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Lucatto LFA, Prazeres JMB, Barbosa GCS, Novais EA, Leitão Guerra RL, Badaró E, de Lima LHSG, Rodrigues EB. Telementoring versus face-to-face mentoring in the training of scleral fixation surgery of intraocular lenses. PLoS One 2023; 18:e0290040. [PMID: 38153943 PMCID: PMC10754431 DOI: 10.1371/journal.pone.0290040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/01/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE To assess telementoring as a complementary tool for surgical training of a scleral fixation technique. DESIGN Randomized, controlled, two-arm, blinded clinical trial. METHODS Using a 3D visualization system, 132 participants were randomized in order of enrollment into traditional face-to-face mentoring (n = 66) and telementoring (n = 66). A single surgeon mentored all participants in the 2 groups. The procedure was performed in a model suitable for training in intraocular lens fixation SimulEYE® (INSEYET, WESTLAKE VILLAGE, CA, USA). In the telementoring group, the images captured on a local computer were sent to a second computer located in another room through a teleconferencing platform in real-time. Nine steps of the recorded procedure were evaluated and scored by two masked independent surgeons experienced in the technique. MAIN OUTCOMES MEASURES The primary outcomes evaluated were the global score (the sum of each score on the rubric), surgical failure, and surgical time (in seconds). RESULTS Surgical success was achieved in 98.5% in the face-to-face group and in 95.5% in the telementoring group (p-value = 0.619). Minimal technical problems were reported in 8 procedures in the telementoring group (12%), without interfering with the surgical result, and completion of the procedure. CONCLUSIONS Telementoring is an encouraging educational tool that can overcome geographical barriers to ease the transfer of abilities and knowledge. We lack evidence in terms of group differences for superiority comparing face-to-face and telementoring, in addition to presenting comparable results regarding surgical success and failure. More studies are needed to explore the impact of telementoring in other ophthalmological surgeries. TRIAL REGISTRATION The Federal University of São Paulo institution's Research Ethics Committee reviewed and approved this study protocol (approval number, 5.383.484).
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Affiliation(s)
| | | | | | - Eduardo Amorim Novais
- Ophthalmology Department, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Centro Oftalmológico Città, Rio de Janeiro, Brazil
| | | | - Emmerson Badaró
- Ophthalmology Department, Federal University of São Paulo, São Paulo, São Paulo, Brazil
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Fernandes RD, Ghasroddashti A, Sorefan-Mangou F, Williams E, Choi K, Fasola L, Szasz P, Zevin B. Educational Effectiveness of Telementoring as a Continuing Professional Development Intervention for Surgeons in Practice: A Systematic Review. ANNALS OF SURGERY OPEN 2023; 4:e341. [PMID: 38144497 PMCID: PMC10735140 DOI: 10.1097/as9.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 12/26/2023] Open
Abstract
Objective We performed a systematic review to determine the educational effectiveness of telementoring as a continuing professional development (CPD) intervention for surgeons in practice. Background Surgeons can mentor their peers in remote locations using videoconferencing communication, referred to as telementoring. Methods We searched MEDLINE and EMBASE and included studies assessing the educational effectiveness of telementoring interventions used by surgeons in practice. We excluded studies involving only trainees and those not evaluating educational effectiveness. Two reviewers independently screened, extracted data, and assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI; maximum score 18). Educational outcomes were categorized using Moore's Outcomes Framework. Results We retrieved a total of 1351 records, and 252 studies were selected for full-text review. Twenty-eight studies were included with 1 randomized controlled trial, 19 cohort studies, 5 qualitative studies, and 3 case studies, totaling 178 surgeons and 499 cases. The average MERSQI score was 10.21 ± 2.2 out of 18. Educational outcomes included surgeons' satisfaction with telementoring interventions (Moore's Level 2) in 12 studies, improvement in surgeons' procedural knowledge (Level 3b) in 3 studies, improvements in surgeons' procedural competence in an educational setting (Level 4) in 4 studies, performance in a workplace-based setting (Level 5) in 23 studies, and patient outcomes (Level 6) in 3 studies. No studies reported community health outcomes (Level 7). Conclusions Moderate-level evidence demonstrates the use of telementoring as effective in changing surgeons' knowledge and competence in both educational and workplace-based settings. Its use is also associated with changes in patient outcomes.
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Affiliation(s)
| | | | | | - Erin Williams
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Ken Choi
- From the The School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Laurie Fasola
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Peter Szasz
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
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Carneiro A, Claros OR, Cha JD, Kayano PP, Apezzato M, Wagner AA, Lemos GC. Can remote assistance for robotic surgery improve surgical performance in simulation training? A prospective clinical trial of urology residents using a simulator in south america. Int Braz J Urol 2022; 48:952-960. [PMID: 36173407 PMCID: PMC9747033 DOI: 10.1590/s1677-5538.ibju.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the role of remote proctoring during the initial training phases of a robotics curriculum using surgical robot skills simulator exercises. MATERIALS AND METHODS Prospective randomized study comprising 36 urology residents and junior staff urologists without previous robotic training. Group 1 (G1) performed exercises without any assistance or support, group 2 (G2) received support from in-person proctor, and group 3 (G3) from a remote proctor through a telementoring system. Qualitative and quantitative analyses were conducted for each exercise and group. RESULTS The overall score approval rates (OSA) for the different skill exercises were Ring Walk 2 (RW2) 83%, Energy Dissection 2 (ED2) 81%, and Ring Walk 3 (RW3) 14%. RW2 OSA was higher on attempt 3 than on attempt 1 (83.3% vs. 63.9%, p=0.032). ED2 OSA rate was higher in attempt 3 than in attempt 1 (80.6% vs. 52.8%, p=0.002). RW2 OSA was similar among the groups. In ED2, both remote and live assistance were significantly related to upper OSA (G1=47.2%, G2=75.0%, G3=83.3%, p=0.002). RW3 had similar OSA among the groups, which can be explained by the high level of difficulty and low OSA in all the groups. However, in a sensitive quantitative analysis, the mean overall score of the participants in RW3 was higher in both proctored groups (G1=24, G2=57.5, G3=51.5, p=0.042). CONCLUSION Robotic performance increased significantly over three attempts for simulation exercises of low, medium, but not high-complexity. Proctoring, either in-person or remotely, has a positive impact on approval performance, particularly in intermediate tasks.
