," quips Marcus, who sees her simulator as an invaluable training tool for physicians. Exos, which posted revenues of $1.5 million in 1993, plans to start selling the $8,500 prototypes of the surgical simulator this month. -- Alessandra Bianchi

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