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Wakasa Y, Hakamada K, Morohashi H, Kanno T, Tadano K, Kawashima K, Ebihara Y, Oki E, Hirano S, Mori M. Ensuring communication redundancy and establishing a telementoring system for robotic telesurgery using multiple communication lines. J Robot Surg 2024; 18:9. [PMID: 38206522 PMCID: PMC10784335 DOI: 10.1007/s11701-023-01792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
Assuring communication redundancy during the interruption and establishing appropriate teaching environments for local surgeons are essential to making robotic telesurgery mainstream. This study analyzes robotic telesurgery with telementoring using standard domestic telecommunication carriers. Can multiple carriers guarantee redundancy with interruptions? Three commercial optical fiber lines connected Hirosaki University and Mutsu General Hospitals, 150 km apart. Using Riverfield, Inc. equipment, Hirosaki had a cockpit, while both Mutsu used both a cockpit and a surgeon's console. Experts provided telementoring evaluating 14 trainees, using objective indices for operation time and errors. Subjective questionnaires addressed image quality and surgical operability. Eighteen participants performed telesurgery using combined lines from two/three telecommunication carriers. Manipulation: over 30 min, lines were cut and restored every three minutes per task. Subjects were to press a switch when noticing image quality or operability changes. Mean time to task completion was 1510 (1186-1960) seconds: local surgeons alone and 1600 (1152-2296) seconds for those under remote instructor supervision, including expert intervention time. There was no significant difference (p = 0.86). The mean error count was 0.92 (0-3) for local surgeons and 0.42 (0-2) with remote instructors. Image quality and operability questionnaires found no significant differences. Results communication companies A, B, and C: the A/B combination incurred 0.17 (0-1) presses of the environment change switch, B/C had 0, and C/A received 0.67 (0-3), showing no significant difference among provider combinations. Combining multiple communication lines guarantees communication redundancy and enables robotic telementoring with enhanced communication security.
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Affiliation(s)
- Yusuke Wakasa
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho Hirosaki, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho Hirosaki, Aomori, 036-8562, Japan.
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho Hirosaki, Aomori, 036-8562, Japan
| | | | | | - Kenji Kawashima
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Oki
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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Nankaku A, Tokunaga M, Yonezawa H, Kanno T, Kawashima K, Hakamada K, Hirano S, Oki E, Mori M, Kinugasa Y. Maximum acceptable communication delay for the realization of telesurgery. PLoS One 2022; 17:e0274328. [PMID: 36201429 PMCID: PMC9536636 DOI: 10.1371/journal.pone.0274328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
AIM To determine acceptable limits of communication delays in telesurgery, we investigated the impact of communication delays under a dynamic environment using a surgical assist robot. Previous studies have evaluated acceptable delays under static environments. Effects of delays may be enhanced in dynamic environments, but studies have not yet focused on this point. METHODS Thirty-four subjects with different surgical experience (Group1: no surgical experience; Group2: only laparoscopic surgical experience; Group3: robotic surgery experience) performed 4 tasks under different delays (0, 70, 100, 150, 200, or 300 ms) using a surgical assist robot. Task accomplishment time and total movement distance of forceps were recorded and compared under different communication delays of 0-300 ms. In addition, surgical performance was compared between Group1or Group2 without delay and Group3 with communication delays. RESULTS Significant differences in task accomplishment time were found between delays of 0 and 70 ms, but not between delays of 70 and 100 ms. Thereafter, the greater the communication delay, the longer the task accomplishment time. Similar results were obtained in total movement distance of forceps. Comparisons between Group3 with delay and Group1 or Group2 without delay demonstrated that surgical performance in Group3 with delay was superior or equal to that of Group1 or Group2 without delay as long as the delay was 100 ms or less. CONCLUSIONS Communication delays in telesurgery may be acceptable if 100 ms or less. Experienced surgeons with more than 100 ms of delay could outperform less-experienced surgeons without delay.