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Din N, Chan CC, Cohen E, Iovieno A, Dahan A, Rootman DS, Litvin G. Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training. Cornea 2022; 41:385-389. [PMID: 34759203 PMCID: PMC8820774 DOI: 10.1097/ico.0000000000002921] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the first known use of telementoring in corneal surgery and technology combining a 3-dimensional microscope system, 5G live streaming technology, group chat software, and a virtual reality headset for intercontinental surgical supervision. METHODS Three surgeons in Toronto were proctored by a surgeon in Israel in the implantation of a novel keratoprosthesis device (CorNeat KPro; Ra'anana, Israel) into cadaver eyes. In Toronto, the NGENUITY platform (Alcon) transmitted high-definition, 3-dimensional images to the proctor in Israel who viewed the live video through a GOOVIS Virtual Reality headset with subsecond latency. This was made possible by the LiveU technology (Hackensack, NJ), which is a portable device to increase the bandwidth of transmission. The primary outcome was the successful completion of CorNeat KPro implantation. After each procedure, all surgeons completed a Likert scale questionnaire that assessed opinions on telementoring. RESULTS All participants implanted the CorNeat KPro device. There was significant satisfaction reported. A total cumulative score from the questionnaire was 149 of 150 from the operating surgeons, with a score of 135 of 150 by the proctor. All felt that there was excellent AV quality with no lag time and recommended the technology. CONCLUSIONS Telementoring is a promising tool that can traverse large distances for ophthalmic education.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Clara C. Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; and
| | | | - David S. Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
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Iyer S, Shafi K, Lovecchio F, Turner R, Albert TJ, Kim HJ, Press J, Katsuura Y, Sandhu H, Schwab F, Qureshi S. The Spine Physical Examination Using Telemedicine: Strategies and Best Practices. Global Spine J 2022; 12:8-14. [PMID: 32755256 PMCID: PMC8965294 DOI: 10.1177/2192568220944129] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY DESIGN Technical note. OBJECTIVES To provide spine surgeons new to telemedicine with a structured physical examination technique based on manual motor testing principles. METHODS Expert experience describing a series of specific maneuvers for upper and lower extremity strength testing that can be performed using a telemedicine platform. In addition, we offer instruction on "setting up" for these visits and highlight special tests that can be used to diagnose specific cervical and lumbar spine conditions. RESULTS From our experiences in conducting telemedicine visits, we provide a means of testing and scoring upper and lower extremity strength for interpretation of weakness in the context of traditional manual motor testing. Also, we acknowledge the limitations of a remote examination and discuss maneuvers that cannot be performed remotely. CONCLUSIONS COVID-19 has drastically altered the delivery of care for patients with spine-related complaints. The need for social distancing has led to the widespread adoption of telemedicine. This technical note provides an urgently needed framework for the standardization of the remote physical exam. Validation of the exam as a diagnostic tool will be a crucial next step in studying the impact of telemedicine.
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Affiliation(s)
- Sravisht Iyer
- Hospital for Special Surgery, New York,
NY, USA,Sravisht Iyer, Hospital for Special Surgery,
535 East 70th Street, New York, NY 10021, USA.
| | - Karim Shafi
- Hospital for Special Surgery, New York,
NY, USA
| | | | | | | | - Han Jo Kim
- Hospital for Special Surgery, New York,
NY, USA
| | - Joel Press
- Hospital for Special Surgery, New York,
NY, USA
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Vera M, Kattan E, Cerda T, Niklitshek J, Montaña R, Varas J, Corvetto MA. Implementation of Distance-Based Simulation Training Programs for Healthcare Professionals: Breaking Barriers During COVID-19 Pandemic. Simul Healthc 2021; 16:401-406. [PMID: 33913677 DOI: 10.1097/sih.0000000000000550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT The sudden rise of critically ill patients secondary to the SARS-CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses allowed the acquisition of skills for the complete critical care patient management chain: use of personal protection equipment, use of a high-flow nasal cannula, endotracheal intubation, and prone positioning. Participants logged into the platform, reviewed material, practiced while recording the session, and uploaded the video through the training platform. The expert tutor remotely delivered asynchronous feedback. Participants trained remotely until achieving course approval. Remote-based simulation seems a feasible and attractive alternative to provide adequate educational solutions, especially for remote and rural areas.
