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Grubnik VV, Parfentiev RS, Grubnyk VV, Grubnik YV, Sliepov VV. Transabdominal and retroperitoneal adrenalectomy: comparative study. Surg Endosc 2024; 38:1541-1547. [PMID: 38092972 DOI: 10.1007/s00464-023-10533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Laparoscopic adrenalectomy is recognized as the "gold standard" approach for benign adrenal tumors. The majority of surgeons opt for laparoscopic transabdominal adrenalectomies (LTA), while retroperitoneoscopic adrenalectomies (RPA) in the prone position have certain advantages for patients. The aim of this study was to compare the effectiveness and safety of the transabdominal and retroperitoneoscopic laparoscopic adrenalectomies. MATERIALS AND METHODS Between 2000 and 2021, our clinic performed 472 laparoscopic adrenalectomies. The age ranged from 19 to 79 years, with a mean age of 50.5 ± 10.2 years. The patient pool consisted of 315 women and 157 men. Tumor sizes ranged from 1 to 10 cm. RESULTS In a study of 316 patients undergoing LTA versus 156 with RPA, the TLA averaged 82.5 min (70-98), while the RPA took 56.4 min (46-62) (P < 0.001). Intraoperative blood loss was 110 cc for the LTA group and 80 cc for the RPA group (P < 0.05) Conversion rates stood at 2.5% for transabdominal and 4.5% for retroperitoneoscopic procedures (P = 0.254). At 24 h post-operation, pain scores were 3.6 and 1.6, respectively (P < 0.001). Time to resume solid oral intake was 15.2 h for TLA and 8 h for RPA, with hospital stays at 4.5 days and 3 days respectively (P < 0.001). Short-term complications occurred in 8.9% of transabdominal and 12.2% of retroperitoneoscopic patients (P = 0.257). CONCLUSIONS For small tumors, RPA offers advantages over the transabdominal method in surgery time, blood loss, post-op pain, and recovery. These benefits are enhanced for patients with prior abdominal surgeries. However, large tumors present challenges in the retroperitoneal approach due to limited space and anatomical orientation. If complications emerge, surgeons can seamlessly switch to the LTA.
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Affiliation(s)
| | - Roman S Parfentiev
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine
| | - Viktor V Grubnyk
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine.
| | - Yurii V Grubnik
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine
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Bui DT, Barnett T, Hoang H, Chinthammit W. Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study. JMIR MEDICAL EDUCATION 2023; 9:e47228. [PMID: 37782533 PMCID: PMC10580139 DOI: 10.2196/47228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. OBJECTIVE This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. METHODS This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR's usability, mentorship effectiveness, and mentees' self-confidence and skill performance. RESULTS A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees' confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees' individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. CONCLUSIONS This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research.
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Affiliation(s)
- Dung T Bui
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Ha Hoang
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Winyu Chinthammit
- Human Interface Technology Laboratory, School of Information and Communication Technology, College of Sciences and Engineering, University of Tasmania, Launceston, Australia
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Bui DT, Barnett T, Hoang H, Chinthammit W. Development of a framework to support situational tele-mentorship of rural and remote practice. MEDICAL TEACHER 2023; 45:642-649. [PMID: 36441667 DOI: 10.1080/0142159x.2022.2150607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Situational tele-mentorship refers to the use of technology to provide interactive, two-way communication between an advisor (the mentor) and a novice (mentee) to enhance the management of a dynamic clinical scenario in real-time.This article develops a conceptual framework to support situational tele-mentorship of healthcare professionals working in rural and remote practices by critically exploring the concept of mentorship within medical education literature and applied to healthcare professionals working in more isolated settings.The situational tele-mentorship framework consists of synchronous telecommunication technologies and the problem-solving process. The end-users of the framework are the mentor located centrally and the mentee dealing with a challenging situation at a remote location using communication technology. The problem-solving process' stages are preparation, identification, action, and evaluation. The mentor and mentee use the 5W1H model, which is a summary of the questions of who, what, where, when, why, and how, applied in two-way communication.This framework provides medical teachers and clinicians with a detailed, yet concise exposition of critical elements required to implement situational tele-mentorship. Healthcare providers can also use this framework to help coordinate resources and manage stakeholders in tele-mentoring situations.