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Affiliation(s)
- Akitoshi Nankaku
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Hiroki Yonezawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kenji Kawashima
- Riverfield Corporation, Tokyo, Japan
- Department of Information Physics and Computing, the University of Tokyo, Tokyo, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University, Aomori, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Hokkaido, Japan
| | - Eiji Oki
- Department of Gastrointestinal Surgery, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Tokai University School of Medicine, Kanagawa, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Watson G, Payne SR, Kunitsky K, Natchagande G, Mabedi C, Scotland KB. Stone disease in low-middle income countries. Could augmented reality have a role in its management? BJU Int 2022; 130:400-407. [PMID: 35993671 DOI: 10.1111/bju.15877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urolithiasis is a global phenomenon. Cystolithiasis is common in parts of Africa due to low protein intake and dehydration from endemic diarrhoeal illnesses. Nephrolithiasis is less prevalent than in high income countries, probably due to a variety of lifestyle issues, such as a more elemental diet, higher physical activity and less obesity. Although renal stones are less common in low-middle income countries (LMICs), the social and economic impacts of nephrolithiasis are still considerable; many stones present late or with complications such as upper urinary tract obstruction or urosepsis. These may lead to the development of chronic kidney disease, or end-stage renal failure in a small proportion of cases, conditions for which there is very poor provision in most LMICs. Early treatment of nephrolithiasis by the least invasive method possible can, however, reduce the functional consequences of urinary stone disease. Although ESWL is uncommon, and endoscopic interventions for stone are not widespread in most of Africa, percutaneous nephrolithomy and ureteroscopic renal surgery are viable techniques in those regional centres with infrastructure to support them. Longitudinal mentoring has been shown to be a key step in the adoption of these minimally invasive procedures by local surgeons, something that has been difficult during the COVID-19 pandemic due to travel restriction. Augmented reality (AR) technology is an alternative means of providing remote mentoring, something that has been trialled by Urolink, the MediTech Trust and other global non-governmental organisations during this period. Our preliminary experience suggests that this is a viable technique for promulgating skills in LMICs where appropriate connectivity exists to support remote communication. AR may also have long term promise for decreasing the reliance upon short-term surgical visits to consolidate competence, thereby reducing the carbon footprint of global surgical education.
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Affiliation(s)
- Graham Watson
- East Sussex Hospitals NHS Trust, Eastbourne, UK.,Medi Tech Trust, Eastbourne, UK
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Merali HS, Hemed M, Fernando AM, Rizwan S, Mangala EL, Wood AM, Abdalla K, Patterson J, Amick E, Foehringer Merchant H, Smith SL, Wheatley RR, Kamath-Rayne BD. Telementoring initiative for newborn care providers in Kenya, Pakistan and Tanzania. Trop Med Int Health 2022; 27:426-437. [PMID: 35239251 DOI: 10.1111/tmi.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To support governments' efforts at neonatal mortality reduction, UNICEF and the American Academy of Pediatrics launched a telementoring project in Kenya, Pakistan and Tanzania. METHODS In Fall 2019, an individualised 12-session telementoring curriculum was created for East Africa and Pakistan after site visits that included care assessment, patient data review and discussion with faculty and staff. After the programme, participants, administrators and UNICEF staff were surveyed and participated in focus group discussions. RESULTS Participants felt the programme improved knowledge and newborn care. Qualitative analysis found three common themes of successful telementoring: local buy-in, use of existing training or clinical improvement structures, and consideration of technology needs. CONCLUSIONS Telementoring has potential as a powerful tool in newborn education. It offers more flexibility and easier access than in-person sessions. This project has the potential for scale-up, particularly when physical distancing and travel restrictions are the norm.
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Affiliation(s)
- Hasan S Merali
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | | | | | - Amy M Wood
- Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | | | | | - Erick Amick
- American Academy of Pediatrics, Itasca, IL, USA
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5
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Abu-Rmaileh M, Osborn T, Gonzalez SR, Yuen JC. The Use of Live Streaming Technologies in Surgery: A Review of the Literature. Ann Plast Surg 2022; 88:122-127. [PMID: 34270473 DOI: 10.1097/sap.0000000000002909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Live streaming surgery is a developing communication platform in medicine. To maximize the technological advances that allow for the live streaming of surgery, it is crucial to have an understanding of the various video-capturing devices that are available and their pros and cons of implementation. Possible barriers to the widespread use of live streaming surgery include cost, concerns about patient safety and privacy, and limited understanding of the current available resources. In this article, we present the results of our literature review of techniques for live streaming of surgery as a means to inform readers and promote their implementation. METHODS We conducted a literature review of the literature to identify previous articles indexed in PubMed and Ovid. We used the following search terms: [Surgery AND Streaming], which generated 32 articles for initial review. References were reviewed within each document to find similar articles that were not captured by the initial search. The article selection criteria were peer-reviewed publications, case reports, and case series describing the use of live surgical streaming technologies. RESULTS Literature review showed enhanced surgeon interaction with viewers and improved anatomy scores with the widespread use of live streaming. Surgeons reported positive feedback and wished to engage in more sessions in the future. The largest barriers to implementation of streaming technology are video quality through the Internet and patient information protection. CONCLUSIONS Live streaming of surgery for educational purposes has not been widely accepted in surgical training programs to date. Streaming accessibility has advanced over the past 2 decades with the availability of handheld mobile devices. However, little has been done to allow for live streaming of surgery to trainees in a manner compliant with the Health Portability Insurance and Accountability Act.