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Affiliation(s)
- Magdalena Vera
- From the División de Anestesiología, Facultad de Medicina (R.M., M.A.C.); Departamento de Medicina Intensiva, Facultad de Medicina (M.V., E.K.); Escuela de Medicina, Facultad de Medicina (T.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; División de Pediatria, Facultad de Medicina (J.N.); Pontificia Universidad Católica de Chile; and Departamento de Cirugía Digestiva, Facultad de Medicina (J.V.), Pontificia Universidad Católica de Chile, Santiago, Chile
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Feeley A, Feeley I, Healy E, Sheehan E, Hehir DJ. Acquisition of Surgical Skills in Medical Students via Telementoring: A Randomized Controlled Trial. J Surg Res 2021; 270:471-476. [PMID: 34800793 DOI: 10.1016/j.jss.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pandemic related changes have radically altered the delivery of medical teaching. The practical skills of medicine which students should be proficient in at time of graduation have tended to require in-person tutelage, with reduced access resulting in the risk of skill deficits in newly qualified doctors. Small group teaching sessions are amenable to a virtual mode of delivery, with the ability of the virtual platform to confer practical skills unproven. The objective of the study was to evaluate the use of teleproctoring in acquisition of suturing skills in medical students. METHODS This was a single blinded two- armed randomized control trial. Medical students undergoing clinical rotations in their penultimate and final years who were able to complete the suturing tutorial were invited to participate in this study. Control groups underwent conventional suturing training under direct supervision, with the interventional group undergoing the tutorial in a remote learning setting via live streaming. Pre- and post-test assessment was carried out using validated suturing Global Rating Scale tool. RESULTS A total of 24 participants were recruited, with 23 participants completing the task. Adequacy of sampling was demonstrated in both groups using Box's M test (P = 0.9). Participants' individual and composite scores were comparable at baseline (P = 0.28) and following the tutorial (P = 0.52). Participants improved to a statistically significant degree regardless of method of teaching delivery, in all skill parameters (P < 0.001). CONCLUSIONS Teleproctoring is an effective tool in the provision of teaching basic suturing skills in medical students. Research on its use in more complex practical skills is warranted.
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Affiliation(s)
- Aoife Feeley
- Midlands Regional Hospital Tullamore, Tullamore, Co. Offaly, Ireland; University College Dublin, Belfield, Ireland; Royal College of Surgeons Ireland, Ireland.
| | - Iain Feeley
- Mater Misericoridae University Hospital, Ireland
| | - Eibhlin Healy
- Midland Regional Hospital Mullingar, Mullingar, Co. Westmeath, Ireland
| | - Eoin Sheehan
- Midlands Regional Hospital Tullamore, Tullamore, Co. Offaly, Ireland
| | - Dermot J Hehir
- Midlands Regional Hospital Tullamore, Tullamore, Co. Offaly, Ireland
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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: 9.7] [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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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: 1.0] [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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Rojas-Muñoz E, Couperus K, Wachs JP. The AI-Medic: an artificial intelligent mentor for trauma surgery. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2020.1835548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Kyle Couperus
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Juan P. Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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Lee KW, Choi HS, Chun HJ, Lee JM, Kim ES, Keum B, Seo YS, Jeen YT, Um SH, Lee HS. Feasibility of Wearable Display Glasses for Medical Students in the Endoscopy Room. Clin Endosc 2021; 54:694-700. [PMID: 33715343 PMCID: PMC8505181 DOI: 10.5946/ce.2020.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background/Aims Several attempts have been made to incorporate smart glasses in the medical field. We applied wearable display glasses to show the position of an observer during endoscopy and compared students’ responses between the conventional and new methods.
Methods We surveyed 28 medical students regarding the use of wearable display devices. The students used wearable display glasses to observe an endoscopic procedure and answered the prepared questionnaire. Their collected responses were analyzed for statistical correlations between each variable.
Results The survey of medical students revealed disadvantages including dizziness (dissatisfied and very dissatisfied: 21.5%) and eye fatigue (25% dissatisfied) and advantages including concentration (satisfied and very satisfied: 57.2%) and securing patient rights (71.4%). The students showed more positive than negative reviews regarding the new devices (32.1% vs. 21.5%).
Conclusions We investigated the advantages and disadvantages of viewing the endoscope image with new wearable display glasses compared to the conventional method using the survey to record user experience. The results revealed relatively positive responses from the medical students in the survey. If the new device compensates for some shortcomings, its use in the endoscopy room will be feasible.
