Use of a low-cost telementoring solution for the introduction of a new surgical procedure; Preliminary results.

Etai M. Bogen, MD1, Petter F. Gjessin, MD, PhD1, Nicholas E. Bruns, MD2, Line L. Warth, PhD3, Hiten R.H. Patel, MD, PhD4, Rolv-Ole Lindsetmo, MD, PhD, MPH1, Todd A. Ponsky2. 1Department of Digestive Surgery, University Hospital of Northern Norway, Tromso, Norway, 2Department of Pediatric Surgery, Akron Children’s Hospital Akron, Ohio, USA, 3Norwegian Center for Telemedicine and Integrated Care, Tromso, Norway, 4Department of Urology, University Hospital of Northern Norway, Norway

Objective of the technology or device:

Learning and mastering a new surgical technique, especially in minimally invasive surgery, is challenging due to a complex learning curve. Telementoring is an emerging field that might improve the quality and efficiency of surgical education. Most existing surgical telementoring solutions are costly and technologically demanding to setup. Our novel telementoring technology provides a platform for delivering surgical education and training in a low-cost and safe manner. We aimed to study the feasibility and educational potential of this technology as part of the introduction of a new surgical procedure.

Description of the technology and method of its use or application:

The current telementoring technology/software is based on an HIPAA compliant in-house system developed and tested in over 25 previous cases. Video and audio data are transmitted over Internet (Wi-Fi) or mobile (4G/LTE/3G) lines. The software and hardware solution captures the laparoscopic image directly from the laparoscopic camera. Real–time image manipulations (telestration) can be performed by the mentor on the touch screen of a tablet to facilitate guidance of the trainee. Freehand drawing over a live video stream enables the mentor to visually and accurately define anatomical locations and planes of dissection. In addition, an external camera allows the mentor to pan, tilt and zoom, simultaneously giving an overview of the external operating field. Total cost of the hardware used in the current setup is approximately 1000USD.

One resident surgeon with no previous experience in laparoscopic non-mesh pediatric inguinal hernia repair was mentored by an expert pediatric surgeon according to a structured learning program. Upon completion of systematic core training including a demonstration video of the surgical procedure, simulation training on a surgical model and traditional hands-on mentoring during the initial cases, the mentor was able to step back and allow the trainee to operate under telementored supervision.

Preliminary results:

A total of 11 hernias (two bilateral cases) were operated in 9 patients ranging from 18 months to 9 years of age. Seven of the cases were performed using telementoring-assisted supervision. Four cases were telementored locally from within hospital and three cases were then telementored over a distance of 6152 km (Akron, Ohio, USA – Tromsø, Norway). The average operating time was 40 minutes. No technical or clinical complications occurred. The image and sound quality was satisfactory with latency of 170-300ms. The annotation tool was utilized by the mentor throughout the training period and was found, both by the mentor and the trainee, to effectively facilitate and improve the precision level of the surgical guidance. The trainee was able to reach a satisfactory skill level as assessed subjectively by the expert mentor.

Conclusions and future directions:

The current study demonstrates that our low-cost telementoring technology provides a valuable asset to surgical training that is feasible and safe, perhaps smoothing the learning curve for new procedures. Future studies are needed to objectively assess the educational potential and viability of telementoring in more complex laparoscopic surgical procedures.

// This abstract will have a video as well //

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