Satoru Imura1, Takuya Tokunaga, MD1, Masayuki Sumitomo1, Shinichiro Yamada2, Chie Takasu2, Yu Saito2, Jun Higashijima2, Kozo Yoshikawa2, Tetsuya Ikemoto2, Yuji Morine2, Mitsuo Shimada2. 1Department of Minimum invasive and Telesurgery, Tokushima University Hospital, 2Department of Surgery, Tokushima University
INTRODUCTION: We set up a local surgical care department aiming at cancellation short of local surgeons in Tokushima in 2010. After that we tried to standardize operative procedures in laparoscopic surgery and introduced Telementoring systems (TeMS) between university hospital and our hospital in the rural area with a few cases. To evaluate the usefulness of live surgery with remote instruction by certified surgeons using TeMS for surgeons in prefectural Miyoshi Hospital 100km away from the university hospital.
METHODS:  Laparoscopy assisted gastrectomy (LAG): Miyoshi Hospital (A): 15 cases and Tokushima university hospital (B): 197 cases. Laparoscopy assisted colectomy (LAC): A: 13 cases and B: 163 cases. We compared the surgical results between the two hospitals.  Questionnaire survey about a utility of TeMS was performed to young surgeons and medical students.
RESULTS:  There was not significant difference in intraoperative blood loss (A: 92ml vs. B: 95ml), the lymphnode dissection number (A: 26 vs. B: 28), operative time (A: 342 min vs. B: 310 min) in LAG. There was not significant difference in intraoperative blood loss (A: 38ml vs. B: 47ml), operative time (A: 264 min vs. B: 220 min) in LAC. Regarding postoperative complications, there was no difference between the two.  Resident, medical students of approximately 70% obtained an answer saying "TeMS is useful in improvement of the regional medicine", "They want to work at rural hospital if introduced TeMS".
CONCLUSION: TeMS could eliminate disparities in laparoscopic surgery between university hospital and rural hospital and contribute education, which leads to findings of human resources.