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Affiliation(s)
| | - Tamara Osborn
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Santiago R Gonzalez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - James C Yuen
- Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1948-1964. [PMID: 34059480 PMCID: PMC8894132 DOI: 10.1016/j.jsurg.2021.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery. OBJECTIVE This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field. DESIGN A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy. RESULTS 134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%). CONCLUSION The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.
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Affiliation(s)
- Layne N Raborn
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Columbus, Ohio.
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Anvari M, Manoharan B, Barlow K. From telementorship to automation. J Surg Oncol 2021; 124:246-249. [PMID: 34245577 DOI: 10.1002/jso.26562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/05/2022]
Abstract
The effective integration of robotic technology and surgical tools has played a vital role in advancing surgical care by enabling telepresence in surgery to provide mentorship and surgical care across long distances in the absence of surgeons. This article describes our experiences with advancing surgical education and innovation through telementoring community surgeons, establishing the world's first telerobotic surgical service, and the integration of Artificial Intelligence and robotics to provide remote surgical care and training.
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Affiliation(s)
- Mehran Anvari
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Baanu Manoharan
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Karen Barlow
- Department of Surgery, Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada
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8
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Wachs JP, Kirkpatrick AW, Tisherman SA. Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives. Annu Rev Biomed Eng 2021; 23:115-139. [PMID: 33770455 DOI: 10.1146/annurev-bioeng-083120-023315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes aset of requirements for such systems. We conclude with a perspective on the future of telementoring systems and the integration of artificial intelligence within those systems.
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Affiliation(s)
- Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
| | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine, Surgery, and Medicine; Snyder Institute for Chronic Diseases; and the Trauma Program, University of Calgary and Alberta Health Services, Calgary, Alberta T2N 2T9, Canada.,Tele-Mentored Ultrasound Supported Medical Interaction (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada
| | - Samuel A Tisherman
- Department of Surgery and the Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Börner Valdez L, Datta RR, Babic B, Müller DT, Bruns CJ, Fuchs HF. 5G mobile communication applications for surgery: An overview of the latest literature. Artif Intell Gastrointest Endosc 2021; 2:1-11. [DOI: 10.37126/aige.v2.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
Fifth-generation wireless network, 5G, is expected to bring surgery to a next level. Remote surgery and telementoring could be enabled and be brought into routine medical care due to 5G characteristics, such as extreme high bandwidth, ultra-short latency, multiconnectivity, high mobility, high availability, and high reliability. This work explores the benefits, applications and demands of 5G for surgery. Therefore, the development of previous surgical procedures from using older networks to 5G is outlined. The current state of 5G in surgical research studies is discussed, as well as future aspects and requirements of 5G in surgery are presented.
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Affiliation(s)
| | - Rabi R Datta
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Benjamin Babic
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | - Dolores T Müller
- Department of Surgery, University of Cologne, Cologne 50937, Germany
| | | | - Hans F Fuchs
- Department of Surgery, University of Cologne, Cologne 50937, Germany
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10
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Huang EY, Knight S, Guetter CR, Davis CH, Moller M, Slama E, Crandall M. Telemedicine and telementoring in the surgical specialties: A narrative review. Am J Surg 2019; 218:760-766. [PMID: 31350010 DOI: 10.1016/j.amjsurg.2019.07.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology. DATA SOURCES A search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients. CONCLUSIONS Telemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.
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Affiliation(s)
- Eunice Y Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N. Dunlap St., Second Floor, Memphis, TN, 38105, USA.
| | - Samantha Knight
- Southern Illinois School of Medicine, 701 N. First Street, PO Box 19638, Springfield, IL, 62702, USA.
| | - Camila Roginski Guetter
- Federal University of Parana, Medical School. Rua Padre Camargo, 285. Alto da Glória, Curitiba, PR, 80060-240, Brazil.
| | | | - Mecker Moller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, Fl, 33131, USA.
| | - Eliza Slama
- Department of Surgery, St. Agnes Hospital, 900 S. Caton Avenue, Baltimore, MD, 21229, USA.
| | - Marie Crandall
- University of Florida College of Medicine, Jacksonville 655 W. 8th Street Jacksonville, FL, 32209, USA.
