BACKGROUND: Endoscopic surgery has developed dramatically during the past decade because of its several advantages. Endoscopic surgery requires new unique skills that differ from those in open surgery, and therefore, a professional education / training is very important. However, since there is not necessarily an excellent instructor anywhere, the difference of surgical skill level between areas or countries occurs. The tele-mentoring that an instructor indicates in real time from a distant place or the foreign country may solve such problems.
METHODS: Two human soft adult cadavers, which rendered the muscles, soft tissues, and neurovascular structures soft and pliable, resembling fresh tissues, were prepared in the operation room of the surgical training center, Chulalongkorn University, Thailand. A high speed Internet, JGN2 (Japan Gigabit Network 2) was used as an information transmission channel in this tele-mentoring between Thailand and Japan supported by NTT Communications. We selected laparoscopic gastrectomy as a training subject, because this operation was flourishingly performed in Japan, but was not almost performed in Thailand at that time. The Japanese expert surgeon who was familiar with the laparoscopic gastrectomy instructed the procedures of the operation, and gave advices about the surgical anatomy, the method of making a proper surgical view with assistants, the direction of dissection, the point of resection, etc.
RESULTS: The surgical anatomy, the tissue consistency and anatomical plane were well preserved, and all procedures were completely performed in both tables. All Thai surgeons were satisfied with understanding the detail procedures of the operation or usage of the instruments, by the tele-mentoring from Japan. The quality of the operative view sent from Thailand was enough feasible to recognize the anatomy or operative procedures. The time delay was about 0.6 seconds, but the delay did not produce any problem in exchange of each information during the operation. The department of surgery in Chulalongkorn University clinically introduced the laparoscopic gastrectomy for gastric cancer after this tele-mentoring mission, and they performed the operations in six patients in 6 months with satisfactory results.
CONCLUSION: In the present trial, the results indicated that the tele-mentoring in the long distance (3750 km) using the soft cadavers was satisfactory to both countries. We proposed that such training system could contribute to improvement in the level of surgical skills in endoscopic surgery internationally.
Program Number: P233