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Horowitz DL, Mandelin AM, Tabechian D, Ben-Artzi A. Precision Medicine in Rheumatology: The Promise of Ultrasound-Guided Synovial Biopsy, Barriers to Its Implementation in the United States, and Proposed Solutions. Curr Rheumatol Rep 2024; 26:197-203. [PMID: 38376666 DOI: 10.1007/s11926-024-01138-9] [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] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW In the clinical evaluation of inflammatory arthritis and the research into its pathogenesis, there is a growing role for the direct analysis of synovial tissue. Over the years, various biopsy techniques have been used to obtain human synovial tissue samples, and there have been progressive improvements in the safety, tolerability, and utility of the procedure. RECENT FINDINGS The latest advancement in synovial tissue biopsy techniques is the use of ultrasound imaging to guide the biopsy device, along with evolution in the characteristics of the device itself. While ultrasound guided synovial biopsy (UGSB) has taken a strong foothold in Europe, the procedure is still relatively new to the United States of America (USA). In this paper, we describe the expansion of UGSB in the USA, elucidate the challenges faced by rheumatologists developing UGSB programs in the USA, and describe several strategies for overcoming these challenges.
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Endo K, Morishima K, Koizumi M, Sasanuma H, Sakuma Y, Lefor AK, Sata N. Lateral retroperitoneal adrenalectomy: Comparison of introduction and education periods of a new surgical procedure in a teaching hospital. A retrospective case series study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pfennig M, Lee A, Mi M. How does telementoring impact medical education within the surgical field? A scoping review. Am J Surg 2022; 224:869-880. [PMID: 35545476 PMCID: PMC9417933 DOI: 10.1016/j.amjsurg.2022.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Background Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. Methods A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. Results The overall consensus of telementoring experience among all 25 studies was generally positive, citing “positive experience,” “increased confidence,” and “increased surgical skill.” Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. Conclusions The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.
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Affiliation(s)
- Mitchell Pfennig
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Andrew Lee
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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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: 26] [Impact Index Per Article: 8.7] [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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Cherry TJ, Gorelik A, Miller JA. Evolution of surgical management for phaeochromocytoma over a 17-year period: an Australian perspective. ANZ J Surg 2021; 91:1792-1797. [PMID: 33844390 DOI: 10.1111/ans.16847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimally invasive adrenalectomy and advances in anaesthetic techniques have transformed surgery for phaeochromocytoma. This 17-year review describes the evolution of phaeochromocytoma care in our unit. METHODS We performed a retrospective cohort review of all patients who underwent adrenalectomy for phaeochromocytoma from 2000 to 2016. Patients were divided into three time periods, early: 2000-2005 (n = 17), middle: 2006-2010 (n = 15) and late: 2011-2016 (n = 24). The posterior retroperitoneoscopic adrenalectomy was introduced in 2011. Demographics and clinicopathological details were extracted. Median values for nominal data were compared using Mann-Whitney U-test. A chi-squared test was used to compare categorical data. RESULTS Sixty-one adrenalectomies were performed on 56 patients: 19 open, 17 laparoscopic and 20 posterior retroperitoneoscopic adrenalectomies. The median length of operation decreased from 135 to 90 min from the early to the late time period (P > 0.05). Length of stay decreased from a median of 5 days in the early group to 1 day in the late group (P = 0.01). A total of 94.1% of the early period patients were admitted to the intensive care unit compared to 30.4% of the late group (P = <0.01). Need for post-operative vasopressors and blood transfusions was significantly reduced. CONCLUSION Over the 17-year period, the choice of operative technique has transitioned towards posterior retroperitoneoscopic adrenalectomy. Operative time, rate of intensive care unit admission, and admission length have all decreased without any increase in rates of complications.
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Affiliation(s)
- Tiffany J Cherry
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Julie A Miller
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Epworth Freemason's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Tel A, Bortuzzo F, Pascolo P, Costa F, Sembronio S, Bresadola V, Baldi D, Robiony M. Maxillofacial Surgery 5.0: a new paradigm in telemedicine for distance surgery, remote assistance, and webinars. ACTA ACUST UNITED AC 2020; 69:191-202. [DOI: 10.23736/s0026-4970.20.04274-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Isaak A, Mallios A, Gürke L, Wolff T. Teleproctoring in Vascular Surgery to Defy COVID-19 Travel Restrictions. Eur J Vasc Endovasc Surg 2020; 60:623-624. [PMID: 32718826 PMCID: PMC7332910 DOI: 10.1016/j.ejvs.2020.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrej Isaak
- Vascular and Endovascular Surgery Aarau-Basel, Aarau Cantonal Hospital, Aarau, Switzerland; Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland.