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George EI, Brand TC, LaPorta A, Marescaux J, Satava RM. Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS 2018; 22:e2018.00039. [PMID: 30524184 PMCID: PMC6261744 DOI: 10.4293/jsls.2018.00039] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The uses of robotics in surgery were hypothesized as far back as 1967, but it took nearly 30 years and the nation's largest agency, the Department of Defense, in conjunction with innovative startups and established research agencies to complete the first fully functional multipurpose surgical robot. Currently, the most prominently available multipurpose robotic surgery system with US Food and Drug Administration approval is Intuitive Surgical Inc.'s da Vinci Surgical System, which is found in operating rooms across the globe. Although now ubiquitous for minimally invasive surgery, early surgical robot prototypes were specialty focused. Originally, multipurpose robotic systems were intended for long-distance trauma surgery in battlefield settings. While there were impressive feats of telesurgery, the marketable focus has veered from this goal. Initially developed through SRI International and Defense Advanced Research Projects Agency, surgical robotics reached private industry through two major competitors, who later merged. METHODS A thorough search of PubMed, Clinical Key, EBSCO, Ovid, ProQuest, and industry manufacturers' websites yielded 62 relevant articles, of which 51 were evaluated in this review. CONCLUSION We analyzed the literature and referred to primary sources by conducting interviews with present and historical leaders in the field to yield a detailed chronology of surgical robotics development. As minimally invasive robotic procedures are becoming the standard of care, it is crucial to comprehensively document their historical context and importance as an emerging and evolving discipline.
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Affiliation(s)
- Evalyn I George
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | - Timothy C Brand
- Madigan Army Medical Center, Department of Surgery, Tacoma WA, USA
| | | | - Jacques Marescaux
- Research Institute against Digestive Cancer, Image Guided Surgery, Strasbourg, France
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Bilgic E, Turkdogan S, Watanabe Y, Madani A, Landry T, Lavigne D, Feldman LS, Vassiliou MC. Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review. Surg Innov 2017; 24:379-385. [PMID: 28494684 DOI: 10.1177/1553350617708725] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. METHODS A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. RESULTS A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. CONCLUSION Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.
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Affiliation(s)
- Elif Bilgic
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Sena Turkdogan
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Yusuke Watanabe
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada.,2 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Amin Madani
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Tara Landry
- 3 Montreal General Hospital Medical Library, McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Lavigne
- 3 Montreal General Hospital Medical Library, McGill University Health Centre, Montréal, QC, Canada
| | - Liane S Feldman
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Melina C Vassiliou
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
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13
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Perez M, Xu S, Chauhan S, Tanaka A, Simpson K, Abdul-Muhsin H, Smith R. Impact of delay on telesurgical performance: study on the robotic simulator dV-Trainer. Int J Comput Assist Radiol Surg 2015; 11:581-7. [PMID: 26450105 DOI: 10.1007/s11548-015-1306-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/21/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the impact of communication latency on telesurgical performance using the robotic simulator dV-Trainer®. METHODS Surgeons were enrolled during three robotic congresses. They were randomly assigned to a delay group (ranging from 100 to 1000 ms). Each group performed three times a set of four exercises on the simulator: the first attempt without delay (Base) and the last two attempts with delay (Warm-up and Test). The impact of different levels of latency was evaluated. RESULTS Thirty-seven surgeons were involved. The different latency groups achieved similar baseline performance with a mean task completion time of 207.2 s (p > 0.05). In the Test stage, the task duration increased gradually from 156.4 to 310.7 s as latency increased from 100 to 500 ms. In separate groups, the task duration deteriorated from Base for latency stages at delays ≥300 ms, and the errors increased at 500 ms and above (p < 0.05). The subjects' performance tended to improve from the Warm-up to the Test period. Few subjects completed the tasks with a delay higher than 700 ms. CONCLUSION Gradually increasing latency has a growing impact on performances. Measurable deterioration of performance begins at 300 ms. Delays higher than 700 ms are difficult to manage especially in more complex tasks. Surgeons showed the potential to adapt to delay and may be trained to improve their telesurgical performance at lower-latency levels.
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Affiliation(s)
- Manuela Perez
- IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France.