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Affiliation(s)
- Dung T Bui
- School of Health Sciences, College of Health and Medicine, Centre for Rural Health, University of Tasmania, Launceston, Australia
| | - Tony Barnett
- School of Health Sciences, College of Health and Medicine, Centre for Rural Health, University of Tasmania, Launceston, Australia
| | - Ha Hoang
- School of Health Sciences, College of Health and Medicine, Centre for Rural Health, University of Tasmania, Launceston, Australia
| | - Winyu Chinthammit
- Discipline of ICT, Human Interface Technology Laboratory, School of Technology, Environments and Design, College of Sciences and Engineering, University of Tasmania, Launceston, Australia
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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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Endo K, Morishima K, Koizumi M, Sasanuma H, Sakuma Y, Lefor AK, Sata N. Lateral retroperitoneal adrenalectomy: Comparison of introduction and education periods of a new surgical procedure in a teaching hospital. A retrospective case series study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pfennig M, Lee A, Mi M. How does telementoring impact medical education within the surgical field? A scoping review. Am J Surg 2022; 224:869-880. [PMID: 35545476 PMCID: PMC9417933 DOI: 10.1016/j.amjsurg.2022.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Background Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. Methods A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. Results The overall consensus of telementoring experience among all 25 studies was generally positive, citing “positive experience,” “increased confidence,” and “increased surgical skill.” Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. Conclusions The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.
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Affiliation(s)
- Mitchell Pfennig
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Andrew Lee
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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Zhang F, Contreras CM, Shao P, Zhao L, Wu B, Li C, Lin F, Zhong X, Lang Z, Liu P, Xu RX. Co-axial Projective Imaging for Augmented Reality Telementoring in Skin Cancer Surgery. Ann Biomed Eng 2022; 50:1846-1856. [PMID: 35788468 PMCID: PMC9255459 DOI: 10.1007/s10439-022-03000-4] [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: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 12/30/2022]
Abstract
Telemedicine has the potential to overcome the unequal distribution of medical resources worldwide. In this study, we report the second-generation co-axial projective imaging (CPI-2) system featured with orthotopic image projection for augmented reality surgical telementoring. The CPI-2 system can acquire surgical scene images from the local site, transmit them wirelessly to the remote site, and project the virtual annotations drawn by a remote expert with great accuracy to the surgical field. The performance characteristics of the CPI-2 system are quantitatively verified in benchtop experiments. The ex vivo study that compares the CPI-2 system and a monitor-based telementoring system shows that the CPI-2 system can reduce the focus shift and avoid subjective mapping of the instructions from a monitor to the real-world scene, thereby saving operation time and achieving precise teleguidance. The clinical feasibility of the CPI-2 system is validated in teleguided skin cancer surgery. Our ex vivo and in vivo experiment results imply the improved performance of surgical telementoring, and the clinical utility of deploying the CPI-2 system for surgical interventions in resource-limited settings. The CPI-2 system has the potential to reduce healthcare disparities in remote areas with limited resources.
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Affiliation(s)
- Fan Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026 Anhui China ,Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, 230026 Anhui China
| | - Carlo M. Contreras
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Pengfei Shao
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026 Anhui China ,Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, 230026 Anhui China
| | - Liping Zhao
- First Affiliated Hospital, University of Science and Technology of China, Hefei, 230031 Anhui China
| | - Bingxuan Wu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026 Anhui China ,Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, 230026 Anhui China
| | - Chenmeng Li
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026 Anhui China ,Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, 230026 Anhui China
| | - Feng Lin
- First Affiliated Hospital, University of Science and Technology of China, Hefei, 230031 Anhui China
| | - Xiaohong Zhong
- First Affiliated Hospital, University of Science and Technology of China, Hefei, 230031 Anhui China
| | - Zhongliang Lang
- First Affiliated Hospital, University of Science and Technology of China, Hefei, 230031 Anhui China
| | - Peng Liu
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, 215000 Jiangsu China
| | - Ronald X. Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026 Anhui China ,Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, 215000 Jiangsu China
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8
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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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9
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Galvao Neto M, Jerez J, Brunaldi VO, Cabrera D, Benavides C, Moreno M, Romero G, Guiatara D, Abu Dayyeh BK. Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure. Obes Surg 2021; 31:5486-5493. [PMID: 34664148 PMCID: PMC8523006 DOI: 10.1007/s11695-021-05757-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023]
Abstract
Background and Aims The COVID‐19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician’s ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG). Methods Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition. Results All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves. Conclusions The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic. Graphical abstract ![]()
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Affiliation(s)
- Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | - Jonathan Jerez
- Diagnostic and Therapeutic Gastroenterology Amazon Region, Puyo, Ecuador
| | - Vitor Ottoboni Brunaldi
- Center for Digestive Endoscopy, Surgery and Anatomy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, Brazil.
| | - David Cabrera
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Christian Benavides
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Monica Moreno
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Ginesio Romero
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Daniela Guiatara
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Gerardo R, Lele P, Sundaram K, Ponsky T. Surgical telementoring: Feasibility, applicability, and how to. J Surg Oncol 2021; 124:241-245. [PMID: 34245573 DOI: 10.1002/jso.26511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022]
Abstract
Surgical training does not end at the conclusion of residency training. Expansions in medical technology and surgical technique have created a steep learning curve for the young attending surgeon. The emergence of intraoperative telementoring has allowed experienced surgeons to guide learners through complex surgical cases remotely with the assistance of streaming video technology. Here, we describe the basics of telementoring, financial and legal considerations, and recommend hardware specifications for optimal use.