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Affiliation(s)
- Kang Won Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
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Valanci-Aroesty S, Alhassan N, Feldman LS, Landry T, Mastropietro V, Fiore J, Lee L, Fried GM, Mueller CL. Implementation and Effectiveness of Coaching for Surgeons in Practice - A Mixed Studies Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:837-853. [PMID: 32057740 DOI: 10.1016/j.jsurg.2020.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/02/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Despite recent changes to medical education, surgical training remains largely based on the apprenticeship model. However, after completing training, there are few structured learning opportunities available for surgeons in practice to refine their skills or acquire new skills. Personalized observation with feedback is rarely a feature of traditional continuing medical education learning. Coaching has recently been proposed as a modality to meet these educational gaps; however, data are limited, and few coaching programs presently exist. The purpose of this study is to summarize the characteristics of coaching programs for surgeons in practice including participant satisfaction, program outcomes, and barriers to implementation, in the published literature. METHODS A mixed studies systematic review was conducted according to PRISMA guidelines to identify all original studies describing or investigating coaching for practicing surgeons up to 06/2019. Quantitative analysis was used to summarize numerical data, and qualitative analysis using grounded theory methodology for descriptive data was used to summarize the results into themes across studies. RESULTS After identification of articles, 27 were included in the final synthesis. Twenty-six articles described execution of a coaching program. Programs varied widely with 18/26 focusing on teaching new skills, and the remainder on refinement of skills. Thematic analysis identified 2 major data categories that guided deeper analysis: outcomes of and barriers to coaching. Of the 16 (62%) programs that reported outcomes of coaching, 42% to 100% of participants reported changes in clinical practice directly associated with coaching. Positive satisfaction after completion of a program was reported by 82% to 100% of participants. Reported barriers to participating in a coaching program emerged along 3 main themes: logistical constraints, surgical culture, and perceived lack of need. CONCLUSIONS Coaching for surgeons in practice is highly rated by participants and often results in clinical practice changes, while cultural and logistical issues were identified as barriers to implementation. A better understanding of these factors is required to guide coaching program development and implementation.
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Affiliation(s)
- Sofia Valanci-Aroesty
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Noura Alhassan
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Tara Landry
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Victoria Mastropietro
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Julio Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Carmen L Mueller
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada.
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Liu P, Li C, Xiao C, Zhang Z, Ma J, Gao J, Shao P, Valerio I, Pawlik TM, Ding C, Yilmaz A, Xu R. A Wearable Augmented Reality Navigation System for Surgical Telementoring Based on Microsoft HoloLens. Ann Biomed Eng 2020; 49:287-298. [PMID: 32504141 DOI: 10.1007/s10439-020-02538-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
This paper reports a new type of augmented reality (AR) system that integrates a Microsoft HoloLens device with a three-dimensional (3D) point tracking module for medical training and telementored surgery. In this system, a stereo camera is used to track the 3D position of a scalpel and transfer its coordinates wirelessly to a HoloLens device. In the scenario of surgical training, a virtual surgical scene with pre-recorded surgical annotations is superimposed with the actual surgical scene so that the surgical trainee is able to operate following virtual instructions. In the scenario of telementored surgery, the virtual surgical scene is co-registered with the actual surgical scene so that the virtual scalpel remotely mentored by an experienced surgeon provides the AR guidance for the inexperienced on-site operator. The performance characteristics of the proposed AR telementoring system are verified by benchtop experiments. The clinical applicability of the proposed system in telementored skin grafting surgery and fasciotomy is validated in a New Zealand rabbit model. Our benchtop and in vivo experiments demonstrate the potential to improve surgical performance and reduce healthcare disparities in remote areas with limited resources.
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Affiliation(s)
- Peng Liu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenmeng Li
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China.,Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Changlin Xiao
- Photogrammetric Computer Vision Laboratory, The Ohio State University, Columbus, USA
| | - Zeshu Zhang
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China.,Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Junqi Ma
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Jian Gao
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Pengfei Shao
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Ian Valerio
- Department of Surgery, The Ohio State University, Columbus, USA
| | | | - Chengbiao Ding
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Alper Yilmaz
- Photogrammetric Computer Vision Laboratory, The Ohio State University, Columbus, USA.
| | - Ronald Xu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China. .,Department of Biomedical Engineering, The Ohio State University, Columbus, USA.
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Rojas-Muñoz E, Cabrera ME, Lin C, Andersen D, Popescu V, Anderson K, Zarzaur BL, Mullis B, Wachs JP. The System for Telementoring with Augmented Reality (STAR): A head-mounted display to improve surgical coaching and confidence in remote areas. Surgery 2020; 167:724-731. [PMID: 31916990 DOI: 10.1016/j.surg.2019.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The surgical workforce particularly in rural regions needs novel approaches to reinforce the skills and confidence of health practitioners. Although conventional telementoring systems have proven beneficial to address this gap, the benefits of platforms of augmented reality-based telementoring in the coaching and confidence of medical personnel are yet to be evaluated. METHODS A total of 20 participants were guided by remote expert surgeons to perform leg fasciotomies on cadavers under one of two conditions: (1) telementoring (with our System for Telementoring with Augmented Reality) or (2) independently reviewing the procedure beforehand. Using the Individual Performance Score and the Weighted Individual Performance Score, two on-site, expert surgeons evaluated the participants. Postexperiment metrics included number of errors, procedure completion time, and self-reported confidence scores. A total of six objective measurements were obtained to describe the self-reported confidence scores and the overall quality of the coaching. Additional analyses were performed based on the participants' expertise level. RESULTS Participants using the System for Telementoring with Augmented Reality received 10% greater Weighted Individual Performance Score (P = .03) and performed 67% fewer errors (P = .04). Moreover, participants with lower surgical expertise that used the System for Telementoring with Augmented Reality received 17% greater Individual Performance Score (P = .04), 32% greater Weighted Individual Performance Score (P < .01) and performed 92% fewer errors (P < .001). In addition, participants using the System for Telementoring with Augmented Reality reported 25% more confidence in all evaluated aspects (P < .03). On average, participants using the System for Telementoring with Augmented Reality received augmented reality guidance 19 times on average and received guidance for 47% of their total task completion time. CONCLUSION Participants using the System for Telementoring with Augmented Reality performed leg fasciotomies with fewer errors and received better performance scores. In addition, participants using the System for Telementoring with Augmented Reality reported being more confident when performing fasciotomies under telementoring. Augmented Reality Head-Mounted Display-based telementoring successfully provided confidence and coaching to medical personnel.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Maria E Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, West Lafayette, IN
| | - Daniel Andersen
- Department of Computer Science, Purdue University, West Lafayette, IN
| | - Voicu Popescu
- Department of Computer Science, Purdue University, West Lafayette, IN
| | | | - Ben L Zarzaur
- School of Medicine, Indiana University, Indianapolis, IN
| | - Brian Mullis
- School of Medicine, Indiana University, Indianapolis, IN
| | - Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN.