- General and Emergency Surgery Department, University Hospital of Nancy, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
- Hôpital Central Service de Chirurgie Générale et Urgences, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.
| | - Song Xu
- IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France
- Urology Department, University Hospital of Nancy, Allée du Morvan, 54511, Vandoeuvre-les-Nancy, France
| | - Sanket Chauhan
- Center for Evidence Based Simulation, Baylor University Medical Center, Dallas, TX, USA
- Associate Professor Texas A&M Health Science Center, College Station, TX, USA
| | - Alyssa Tanaka
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Khara Simpson
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Haidar Abdul-Muhsin
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
| | - Roger Smith
- Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA
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Virtual Interactive Presence in Global Surgical Education: International Collaboration Through Augmented Reality. World Neurosurg 2015; 86:103-11. [PMID: 26342783 DOI: 10.1016/j.wneu.2015.08.053] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Technology allowing a remote, experienced surgeon to provide real-time guidance to local surgeons has great potential for training and capacity building in medical centers worldwide. Virtual interactive presence and augmented reality (VIPAR), an iPad-based tool, allows surgeons to provide long-distance, virtual assistance wherever a wireless internet connection is available. Local and remote surgeons view a composite image of video feeds at each station, allowing for intraoperative telecollaboration in real time. METHODS Local and remote stations were established in Ho Chi Minh City, Vietnam, and Birmingham, Alabama, as part of ongoing neurosurgical collaboration. Endoscopic third ventriculostomy with choroid plexus coagulation with VIPAR was used for subjective and objective evaluation of system performance. RESULTS VIPAR allowed both surgeons to engage in complex visual and verbal communication during the procedure. Analysis of 5 video clips revealed video delay of 237 milliseconds (range, 93-391 milliseconds) relative to the audio signal. Excellent image resolution allowed the remote neurosurgeon to visualize all critical anatomy. The remote neurosurgeon could gesture to structures with no detectable difference in accuracy between stations, allowing for submillimeter precision. Fifteen endoscopic third ventriculostomy with choroid plexus coagulation procedures have been performed with the use of VIPAR between Vietnam and the United States, with no significant complications. 80% of these patients remain shunt-free. CONCLUSION Evolving technologies that allow long-distance, intraoperative guidance, and knowledge transfer hold great potential for highly efficient international neurosurgical education. VIPAR is one example of an inexpensive, scalable platform for increasing global neurosurgical capacity. Efforts to create a network of Vietnamese neurosurgeons who use VIPAR for collaboration are underway.
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A blinded assessment of video quality in wearable technology for telementoring in open surgery: the Google Glass experience. Surg Endosc 2015; 30:372-8. [DOI: 10.1007/s00464-015-4178-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Guo J, Guo S, Tamiya T, Hirata H, Ishihara H. A virtual reality-based method of decreasing transmission time of visual feedback for a tele-operative robotic catheter operating system. Int J Med Robot 2015; 12:32-45. [PMID: 25693866 DOI: 10.1002/rcs.1642] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Jin Guo
- Graduate School of Engineering; Kagawa University; Takamatsu Kagawa Japan
| | - Shuxiang Guo
- Intelligent Mechanical Systems Engineering Department; Kagawa University; Takamatsu Kagawa Japan
- School of Life Science; Beijing Institute of Technology; Haidian District Beijing China
| | - Takashi Tamiya
- Department of Neurological Surgery; Faculty of Medicine; Kagawa University; Takamatsu Kagawa Japan
| | - Hideyuki Hirata
- Intelligent Mechanical Systems Engineering Department; Kagawa University; Takamatsu Kagawa Japan
| | - Hidenori Ishihara
- Intelligent Mechanical Systems Engineering Department; Kagawa University; Takamatsu Kagawa Japan
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Jalil S, Myers T, Atkinson I. A Meta-Synthesis of Behavioral Outcomes from Telemedicine Clinical Trials for Type 2 Diabetes and the Clinical User-Experience Evaluation (CUE). J Med Syst 2015; 39:28. [DOI: 10.1007/s10916-015-0191-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
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Di Cerbo A, Morales-Medina JC, Palmieri B, Iannitti T. Narrative review of telemedicine consultation in medical practice. Patient Prefer Adherence 2015; 9:65-75. [PMID: 25609928 PMCID: PMC4298290 DOI: 10.2147/ppa.s61617] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of telemedicine has grown across several medical fields, due to the increasing number of "e-patients". OBJECTIVE This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care. METHODS A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty). RESULTS Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions. CONCLUSION Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time.