| | | | - Lorenz Gürke
- Vascular and Endovascular Surgery Aarau-Basel, Aarau Cantonal Hospital, Aarau, Switzerland; Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas Wolff
- Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland
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Gimm O, Barczyński M, Mihai R, Raffaelli M. Training in endocrine surgery. Langenbecks Arch Surg 2019; 404:929-944. [PMID: 31701231 PMCID: PMC6935392 DOI: 10.1007/s00423-019-01828-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. METHODS A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. RESULTS For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs. CONCLUSIONS Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Clinical and Experimental Medicine (IKE), Linköping University, 58183 Linköping, Sweden
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202 Kraków, Poland
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 7DU United Kingdom
| | - Marco Raffaelli
- U.O. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
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Kim WW, Lee YM, Chung KW, Hong SJ, Sung TY. Comparison of Robotic Posterior Retroperitoneal Adrenalectomy over Laparoscopic Posterior Retroperitoneal Adrenalectomy: A Single Tertiary Center Experience. Int J Endocrinol 2019; 2019:9012910. [PMID: 31885564 PMCID: PMC6914928 DOI: 10.1155/2019/9012910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study is to compare the clinical outcomes of laparoscopic posterior retroperitoneal adrenalectomy (LPRA) and robotic posterior retroperitoneal adrenalectomy (RPRA) and determine the differences that could affect the outcomes. METHODS We retrospectively analyzed 230 adrenalectomy cases from 2014 to 2017. There were 169 LPRA and 61 RPRA cases, and their clinicopathological features and surgical outcomes were compared. RESULTS In LPRA, there was a positive relationship between operation time and male gender, early period of experience, adrenal tumor size, and pheochromocytoma. In RPRA, adrenal tumor size and pheochromocytoma were the factors affecting the operation time. When the adrenal tumor size was ≤5.5 cm, the operation time of LPRA was shorter than that of RPRA (p=0.001). When the tumor size was >5.5 cm, there was no significant difference in the operation times of LPRA and RPRA (p=0.102). CONCLUSIONS RPRA is a feasible and technically safe approach for benign adrenal diseases. The use of RPRA could benefit patients and provide comfort by overcoming the factors contributing to a longer operation time in the laparoscopic technique, such as male gender and high BMI.
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Affiliation(s)
- Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Yu-mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Erridge S, Yeung DKT, Patel HRH, Purkayastha S. Telementoring of Surgeons: A Systematic Review. Surg Innov 2018; 26:95-111. [DOI: 10.1177/1553350618813250] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Telementoring is a technique that has shown potential as a surgical training aid. Previous studies have suggested that telementoring is a safe training modality. This review aimed to review both the technological capabilities of reported telementoring systems as well as its potential benefits as a mentoring modality. Methods. A systematic review of the literature, up to July 2017, was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Study quality was assessed using the Oxford Levels of Evidence proforma. Data were extracted regarding technical capabilities, bandwidth, latency, and costs. Additionally, the primary aim and key results were extracted from each study and analyzed. Results. A total of 66 studies were identified for inclusion. In all, 48% of studies were conducted in general surgery; 22 (33%), 24 (36%), and 20 (30%) of studies reported telementoring that occurred within the same hospital, outside the hospital, and outside the country, respectively. Sixty-four (98%) of studies employed video and audio and 38 (58%) used telestration. Twelve separate studies directly compared telementoring against on-site mentoring. Seven (58%) showed no difference in outcomes between telementoring and on-site mentoring. No study found telementoring to result in poorer postoperative outcomes. Conclusions. The results of this review suggest that telementoring has a similar safety and efficacy profile as on-site mentoring. Future analysis to determine the potential benefits and pitfalls to surgical education through telementoring are required to determine the exact role it shall play in the future. Technological advances to improve remote connectivity would also aid the uptake of telementoring on a larger scale.