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15
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Quezada J, Achurra P, Jarry C, Asbun D, Tejos R, Inzunza M, Ulloa G, Neyem A, Martínez C, Marino C, Escalona G, Varas J. Minimally invasive tele-mentoring opportunity—the mito project. Surg Endosc 2019; 34:2585-2592. [DOI: 10.1007/s00464-019-07024-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
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16
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McCullough MC, Kulber L, Sammons P, Santos P, Kulber DA. Google Glass for Remote Surgical Tele-proctoring in Low- and Middle-income Countries: A Feasibility Study from Mozambique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1999. [PMID: 30656104 PMCID: PMC6326622 DOI: 10.1097/gox.0000000000001999] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Untreated surgical conditions account for one-third of the total global burden of disease, and a lack of trained providers is a significant contributor to the paucity of surgical care in low- and middle-income countries (LMICs). Wearable technology with real-time tele-proctoring has been demonstrated in high-resource settings to be an innovative method of advancing surgical education and connecting providers, but application to LMICs has not been well-described. METHODS Google Glass with live-stream capability was utilized to facilitate tele-proctoring between a surgeon in Mozambique and a reconstructive surgeon in the United States over a 6-month period. At the completion of the pilot period, a survey was administered regarding the acceptability of the image quality as well as the overall educational benefit of the technology in different surgical contexts. RESULTS Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Both participants reported moderate visual impairment due to image distortion and light over-exposure. Video-stream latency and connection disruption were also cited as limitations. Overall, both participants reported that the technology was highly useful as training tool in both the intraoperative and perioperative setting. CONCLUSIONS Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe and introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees.
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Affiliation(s)
- Meghan C McCullough
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | | | - Patrick Sammons
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Pedro Santos
- Department of Surgery, Matola Hospital, Matola, Mozambique
| | - David A Kulber
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
- Department of Plastic and Reconstructive Surgery, Cedars Sinai Hospital, Los Angeles, Calif
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17
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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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18
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Porretta AP, Alerci M, Wyttenbach R, Antonucci F, Cattaneo M, Bogen M, Toderi M, Guerra A, Sartori F, Di Valentino M, Tutta P, Limoni C, Gallino A, von Segesser LK. Long-term Outcomes of a Telementoring Program for Distant Teaching of Endovascular Aneurysm Repair. J Endovasc Ther 2017; 24:852-858. [DOI: 10.1177/1526602817730841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alessandra Pia Porretta
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Division of Cardiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mario Alerci
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Rolf Wyttenbach
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- University of Bern, Switzerland
| | - Francesco Antonucci
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Mattia Cattaneo
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcel Bogen
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marco Toderi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Adriano Guerra
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Fabio Sartori
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcello Di Valentino
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Paolo Tutta
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Costanzo Limoni
- University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Augusto Gallino
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Ludwig K. von Segesser
- Cardiovascular Research Division, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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19
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Abstract
PURPOSE Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications. MATERIALS AND METHODS Two paired investigators screened PubMed®, Scopus® and Web of Science® databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance." We categorized and included studies of level of interaction between proctors and trainees. Research design, special equipment, telecommunication network bandwidth and research outcomes of each study were ascertained and analyzed. RESULTS Of 65 identified reports 38 peer-reviewed studies qualified for inclusion. Series were categorized into 4 advancing levels, ie verbal guidance, guidance with telestration, guidance with tele-assist and telesurgery. More advanced levels of surgical telementoring provide more effective and experiential teaching but are associated with increased telecommunication network bandwidth requirements and expenses. Concerns regarding patient safety and legal, financial, economic and ethical issues remain to be reconciled. CONCLUSIONS Telementoring and telesurgery in minimally invasive surgery are becoming more practical and cost effective in facilitating teaching of advanced surgical skills worldwide and delivery of surgical care to underserved areas, yet many challenges remain. Maturity of these modalities depends on financial incentives, favorable legislation and collaboration with cybersecurity experts to ensure safety and cost-effectiveness.
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20
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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: 38] [Impact Index Per Article: 5.4] [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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Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:51. [PMID: 28567070 PMCID: PMC5426099 DOI: 10.4103/jrms.jrms_809_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.