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Affiliation(s)
- Rodrigo Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Prachi Lele
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Krithika Sundaram
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Todd Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
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11
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Tong HS, Ng YL, Liu Z, Ho JDL, Chan PL, Chan JYK, Kwok KW. Real-to-virtual domain transfer-based depth estimation for real-time 3D annotation in transnasal surgery: a study of annotation accuracy and stability. Int J Comput Assist Radiol Surg 2021; 16:731-739. [PMID: 33786777 PMCID: PMC8134290 DOI: 10.1007/s11548-021-02346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Surgical annotation promotes effective communication between medical personnel during surgical procedures. However, existing approaches to 2D annotations are mostly static with respect to a display. In this work, we propose a method to achieve 3D annotations that anchor rigidly and stably to target structures upon camera movement in a transnasal endoscopic surgery setting. METHODS This is accomplished through intra-operative endoscope tracking and monocular depth estimation. A virtual endoscopic environment is utilized to train a supervised depth estimation network. An adversarial network transfers the style from the real endoscopic view to a synthetic-like view for input into the depth estimation network, wherein framewise depth can be obtained in real time. RESULTS (1) Accuracy: Framewise depth was predicted from images captured from within a nasal airway phantom and compared with ground truth, achieving a SSIM value of 0.8310 ± 0.0655. (2) Stability: mean absolute error (MAE) between reference and predicted depth of a target point was 1.1330 ± 0.9957 mm. CONCLUSION Both the accuracy and stability evaluations demonstrated the feasibility and practicality of our proposed method for achieving 3D annotations.
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Affiliation(s)
- Hon-Sing Tong
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Yui-Lun Ng
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Zhiyu Liu
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Justin D L Ho
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Po-Ling Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR
| | - Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR.
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong.
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Wachs JP, Kirkpatrick AW, Tisherman SA. Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives. Annu Rev Biomed Eng 2021; 23:115-139. [PMID: 33770455 DOI: 10.1146/annurev-bioeng-083120-023315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes aset of requirements for such systems. We conclude with a perspective on the future of telementoring systems and the integration of artificial intelligence within those systems.
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Affiliation(s)
- Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
| | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine, Surgery, and Medicine; Snyder Institute for Chronic Diseases; and the Trauma Program, University of Calgary and Alberta Health Services, Calgary, Alberta T2N 2T9, Canada.,Tele-Mentored Ultrasound Supported Medical Interaction (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada
| | - Samuel A Tisherman
- Department of Surgery and the Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Rojas-Muñoz E, Lin C, Sanchez-Tamayo N, Cabrera ME, Andersen D, Popescu V, Barragan JA, Zarzaur B, Murphy P, Anderson K, Douglas T, Griffis C, McKee J, Kirkpatrick AW, Wachs JP. Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies. NPJ Digit Med 2020; 3:75. [PMID: 32509972 PMCID: PMC7242344 DOI: 10.1038/s41746-020-0284-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
Abstract
Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient's body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants' years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Maria Eugenia Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Daniel Andersen
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | - Voicu Popescu
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Ben Zarzaur
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Patrick Murphy
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Kathryn Anderson
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | | | | | - Jessica McKee
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
| | - Andrew W. Kirkpatrick
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB Canada
- Canadian Forces Medical Services, Ottawa, ON Canada
| | - Juan P. Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
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14
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Altieri MS, Carmichael H, Jones E, Robinson T, Pryor A, Madani A. Educational value of telementoring for a simulation-based fundamental use of surgical energy™ (FUSE) curriculum: a randomized controlled trial in surgical trainees. Surg Endosc 2020; 34:3650-3655. [DOI: 10.1007/s00464-020-07609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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Surgical Telementoring Without Encumbrance: A Comparative Study of See-through Augmented Reality-based Approaches. Ann Surg 2020; 270:384-389. [PMID: 29672404 DOI: 10.1097/sla.0000000000002764] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study investigates the benefits of a surgical telementoring system based on an augmented reality head-mounted display (ARHMD) that overlays surgical instructions directly onto the surgeon's view of the operating field, without workspace obstruction. SUMMARY BACKGROUND DATA In conventional telestrator-based telementoring, the surgeon views annotations of the surgical field by shifting focus to a nearby monitor, which substantially increases cognitive load. As an alternative, tablets have been used between the surgeon and the patient to display instructions; however, tablets impose additional obstructions of surgeon's motions. METHODS Twenty medical students performed anatomical marking (Task1) and abdominal incision (Task2) on a patient simulator, in 1 of 2 telementoring conditions: ARHMD and telestrator. The dependent variables were placement error, number of focus shifts, and completion time. Furthermore, workspace efficiency was quantified as the number and duration of potential surgeon-tablet collisions avoided by the ARHMD. RESULTS The ARHMD condition yielded smaller placement errors (Task1: 45%, P < 0.001; Task2: 14%, P = 0.01), fewer focus shifts (Task1: 93%, P < 0.001; Task2: 88%, P = 0.0039), and longer completion times (Task1: 31%, P < 0.001; Task2: 24%, P = 0.013). Furthermore, the ARHMD avoided potential tablet collisions (4.8 for 3.2 seconds in Task1; 3.8 for 1.3 seconds in Task2). CONCLUSION The ARHMD system promises to improve accuracy and to eliminate focus shifts in surgical telementoring. Because ARHMD participants were able to refine their execution of instructions, task completion time increased. Unlike a tablet system, the ARHMD does not require modifying natural motions to avoid collisions.