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Ladd BM, Tackla RD, Gupte A, Darrow D, Sorenson J, Zuccarello M, Grande AW. Feasibility of Telementoring for Microneurosurgical Procedures Using a Microscope: A Proof-of-Concept Study. World Neurosurg 2017; 99:680-686. [DOI: 10.1016/j.wneu.2016.11.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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Vrielink OM, Wevers KP, Kist JW, Borel Rinkes IHM, Hemmer PHJ, Vriens MR, de Vries J, Kruijff S. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard? Langenbecks Arch Surg 2016; 402:767-773. [PMID: 27888343 PMCID: PMC5506107 DOI: 10.1007/s00423-016-1533-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
Purpose There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the “classic” laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size. Methods A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches. Results Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0–200) vs. 50 (0–1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches. Conclusions Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.
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Affiliation(s)
- O M Vrielink
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - K P Wevers
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - J W Kist
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P H J Hemmer
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - M R Vriens
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J de Vries
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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Fischer AJ, Schultz BK, Collier-Meek MA, Zoder-Martell KA, Erchul WP. A critical review of videoconferencing software to support school consultation. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21683603.2016.1240129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Aaron J. Fischer
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Brandon K. Schultz
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Melissa A. Collier-Meek
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | | | - William P. Erchul
- Department of Graduate School of Education, University of California, Riverside, Riverside, California, USA
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El-Sabawi B, Magee W. The evolution of surgical telementoring: current applications and future directions. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:391. [PMID: 27867943 DOI: 10.21037/atm.2016.10.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical telementoring is a concept within telemedicine that involves the use of information technology to provide real-time guidance and technical assistance for surgical procedures from an expert physician at a different geographical location. It is a means to overcome the logistic obstacles associated with traditional mentoring and can aid in the distribution of advanced surgical techniques. In addition to its perceived educational benefits, it has the potential to directly impact patient care by providing immediate access to specialized surgical expertise in areas lacking access to qualified surgeons. With advances in technology, surgical telementoring has made significant strides in the past two decades and a breadth of positive experiences have been published in the literature. Despite this growth, questions remain regarding ideal videoconferencing methodology, resolution and latency requirements, security and liability issues, and telementoring in combination with emerging technology. This review addresses the history and progression, current applications, and future directions of surgical telementoring as a means to distribute advanced surgical expertise around the world.
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Affiliation(s)
- Bassim El-Sabawi
- Keck School of Medicine of USC, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - William Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA;; Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Kirkpatrick AW, Tien H, LaPorta AT, Lavell K, Keillor J, Wright Beatty HE, McKee JL, Brien S, Roberts DJ, Wong J, Ball CG, Beckett A. The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study. J Trauma Acute Care Surg 2015; 79:741-7. [PMID: 26422331 PMCID: PMC4623848 DOI: 10.1097/ta.0000000000000829] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Canadian Forces Health Services (A.W.K., H.T., J.W., A.B.); Departments of Surgery (A.W.K., D.J.R., C.G.B.), Critical Care Medicine (A.W.K.), and Community Health Sciences (D.J.R.), and Regional Trauma Services (A.W.K., C.G.B.), Foothills Medical Centre; and Innovative Trauma Care (J.L.M.), Edmonton, Calgary, Alberta; Sunnybrook Health Sciences Centre (H.T.), Toronto; and Royal College of Physicians and Surgeons (S.B.); and Flight Research Laboratory (J.K., H.E.W.B.), National Research Council of Canada, Ottawa, Ontario, Canada; Rocky Vista University, Parker, Colorado (A.T.L.); and Strategic Operations (K.L.), San Diego, California
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Armfield NR, Bradford M, Bradford NK. The clinical use of Skype--For which patients, with which problems and in which settings? A snapshot review of the literature. Int J Med Inform 2015; 84:737-42. [PMID: 26183642 DOI: 10.1016/j.ijmedinf.2015.06.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low-cost and no-cost software-based video tools may be a feasible and effective way to provide some telemedicine services, particularly in low-resource settings. One of the most popular tools is Skype; it is freely available, may be installed on many types of devices, and is easy to use by clinicians and patients. While a previous review found no evidence in favor of, or against the clinical use of Skype, anecdotally it is believed to be widely used in healthcare for providing clinical services. However, the range of clinical applications in which Skype has been used has not been described. AIM We aimed to identify and summarize the clinical applications of Skype. METHODS We reviewed the literature to identify studies that reported the use of Skype in clinical care or clinical education. We searched three electronic databases using the single search term "Skype". RESULTS We found 239 unique articles. Twenty seven of the articles met our criteria for further review. The use of Skype was most prevalent in the management of chronic diseases such as cardiovascular diseases and diabetes, followed by educational and speech and language pathology applications. Most reported uses were in developed countries. In all but one case, Skype was reported by the authors to be feasible and to have benefit. However, while Skype may be a pragmatic approach to providing telemedicine services, in the absence of formal studies, the clinical and economic benefits remain unclear.