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Affiliation(s)
- Antonello Forgione
- Department of Surgical Oncology and Minimally Invasive Surgery, AIMS Academy, Niguarda Hospital, Milan, Italy
| | - Salman Y Guraya
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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22
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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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23
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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: 3.8] [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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24
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Shin DH, Dalag L, Azhar RA, Santomauro M, Satkunasivam R, Metcalfe C, Dunn M, Berger A, Djaladat H, Nguyen M, Desai MM, Aron M, Gill IS, Hung AJ. A novel interface for the telementoring of robotic surgery. BJU Int 2015; 116:302-8. [DOI: 10.1111/bju.12985] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel H. Shin
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Leonard Dalag
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Raed A. Azhar
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Michael Santomauro
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Raj Satkunasivam
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Charles Metcalfe
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Matthew Dunn
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Andre Berger
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Hooman Djaladat
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Mike Nguyen
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Mihir M. Desai
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Monish Aron
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Inderbir S. Gill
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Andrew J. Hung
- University of Southern California Institute of Urology; Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
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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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26
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Vera AM, Russo M, Mohsin A, Tsuda S. Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology. Surg Endosc 2014; 28:3467-72. [PMID: 24962856 DOI: 10.1007/s00464-014-3625-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/16/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic skills training has evolved over recent years. However, conveying a mentor's directions using conventional methods, without realistic on-screen visual cues, can be difficult and confusing. To facilitate laparoscopic skill transference, an augmented reality telementoring (ART) platform was designed to overlay the instruments of a mentor onto the trainee's laparoscopic monitor. The aim of this study was to compare the effectiveness of this new teaching modality to traditional methods in novices performing an intracorporeal suturing task. METHODS Nineteen pre-medical and medical students were randomized into traditional mentoring (n = 9) and ART (n = 10) groups for a laparoscopic suturing and knot-tying task. Subjects received either traditional mentoring or ART for 1 h on the validated fundamentals of laparoscopic surgery intracorporeal suturing task. Tasks for suturing were recorded and scored for time and errors. Results were analyzed using means, standard deviation, power regression analysis, correlation coefficient, analysis of variance, and student's t test. RESULTS Using Wright's cumulative average model (Y = aX (b)) the learning curve slope was significantly steeper, demonstrating faster skill acquisition, for the ART group (b = -0.567, r (2) = 0.92) than the control group (b = -0.453, r (2) = 0.74). At the end of 10 repetitions or 1 h of practice, the ART group was faster versus traditional (mean 167.4 vs. 242.4 s, p = 0.014). The ART group also had fewer fails (8) than the traditional group (13). CONCLUSION The ART Platform may be a more effective training technique in teaching laparoscopic skills to novices compared to traditional methods. ART conferred a shorter learning curve, which was more pronounced in the first 4 trials. ART reduced the number of failed attempts and resulted in faster suture times by the end of the training session. ART may be a more effective training tool in laparoscopic surgical training for complex tasks than traditional methods.
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Affiliation(s)
- Angelina M Vera
- University of Nevada School of Medicine, Las Vegas, NV, USA,
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Daruwalla ZJ, Wong KL, Thambiah J. The application of telemedicine in orthopedic surgery in singapore: a pilot study on a secure, mobile telehealth application and messaging platform. JMIR Mhealth Uhealth 2014; 2:e28. [PMID: 25100283 PMCID: PMC4114459 DOI: 10.2196/mhealth.3303] [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: 02/05/2014] [Revised: 04/13/2014] [Accepted: 05/12/2014] [Indexed: 12/18/2022] Open
Abstract
Background The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. Objective A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. Methods By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Results Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Conclusions Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication, clinical outreach in the setting of trauma, supervision in the operating room or watching procedures being performed remotely, providing both patient and parent reassurance in pediatric orthopedic patients, and finally in the setting of outpatient clinics. With our pilot study having excellent results in terms of acceptance and satisfaction, the integration of a secure, mobile telehealth application, and messaging platform, not only in the orthopedic department but also the hospital in general, has an exciting and limitless potential. More so in this era where downsizing hospital costs is beneficial, doing so may also be mandatory in order to comply with the soon to be introduced personal data protection act.
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Affiliation(s)
- Zubin Jimmy Daruwalla
- National University Hospital, Singapore, Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.
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Abstract
In response to rural health workforce shortages, universities and training providers offer rural and remote clinical placements. This has led to development of educational methods to counter the barriers of distance. In this emerging field, recent improvements in technology have provided solutions including the use of sophisticated videoconferencing systems such as the Cisco TelePresence model CTS-500. This paper evaluates the use of TelePresence in diverse medical education activities using a mixed methods design—questionnaires n=60, individual interviews n=33, and observed practice of activities n=22. TelePresence was found to be beneficial to learning and teaching and superior to other systems participants had used. In particular, the audiovisual quality, resulting intimacy, convenience, and ease of use facilitated teaching and learning, while the fixed camera and poorly arranged physical environment were found to be limitations. The system is best suited for small group activities. Clinical skills-based activities are viable. It is recommended that technical support be available during setup and use and a picture-in-picture mode be included and improved integration of office suite software to provide a joint workspace for display of presentations, images, editing or annotation of documents, and file sharing.