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Affiliation(s)
- Alessandro Di Cerbo
- Poliambulatorio del Secondo Parere, University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV, Universidad Autónoma de Tlaxcala, Tlaxcala de Xicohténcatl, Mexico
| | - Beniamino Palmieri
- Poliambulatorio del Secondo Parere, University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Tommaso Iannitti
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
- Correspondence: Tommaso Iannitti, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK, Tel +44 75 2147 1447, Email
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Shenai MB, Tubbs RS, Guthrie BL, Cohen-Gadol AA. Virtual interactive presence for real-time, long-distance surgical collaboration during complex microsurgical procedures. J Neurosurg 2014; 121:277-84. [PMID: 24905563 DOI: 10.3171/2014.4.jns131805] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECT The shortage of surgeons compels the development of novel technologies that geographically extend the capabilities of individual surgeons and enhance surgical skills. The authors have developed "Virtual Interactive Presence" (VIP), a platform that allows remote participants to simultaneously view each other's visual field, creating a shared field of view for real-time surgical telecollaboration. METHODS The authors demonstrate the capability of VIP to facilitate long-distance telecollaboration during cadaveric dissection. Virtual Interactive Presence consists of local and remote workstations with integrated video capture devices and video displays. Each workstation mutually connects via commercial teleconferencing devices, allowing worldwide point-to-point communication. Software composites the local and remote video feeds, displaying a hybrid perspective to each participant. For demonstration, local and remote VIP stations were situated in Indianapolis, Indiana, and Birmingham, Alabama, respectively. A suboccipital craniotomy and microsurgical dissection of the pineal region was performed in a cadaveric specimen using VIP. Task and system performance were subjectively evaluated, while additional video analysis was used for objective assessment of delay and resolution. RESULTS Participants at both stations were able to visually and verbally interact while identifying anatomical structures, guiding surgical maneuvers, and discussing overall surgical strategy. Video analysis of 3 separate video clips yielded a mean compositing delay of 760 ± 606 msec (when compared with the audio signal). Image resolution was adequate to visualize complex intracranial anatomy and provide interactive guidance. CONCLUSIONS Virtual Interactive Presence is a feasible paradigm for real-time, long-distance surgical telecollaboration. Delay, resolution, scaling, and registration are parameters that require further optimization, but are within the realm of current technology. The paradigm potentially enables remotely located experts to mentor less experienced personnel located at the surgical site with applications in surgical training programs, remote proctoring for proficiency, and expert support for rural settings and across different counties.
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Affiliation(s)
- Mahesh B Shenai
- Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Alabama
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Feasibility of remote administration of the Fundamentals of Laparoscopic Surgery (FLS) skills test. Surg Endosc 2013; 27:4033-7. [DOI: 10.1007/s00464-013-3048-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 05/28/2013] [Indexed: 11/24/2022]
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Augestad KM, Bellika JG, Budrionis A, Chomutare T, Lindsetmo RO, Patel H, Delaney C. Surgical telementoring in knowledge translation--clinical outcomes and educational benefits: a comprehensive review. Surg Innov 2013; 20:273-281. [PMID: 23117447 DOI: 10.1177/1553350612465793] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Surgical telementoring has been reported for decades. However, there exists limited evidence of clinical outcome and educational benefits. OBJECTIVE To perform a comprehensive review of surgical telementoring surveys published in the past 2 decades. RESULTS Of 624 primary identified articles, 34 articles were reviewed. A total of 433 surgical procedures were performed by 180 surgeons. Most common telementored procedures were laparoscopic cholecystectomy (57 cases, 13%), endovascular treatment of aortic aneurysm (48 cases, 11%), laparoscopic colectomy (32 cases, 7%), and nefrectomies (41 cases, 9%). In all, 167 (38%) cases had a laparoscopic approach, and 8 cases (5%) were converted to open surgery. Overall, 20 complications (5%) were reported (liver bleeding, trocar port bleeding, bile collection, postoperative ileus, wound infection, serosa tears, iliac artery rupture, conversion open surgery). Eight surveys (23%) have structured assessment of educational outcomes. Telementoring was combined with simulators (n = 2) and robotics (n = 3). Twelve surveys (35%) were intercontinental. Technology satisfaction was high among 83% of surgeons. CONCLUSION Few surveys have a structured assessment of educational outcome. Telementoring has improved impact on surgical education. Reported complication rate was 5%.