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Affiliation(s)
- Nigel R Armfield
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia; Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia.
| | - Madeleine Bradford
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Natalie K Bradford
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
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Budrionis A, Hasvold P, Hartvigsen G, Bellika JG. Assessing the impact of telestration on surgical telementoring: A randomized controlled trial. J Telemed Telecare 2015; 22:12-7. [PMID: 26026177 DOI: 10.1177/1357633x15585071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Using graphical annotations in surgical telementoring promises vast improvements in both clinical and educational outcomes. However, these assumptions do not consider the potential patient safety risks resulting from this feature. Major differences in regulations regarding the implementation of telestration encourage an assessment of the utility of this feature on the outcomes of telementoring sessions. METHODS Eight students participated in a randomized controlled trial, comparing verbal with annotation-supplemented telementoring via video conferencing. A remote mentor guided the participants through four localization exercises, identifying the features in a still laparoscopic surgery scene using a laparoscopic simulator. Clinical and educational outcomes were assessed; the time consumption and quality of mentoring were determined. RESULTS The study revealed no significant difference in localizing the intervention between the studied methods, while educational outcomes favoured verbal mentoring. Telestration-supplemented guidance was considerably faster and resulted in fewer miscommunications between the mentor and mentee. DISCUSSION The initial hypothesis of the major clinical and education benefits of telestration in telementoring was not supported. A potential 33% decrease in the duration of the mentored episodes is expected due to the ability to annotate live video content. However, the impact of time saving on the outcome of the procedure remains unclear. Regardless of the quantitative measures, most of the participants and the mentor agreed that graphical annotations provide advantages over verbal guidance.
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Affiliation(s)
- Andrius Budrionis
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Per Hasvold
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Gunnar Hartvigsen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Johan Gustav Bellika
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
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Forgione A, Kislov V, Guraya SY, Kasakevich E, Pugliese R. Safe introduction of laparoscopic colorectal surgery even in remote areas of the world: the value of a comprehensive telementoring training program. J Laparoendosc Adv Surg Tech A 2014; 25:37-42. [PMID: 25469662 DOI: 10.1089/lap.2014.0191] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Advanced laparoscopic surgery training courses equipped with state-of-the-art lab facilities allow the acquisition of surgical skills in a harmless environment for the patients. In addition, active participation in intensive clinical mini-fellowship programs helps in acquiring clinical competence for the novice surgeons to properly manage patients affected by colorectal diseases. Despite this, inexperienced surgeons still need supervision during their first cases, especially to perform more complex laparoscopic procedures; however, availability of experts is particularly critical in remote areas of the globe. The aim of this study was to demonstrate the feasibility and effectiveness of a comprehensive theoretical and hands-on training program that included long-distance telementoring to assist inexperienced surgeons in performing laparoscopic colonic resections. MATERIALS AND METHODS One surgeon with no previous experience in laparoscopic colonic resection participated in an intensive training program that incorporated a theoretical master class and practical modules in the lab, including telementored sessions in experimental settings. A 4-week intensive clinical mini-fellowship was also part of the training program. RESULTS After completion of the extended training program, two laparoscopic colorectal resections for colon cancer were successfully performed in a remote area of Russia with telementoring assistance from Italy. A highly integrated operative room and standard secured network system were used to connect the expert and the novice surgeon. After this preliminary experience, the remote learner successfully operated on 25 more patients without any further need for remote expert assistance. CONCLUSIONS A comprehensive theoretical and practical mini-fellowship training program associated with initial telementoring assistance can help to safely start to perform advanced laparoscopic procedures, even in remote areas of the globe.
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Isetta V, León C, Torres M, Embid C, Roca J, Navajas D, Farré R, Montserrat JM. Telemedicine-based approach for obstructive sleep apnea management: building evidence. Interact J Med Res 2014; 3:e6. [PMID: 24554392 PMCID: PMC3961625 DOI: 10.2196/ijmr.3060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. OBJECTIVE The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients' CPAP follow-up and training. METHODS We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. RESULTS More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. CONCLUSIONS OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients' CPAP training and clinical follow-up.