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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 2012; 20:273-81. [PMID: 23117447 DOI: 10.1177/1553350612465793] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Choy I, Fecso A, Kwong J, Jackson T, Okrainec A. Remote evaluation of laparoscopic performance using the global operative assessment of laparoscopic skills. Surg Endosc 2012; 27:378-83. [PMID: 22890477 DOI: 10.1007/s00464-012-2456-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although numerous assessment tools currently exist to evaluate laparoscopic surgical skills, no studies have demonstrated the reliability of such tools when used with telementoring technology. This study aimed to determine the reliability of the Global Operative Assessment of Laparoscopic Skills (GOALS) rating scale for assessing laparoscopic skills remotely and to identify how factors unique to remote assessment such as bandwidth and image quality influence its reliability. METHODS Four trained observers evaluated 19 participants for their technical performance during a laparoscopic cholecystectomy using the GOALS assessment tool. One observer assessed the study participants directly in the operating room, whereas the three remaining observers were randomly assigned and blinded to a high- (1.5 Mbps), medium- (256 kbps), or low- (64.4 kbps) bandwidth restriction and observed remotely via Skype. The Maryland Visual Comfort Scale was used to evaluate the video quality of the respective connections. RESULTS The intraclass correlation coefficient (ICC) calculated for the total GOALS score demonstrated a statistically significant correlation of high, medium, and low bandwidths respectively with ICC 0.693 (95 % confidence interval [CI], 0.226-0.883), 0.518 (95 % CI 0.089-0.783), and 0.499 (95 % CI 0.025-0.781). There was a statistically significant difference in the overall perceived visual quality between the high/low (Z = -3.222; P = 0.001) and the medium/low (Z = -3.567; P < 0.001) bandwidth comparison but no difference between the high/medium bandwidths (Z = -0.610; P = 0.542). CONCLUSION The data suggest that the GOALS assessment tool retains its reliability for intraoperative assessment of laparoscopic skills when used remotely. This is a key requirement in telesimulation programs allowing for structured feedback between the mentor and the mentee. This study quantifies the effect that bandwidth has on the reliability of remote assessment, demonstrating that higher bandwidths improve the utility of these tools.
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Affiliation(s)
- Ian Choy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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A comprehensive review of telementoring applications in laparoscopic general surgery. Surg Endosc 2012; 26:2111-6. [PMID: 22350150 DOI: 10.1007/s00464-012-2175-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 01/13/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Incorporation of advanced laparoscopic procedures in the practice of institutions without respective experience is a significant impediment in the dissemination of minimally invasive techniques. On-site mentoring programs carry several cost-related and practical constraints. Telementoring has emerged as a practical and cost-effective alternative mentoring tool. The present study aimed to review the pertinent literature on telementoring applications in laparoscopic general surgery. METHODS A systematic review using the Medline database was performed. Articles reporting on clinical experience with telementoring applications in general surgery were included. Variations in methodology, study design, and operative procedures precluded cumulative outcome evaluation. Instead, a critical appraisal of current evidence was undertaken. RESULTS Seventy-five articles were identified in the primary search, and ten studies were considered eligible. No randomized studies comparing on-site mentoring with telementoring were identified. The included studies reported on a total of 96 laparoscopic telementored procedures: 50 cholecystectomies, 23 colorectal resections, 7 fundoplications, 9 adrenalectomies, 6 hernia repairs, and 2 splenectomies. Completion of remotely assisted procedures was feasible in the vast majority of cases, whereas technical difficulties included video and audio latency with low transfer rates (<128 kbps) and inadequate guidance regarding the correct plane for dissection. CONCLUSION Current evidence supports the feasibility and safety of telementoring programs in general surgery. Their clinical effectiveness as teaching alternatives to traditional mentoring programs remains to be further evaluated.
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“Orthobot, to your station!” The application of the remote presence robotic system in orthopaedic surgery in Ireland: a pilot study on patient and nursing staff satisfaction. J Robot Surg 2010; 4:177-82. [DOI: 10.1007/s11701-010-0207-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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Parker A, Rubinfeld I, Azuh O, Blyden D, Falvo A, Horst M, Velanovich V, Patton P. What ring tone should be used for patient safety? Early results with a Blackberry-based telementoring safety solution. Am J Surg 2010; 199:336-40; discussion 340-1. [PMID: 20226906 DOI: 10.1016/j.amjsurg.2009.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 09/05/2009] [Accepted: 09/05/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Technology currently exists for the application of remote guidance in the laparoscopic operating suite. However, these solutions are costly and require extensive preparation and reconfiguration of current hardware. We propose a solution from existing technology, to send video of laparoscopic cholecystectomy to the Blackberry Pearl device (RIM Waterloo, ON, Canada) for remote guidance purposes. This technology is time- and cost-efficient, as well as reliable. METHODS After identification of the critical maneuver during a laparoscopic cholecystectomy as the division of the cystic duct, we captured a segment of video before it's transection. Video was captured using the laparoscopic camera input sent via DVI2USB Solo Frame Grabber (Epiphan Ottawa, Canada) to a video recording application on a laptop. Seven- to 40-second video clips were recorded. The video clip was then converted to an .mp4 file and was uploaded to our server and a link was then sent to the consultant via e-mail. The consultant accessed the file via Blackberry for viewing. After reviewing the video, the consultant was able to confidently comment on the operation. RESULTS Approximately 7 to 40 seconds of 10 laparoscopic cholecystectomies were recorded and transferred to the consultant using our method. All 10 video clips were reviewed and deemed adequate for decision making. CONCLUSION Remote guidance for laparoscopic cholecystectomy with existing technology can be accomplished with relatively low cost and minimal setup. Additional evaluation of our methods will aim to identify reliability, validity, and accuracy. Using our method, other forms of remote guidance may be feasible, such as other laparoscopic procedures, diagnostic ultrasonography, and remote intensive care unit monitoring. In addition, this method of remote guidance may be extended to centers with smaller budgets, allowing ubiquitous use of neighboring consultants and improved safety for our patients.
