Albert Y Huang, MD1, Victor Wilcox1, Susannah Wyles2, Mark Coleman3, George Hanna4, Brian Dunkin, MD1. 1Houston Methodist, 2UCSF, 3Derriford Hospital, 4Imperial College London
Training in new surgical techniques has traditionally been done through in-person mentoring. Advances in audio-video (AV) communication have made it possible to telementor (TM) over distance, but there is little understanding of the utility of this method or which technology or teaching methodology is best.
This study evaluated the effectiveness of a novel wearable technology platform (MTP–MITIE Telementoring Platform) to mentor novice surgeons through laparoscopic left colectomy. Based on this pilot work, it then compared the effectiveness of commercially available fixed and wearable TM platforms utilizing a structured communication protocol (CP) adopted from in-person mentoring (Lapco).
Methods & Procedures:
Fifteen PGY 4, 5 and MIS fellows with no experience performing laparoscopic colon resection were enrolled. Knowledge and technical skills were normalized using a structured didactic program and validated assessment of laparoscopic skills. Subjects were randomized into three groups (Group A – no mentor, Group B – MTP mentor, Group C – in-person mentor) and asked to attempt a cadaveric laparoscopic left colectomy in an experimental OR. Procedure time, global operative performance, lymph node yield, and anastomotic integrity were measured.
The effectiveness of commercially available fixed and wearable TM platforms utilizing the CP was then evaluated: Platform 1 – hardwired network AV communication via a boom and display system (VisitOR1, Karl Storz Endoscopy, USA); Platform 2 – wireless network communication with wearable technology via Google Glass (Pristine Inc. Austin, TX). Nine expert surgeons mentored two novice surgeons through a cadaveric laparoscopic right colectomy. During the mentoring sessions, the CP was used for instruction. Structured interviews and global assessments were used to determine best methods for communication and mentor/mentee satisfaction.
Despite better technical skills in Group A (GOALS Scores: Group A 20.25, Group B 18.5, Group C 17.4) 40% of these subjects performed the operation in an unacceptable manner by dissecting into unsafe areas that would have caused severe bleeding or damage to adjacent organs during live surgery. In contrast, all mentored subjects completed the operation safely with no unacceptable breaks in technique. Achieving a completion time ≤4.5 hours with a lymph node yield ≥12 trended toward better performance in the mentored groups. Mentored subjects rated the MTP system highly (Satisfaction Survey Score of ≥ 4.5 on a scale of 1-to-5) with 50% preferring telementoring to traditional live mentoring.
When comparing the commercial TM platforms, Platform 1 provided a more reliable AV connection with better image resolution. Platform 2 was very comfortable to wear and provided greater mobility than Platform 1. Overall, Platform 1 was found to be more effective than Platform 2, but both were acceptable for safely completing a TM session. Structured interviews revealed that the communication protocol is extremely well suited to TM.
This study demonstrates that TM is as effective as in-person mentoring during complex laparoscopic surgery. A fixed, hardwired AV platform is currently more effective than Google Glass for operative TM, and the Lapco communication protocol is extremely well suited to TM.