A Low Cost, Plug and Play, PC Tablet For Intrahospital, Interhospital and Intercontinental Surgical Telestration and Telementoring.

Etai Bogen, MD, Knut Magne Augestad, MD, PhD, Stig Norderval, MD, PhD, Hiten Patel, MD, PhD, FRCS, Conor P Delaney, MD, MCh, PhD, FRCSI, FACS, FASCRS, Rolv-Ole Lindsetmo, MD, PhD, MPH. Norwegian Centre of Telemedicine and Department of Surgery, University Hospital North-Norway, Tromso, Norway; Department of Colorectal Surgery, University Hospitals Case Medical Centre, Cleveland, USA.

Objective of the technology: Surgical education is time consuming, resource demanding and has a complex learning curve. Surgical telementoring is an emerging field, and might improve the quality and efficiency of surgical education. However, most of the existing surgical telementoring solutions are costly and technologically demanding. We aimed to test the feasibility and educational potential of a low cost, plug and play, telementoring and telestration PC tablet device.

Description of the technology: A telementoring prototype was developed, based on a personal computer, a tablet, and downloadable software. Tablet telestration allow surgeons to draw a freehand sketch over a live video stream, and enables the mentors to accurately define anatomical landmarks. The software is compliant with the HIPPA (Health Insurance Portability and Accountability Act) security regulations. The overall cost of the setup is          ± 1000 USD (1 tablet, pc and software).

Preliminary results: Telementoring and telestration with PC tablets were performed for 23 surgical procedures. The mentors were located inter-hospital outside-hospital, at the mentor’s homes, or intercontinental, using a regular Wi-Fi Internet connection or the 4G cellular phone network (table 1). Two procedures (laparoscopic abdominoperineal resections) were telementored between USA and Norway (6500km apart). We used a regular Wi-Fi Internet line and the latency was 170-250 ms, the mentroing sessions lasted 45min. Vessel identification and anatomical planes were discussed with real-time tablet guided telestration.

Conclusions and future directions: We have shown that a surgical telementoring and telestration PC tablet device, is easy to use in different mentor settings. The Internet lines or cellular phone network provided good quality of the video and audio, without disturbing latency. Telestration provides an improved teaching modality, by identifying key anatomical landmarks and correct  dissection planes. The potential of tablet telementoring in surgical education is huge, due to the low cost, easy setup and tablet mobility. Prospective trials are needed, to further explore at what stage telementoring can augment surgical training, by permitting continued supervision and mentoring after initial training.


LRRPI2   1
LAPI/VI1   1
LCPI/VI11  1
LLRPI1   1
RNPI1   1

Table 1. Tablet surgical telementoring and telestration sessions.  Abbreviations: LP: laparoscopic prostatectomy; LRR: laparoscopic renal resection; LA: laparoscopic adrenalectomy; LAPR: laparoscopic abdominoperineal resection; LC: laparoscopic colectomy; LLR: laparocopic liver resection; RP: robotic prostatectomy; RN: robotic nephropexy; PI: plane identification, VI: vessel identification. NCT: nerve conserving technique discussed.

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