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Affiliation(s)
- Alton Parker
- Department of General Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
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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: 110] [Impact Index Per Article: 7.3] [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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Reiner B. Automating Radiologist Workflow Part 1: The Digital Consultation. J Am Coll Radiol 2008; 5:1080-5. [PMID: 18812153 DOI: 10.1016/j.jacr.2008.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Bruce Reiner
- Baltimore VA Medical Center, Department of Diagnostic Imaging, Baltimore, MD 21201, USA.
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Huang KJ, Qiu ZJ, Fu CY, Shimizu S, Okamura K. Uncompressed video image transmission of laparoscopic or endoscopic surgery for telemedicine. Telemed J E Health 2008; 14:479-85. [PMID: 18578684 DOI: 10.1089/tmj.2007.0088] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traditional narrowband telemedicine cannot provide quality dynamic images. We conducted videoconferences of laparoscopic and endoscopic operations via an uncompressed video transmission technique. A superfast broadband Internet link was set up between Shanghai in the People's Republic of China and Fukuoka in Japan. Uncompressed dynamic video images of laparoscopic and endoscopic operations were transmitted by a digital video transfer system (DVTS). Seven teleconferences were conducted between June 2005 and June 2007. Of the 7 teleconferences, 5 were live surgical demonstrations and 3 were recorded video teleconsultations. Smoothness of the motion picture, sharpness of images, and clarity of sound were benefited by this form of telemedicine based upon DVTS. Telemedicine based upon DVTS is a superior choice for laparoscopic and endoscopic skill training across the borders.
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Affiliation(s)
- Ke-Jian Huang
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai First Peoples Hospital, Shanghai, PR China.
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Pradeep PV, Mishra A, Mohanty BN, Mohapatra KC, Agarwal G, Mishra SK. Reinforcement of endocrine surgery training: impact of telemedicine technology in a developing country context. World J Surg 2008; 31:1665-71. [PMID: 17551784 DOI: 10.1007/s00268-007-9108-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS AND OBJECTIVES Technology-based outreach programs for knowledge sharing and skill development using telemedicine is a novel approach to developing subspecialties in regions where there is a lack of specialists and dedicated departments. Endocrine surgery is one such emerging subspecialty. There are few dedicated surgeons and centers even in the developed world. India has only one such center. The aim of this study was to assess the feasibility and impact of telemedicine on the reinforcement of endocrine surgery training at distant places to develop this subspecialty in a developing country such as India. MATERIAL AND METHODS Two faculty members from the General Surgery Department at SCB Medical College in Cuttack, Orissa, India registered at Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow for a short 3-month training course in endocrine surgery in 1998 and thereafter consulted through telephone calls and e-mail when required. Telemedicine-based mentoring was introduced in 2001 as a reinforcement method for continuing training and skills development. Various training modules were used, including tele-consultation, case presentation, treatment planning, tele-radiology, tele-pathology, and tele-continuing medical education (CME) programs and workshops. The outcome was assessed in terms of the increase in the number of patients with endocrine disorders seen and operated on by trainees and the complication rates. RESULTS A total of 70 telemedicine sessions were held between 2001 and 2005. They included tele-education and surgical treatment planning (n = 44), tele-consultation including tele-pathology and tele-radiology (n = 26), and tele-surgical conferences/CME (n = 6). The number of endocrine surgical cases performed by trainees after training (phase II) increased significantly compared to those before training (phase I), with a further increase after starting telemedicine-enabled mentoring (phase III). Most of the patients operated on by the trainees had thyroid problems, although these surgeons started operating on a few patients with parathyroid and adrenal disorders as well. The morbidity figures for the thyroidectomy operations (including total thyroidectomy) were comparable to those at the training institution. CONCLUSION The concept of training a group of motivated general surgeons to practice safe endocrine surgery at a remote center via telemedicine-aided reinforcement of their training is thus feasible. This is particularly true in the case of thyroidectomy operations, which constitute the major workload of endocrine surgery in our country. The same program might be applicable to the development of other medical subspecialties in a developing country as well.
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Affiliation(s)
- P V Pradeep
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Anvari M. Telesurgery: remote knowledge translation in clinical surgery. World J Surg 2007; 31:1545-50. [PMID: 17534550 DOI: 10.1007/s00268-007-9076-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 03/08/2007] [Indexed: 12/24/2022]
Abstract
Dissemination of new surgical knowledge, skills, and techniques across the wide spectrum of practicing surgeons in the community is often difficult and slow. This is even more problematic in countries such as Canada, where geographic distances separate a large portion of community surgeons from the large teaching centers. As an example, the penetration of advanced minimally invasive techniques in Canada has been severely hampered by the inability to provide adequate training opportunities and support for community surgeons, many of whom live in remote regions of the country. In an attempt to overcome the barriers that exist, the Centre for Minimal Access Surgery (CMAS) at McMaster University has been using broadband Internet and telecommunication systems to provide distance training and mentoring to community surgeons living in remote northern communities of Canada. This article describes our experience with telementoring and robot-assisted remote telepresence surgery and assisting, between a teaching hospital in Hamilton and two community hospitals in northern Ontario and Quebec.
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Affiliation(s)
- Mehran Anvari
- McMaster University, 8th Floor, Mary Grace Wing, 50 Charlton Ave. E, L8N 4A6, Hamilton, Ontario, Canada.
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