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Abdul Karim R, Zakaria NF, Zulkifley MA, Mustafa MM, Sagap I, Md Latar NH. Telepointer technology in telemedicine: a review. Biomed Eng Online 2013; 12:21. [PMID: 23496940 PMCID: PMC3610246 DOI: 10.1186/1475-925x-12-21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/04/2013] [Indexed: 11/10/2022] Open
Abstract
Telepointer is a powerful tool in the telemedicine system that enhances the effectiveness of long-distance communication. Telepointer has been tested in telemedicine, and has potential to a big influence in improving quality of health care, especially in the rural area. A telepointer system works by sending additional information in the form of gesture that can convey more accurate instruction or information. It leads to more effective communication, precise diagnosis, and better decision by means of discussion and consultation between the expert and the junior clinicians. However, there is no review paper yet on the state of the art of the telepointer in telemedicine. This paper is intended to give the readers an overview of recent advancement of telepointer technology as a support tool in telemedicine. There are four most popular modes of telepointer system, namely cursor, hand, laser and sketching pointer. The result shows that telepointer technology has a huge potential for wider acceptance in real life applications, there are needs for more improvement in the real time positioning accuracy. More results from actual test (real patient) need to be reported. We believe that by addressing these two issues, telepointer technology will be embraced widely by researchers and practitioners.
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Affiliation(s)
- Rohana Abdul Karim
- Department of Electrical, Electronic & Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi, Malaysia.
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Miller JA, Kwon DS, Dkeidek A, Yew M, Hisham Abdullah A, Walz MK, Perrier ND. Safe introduction of a new surgical technique: remote telementoring for posterior retroperitoneoscopic adrenalectomy. ANZ J Surg 2012; 82:813-6. [PMID: 23013552 DOI: 10.1111/j.1445-2197.2012.06188.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) is a safe and effective approach to adrenalectomy, offering less pain and faster recovery than open or laparoscopic surgery. Although the popularity of PRA is increasing, few surgical centres have extensive experience with the procedure. The ideal approach to achieve proficiency with any new technique involves on-site observation of an experienced surgeon-mentor, followed by mentored hands-on experience of the surgeon-learner. However, it is not always feasible for a surgeon-mentor to offer on-site supervision to the surgeon-learner in his or her home institution. Advances in Internet applications have made remote telementoring a viable alternative to on-site mentoring in selected situations. METHODS We describe our experience in safely introducing PRA to Melbourne, Australia, where no highly experienced surgeon-mentors were available. A surgeon with experience of 12 PRA procedures attended from interstate, along with live telementoring via Skype video link by an overseas surgeon who had performed more than 200 PRA procedures, to mentor the surgeon-learner performing her first three cases. RESULTS The operating surgeon's first three PRA procedures proceeded uneventfully, with no complications, relatively short operative times and one-night hospital stays for all three patients. Twenty-two more have been performed since, without complications. CONCLUSION Remote telementoring is a safe and feasible way to assist surgeons in safely introducing new techniques. This strategy is particularly applicable in centres where no surgeon-mentor is locally available. It is important that the surgeon-learner has the skills and experience to complete the procedure using alternative techniques in the case of complications or technical failure.
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Affiliation(s)
- Julie A Miller
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
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Costantino F, Mutter D, D'Agostino J, Dente M, Leroy J, Wu HS, Marescaux J. Mentored trainees obtain comparable operative results to experts in complex laparoscopic colorectal surgery. Int J Colorectal Dis 2012; 27:65-69. [PMID: 21861072 DOI: 10.1007/s00384-011-1290-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes. METHODS Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured. RESULTS Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD ± 50) vs. 131 min (SD ± 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred. CONCLUSIONS Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
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Affiliation(s)
- Federico Costantino
- IRCAD-EITS Institute, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
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Abboudi M, Ahmed K, Kirby R, Khan MS, Dasgupta P, Challacombe B. MENTORSHIP PROGRAMMES FOR LAPAROSCOPIC AND ROBOTIC UROLOGY. BJU Int 2011; 107:1869-71. [DOI: 10.1111/j.1464-410x.2011.10244.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gagliardi AR, Wright FC. Exploratory evaluation of surgical skills mentorship program design and outcomes. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2010; 30:51-56. [PMID: 20222034 DOI: 10.1002/chp.20056] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION There are few opportunities for mentorship of practicing surgeons and no evidence to guide the design of such programs. This study explored outcomes and barriers associated with the design of surgical mentorship programs. METHODS Interviews were held with organizers, mentors, and protégés of 2 programs. Data from 23 participant interviews and 23 nonparticipant surveys were analyzed thematically. RESULTS Participation was greater in the program where planning was participatory and mentors visited protégés. Scheduling was a key barrier, and existing relationships enabled mentorship. Most nonparticipants said they were already trained or had no interest in the skill. Mentorship was valued for exchange of tacit knowledge, hands-on learning, and real-time feedback. Mentorship prompted participants to realize gaps in skill; several said they already adopted the new skill, and many were interested in ongoing mentorship. DISCUSSION Several beneficial outcomes appear to be associated with mentorship, but longitudinal evaluation is required. Telementoring and train-the-trainer models may promote participation in surgical mentorship. Participants suggested that technical training be integrated within pre- and postmentorship education and follow-up. Such programs can only be implemented if issues of sponsorship and funding are addressed.