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Affiliation(s)
- Valentina Isetta
- Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Cabalag MS, Mann GB, Gorelik A, Miller JA. Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases. ANZ J Surg 2014; 85:478-82. [PMID: 24438017 DOI: 10.1111/ans.12508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative approach to minimally invasive adrenalectomy, potentially offering less pain and faster recovery compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their first 50 cases. METHODS Data were prospectively collected for 50 consecutive PRAs performed by the same surgeon. Patient demographics, tumour characteristics, analgesia use, operative and preparation time, length of stay, and complications were recorded. RESULTS Fifty adrenalectomies were performed in 49 patients. The median (range) age was 58.5 years (30-83) and the majority of patients were female (n = 33, 66.0%). The median (interquartile range (IQR)) preparation time was 35.5 (28.5-50.0) and median operation time was 70.5 (54-85) min, which decreased during the study period. After a learning curve of 15 cases, median operative time reached 61 min. PRA patients required minimal post-operative analgesia, with a median (IQR) of 0 (0-5) mg of intravenous morphine equivalent used. The median (IQR) length of stay was 1 (1-1) day, with 8 (16.0%) same-day discharges. There were four complications: one blood pressure lability from a phaeochromocytoma, one reintubation, one self-limited bleed and one temporary subcostal neuropraxia. There were no conversions to open surgery or deaths. CONCLUSION Our results support previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in minimal post-operative analgesia use and short length of hospital stay.
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Affiliation(s)
- Miguel S Cabalag
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Epworth Freemasons Hospital, Victoria, Australia
| | - G Bruce Mann
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
| | | | - Julie A Miller
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Epworth Freemasons Hospital, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
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Epelboym I, Digesu CS, Johnston MG, Chabot JA, Inabnet WB, Allendorf JD, Lee JA. Expanding the indications for laparoscopic retroperitoneal adrenalectomy: experience with 81 resections. J Surg Res 2013; 187:496-501. [PMID: 24314603 DOI: 10.1016/j.jss.2013.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/22/2013] [Accepted: 10/31/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic retroperitoneal (RP) adrenalectomy has gained popularity as the preferred approach over transabdominal (TA) method; however, surgeons have been reluctant to offer this operation to obese patients because of the concerns over inadequate working space and overall perceived higher rate of complications. The aim of the present study was to evaluate the feasibility and safety of RP adrenalectomy compared with TA adrenalectomy, specifically in morbidly obese patients. METHODS All laparoscopic adrenalectomies performed at our institution between 2004 and 2012 were reviewed retrospectively. Presenting features, operative characteristics, and postoperative outcomes were evaluated. Complications were graded using Clavien system. Continuous variables were compared using Student t-test. Categorical variables were compared using χ(2)-test. Prediction models were constructed using linear or logistic regression as appropriate. RESULTS Eighty-one RP and 130 TA procedures were performed, 26 (12.3%) and 60 (28.4%), respectively in obese patients (BMI > 30). Among the obese patients, operative time and estimated blood loss were less for RP (90 versus 130 min; P < 0.001 and 0 versus 50 mL; P < 0.001). Differences in the length of stay, overall mortality, incidence and severity of postoperative complications, and rates of readmission were not statistically significant between RP and TA procedures for all comers and in the obese patients. Controlling the operative characteristics and patient-specific factors, neither operative approach nor obesity was found to independently predict the postoperative complications. CONCLUSIONS Laparoscopic RP adrenalectomy is a safe and feasible technique for obese patients. In the obese patients and for all comers, it offers shorter operative time, decreased estimated blood loss, with comparable length of stay and morbidity and mortality rates. We therefore recommend that this technique should be considered for patients undergoing adrenal resection.
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Affiliation(s)
- Irene Epelboym
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Christopher S Digesu
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Michael G Johnston
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - John A Chabot
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - William B Inabnet
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida, Mount Sinai Hospital, New York, NY
| | - John D Allendorf
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - James A Lee
- Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
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Treter S, Perrier N, Sosa JA, Roman S. Telementoring: A Multi-institutional Experience with the Introduction of a Novel Surgical Approach for Adrenalectomy. Ann Surg Oncol 2013; 20:2754-8. [DOI: 10.1245/s10434-013-2894-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Indexed: 11/18/2022]
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Louie-Johnsun M, Liodakis P, Sofield D. Re: Safe introduction of a new surgical technique: remote telementoring for posterior retroperitoneoscopic adrenalectomy. ANZ J Surg 2013; 83:192. [PMID: 23465214 DOI: 10.1111/ans.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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