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Purpose To assess the quality of sound and uncompressed images during an international broadcast of live surgery using the newly developed digital video transport system (DVTS).Methods Three networks connected hospitals in Seoul, Korea, and Fukuoka, Japan. A teleconference system with bidirectional transmission over the network was set up. DVTS was used to send and receive visual and audio signals during a live broadcast of a laparoscopic partial nephrectomy to viewers at the 94th annual meeting of the Japanese Urological Association. A questionnaire was used to assess the quality of images and sound.Results Of 713 questionnnaires distributed, 418 were collected. The quality of image and voice was ranked very good or good by 95 and 92 of the audience, respectively. The quality of live surgery was considered high by 94 of the audience.Conclusion Digital video images can be transformed directly to an Internet protocol without compression of the motion images using DVTS. Live surgery via teleconference using DVTS can help surgeons learn the skills of endoscopic surgery. [ABSTRACT FROM AUTHOR]