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Affiliation(s)
- Anna R Gagliardi
- Department of Surgery Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Affiliate Scientist, Toronto General Research Institute, Ontario, Canada.
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Augestad KM, Lindsetmo RO. Overcoming distance: video-conferencing as a clinical and educational tool among surgeons. World J Surg 2009; 33:1356-65. [PMID: 19384459 PMCID: PMC2691934 DOI: 10.1007/s00268-009-0036-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Since the 1960s, there has been substantial development in the uses of video-conferencing (VC) among medical personnel, including surgeons who have adopted the technology. Methods A report on our own experience with VC was combined with a comprehensive PubMed search with the key words telepresence, video-conferencing, video-teleconferencing, telementoring and surgery, trauma, follow-up, education, and multidisciplinary teams. A search through two peer-reviewed telemedicine journals—Journal of Telemedicine and Telecare and Telemedicine and e-Health Journal—and references of all included papers and identified additional reports was conducted. Results A total of 517 articles were identified with 51 relevant manuscripts, which included the key phrases. VC is widely used among surgeons for telementoring surgical procedures and in trauma and emergency medicine. Furthermore, VC is widely used by multidisciplinary teams and for the follow-up of patients after surgery. Conclusions VC is a common clinical tool for surgeons and provides a great opportunity to alter surgical practice and to offer patients the best expertise in surgical treatment despite long distances, especially in rural areas.
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Ahmed K, Khan MS, Vats A, Nagpal K, Priest O, Patel V, Vecht JA, Ashrafian H, Yang GZ, Athanasiou T, Darzi A. Current status of robotic assisted pelvic surgery and future developments. Int J Surg 2009; 7:431-40. [PMID: 19735746 DOI: 10.1016/j.ijsu.2009.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 08/19/2009] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this review is to assess the role of robotics in pelvic surgery in terms of outcomes. We have also highlighted the issues related to training and future development of robotic systems. MATERIALS AND METHODS We searched MEDLINE, EMBASE and the Cochrane Databases from 1980 to 2009 for systematic reviews of randomised controlled trials, prospective observational studies, retrospective studies and case reports assessing robotic surgery. RESULTS During the last decade, there has been a tremendous rise in the use of robotic surgical systems for all forms of precision operations including pelvic surgery. The short-term results of robotic pelvic surgery in the fields of urology, colorectal surgery and gynaecology have been shown to be comparable to the laparoscopic and open surgery. Robotic surgery offers an opportunity where many of these obstacles encountered during open and laparoscopic surgery can be overcome. CONCLUSIONS Robotic surgery is a continually advancing technology, which has opened new horizons for performing pelvic surgery with precision and accuracy. Although its use is rapidly expanding in all surgical disciplines, particularly in pelvic surgery, further comparative studies are needed to provide robust guidance about the most appropriate application of this technology within the surgical armamentarium.
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Affiliation(s)
- Kamran Ahmed
- Department of Biosurgery & Surgical Technology, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom.
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Dekastle R. Telesurgery: providing remote surgical observations for students. AORN J 2009; 90:93-101. [PMID: 19580898 DOI: 10.1016/j.aorn.2009.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 03/26/2009] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
Abstract
Meeting students' needs for a valuable experience in the OR presents many challenges especially in a non-teaching hospital setting. Creating a means for students to observe surgery from a remote site can meet students' needs without causing scheduling, supervision, or patient care problems for the OR staff members who are hosting the students. Incorporating existing technology and recruiting staff members and physicians who are willing to participate and share their knowledge with students helps to create a valuable experience for all participants.
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Fried GM. Canadian surgery: a reflection on the people and the land. World J Surg 2007; 31:1533-5. [PMID: 17571204 DOI: 10.1007/s00268-007-9137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Gerald M Fried
- Department of Surgical Education, McGill University Health Centre, McGill University, Montreal, Quebec, Canada H3G 1A4.
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