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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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17
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Gimm O, Barczyński M, Mihai R, Raffaelli M. Training in endocrine surgery. Langenbecks Arch Surg 2019; 404:929-944. [PMID: 31701231 PMCID: PMC6935392 DOI: 10.1007/s00423-019-01828-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. METHODS A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. RESULTS For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs. CONCLUSIONS Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Clinical and Experimental Medicine (IKE), Linköping University, 58183 Linköping, Sweden
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202 Kraków, Poland
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 7DU United Kingdom
| | - Marco Raffaelli
- U.O. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
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Dworak J, Wysocki M, Rzepa A, Natkaniec M, Pędziwiatr M, Budzyński A, Major P. Laparoscopic adrenalectomy - is it safe in hands of residents in training? BMC Urol 2019; 19:102. [PMID: 31660932 PMCID: PMC6816204 DOI: 10.1186/s12894-019-0538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/10/2019] [Indexed: 01/10/2023] Open
Abstract
Background Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery. Methods A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”. Results We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741). Conclusions Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
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Affiliation(s)
- Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Anna Rzepa
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
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19
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Zhang F, Zhu X, Gao J, Wu B, Liu P, Shao P, Xu M, Pawlik TM, Martin EW, Xu RX. Coaxial projective imaging system for surgical navigation and telementoring. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-9. [PMID: 31650743 PMCID: PMC7000882 DOI: 10.1117/1.jbo.24.10.105002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/10/2019] [Indexed: 05/13/2023]
Abstract
A coaxial projective imaging (CPI) module acquires surgical scene images from the local site of surgery, transfers them wirelessly to the remote site, and projects instructive annotations to the surgical field. At the remote site, the surgical scene images are displayed, and the instructive annotations from a surgical specialist are wirelessly transferred back to the local site in order to guide the surgical intervention by a less experienced surgeon. The CPI module achieves seamless imaging of the surgical field and accurate projection of the instructive annotations, by a coaxial optical path design that couples the imaging arm with the projection arm and by a color correction algorithm that recovers the true color of the surgical scene. Our benchtop study of tele-guided intervention verifies that the proposed system has a positional accuracy of better than 1 mm at a working distance ranging from 300 to 500 mm. Our in vivo study of cricothyrotomy in a rabbit model proves the concept of tele-mentored surgical navigation. This is the first report of tele-guided surgery based on CPI. The proposed technique can be potentially used for surgical training and for telementored surgery in resource-limited settings.
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Affiliation(s)
- Fan Zhang
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Xiang Zhu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Jian Gao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Bingxuan Wu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Peng Liu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
- Address all correspondence to Peng Liu, E-mail: ; Ronald X. Xu, E-mail:
| | - Pengfei Shao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- University of Science and Technology of China, Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Hefei, China
| | - Min Xu
- Sino-Medic, Hefei, Anhui, China
| | - Timothy M. Pawlik
- The Ohio State University, Department of Surgery, Columbus, Ohio, United States
| | - Edward W. Martin
- The Ohio State University, Department of Surgery, Columbus, Ohio, United States
| | - Ronald X. Xu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, China
- The Ohio State University, Department of Biomedical Engineering, Columbus, Ohio, United States
- Address all correspondence to Peng Liu, E-mail: ; Ronald X. Xu, E-mail:
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Rojas-Muñoz E, Andersen D, Cabrera ME, Popescu V, Marley S, Zarzaur B, Mullis B, Wachs JP. Augmented Reality as a Medium for Improved Telementoring. Mil Med 2019; 184:57-64. [PMID: 30901394 DOI: 10.1093/milmed/usy300] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
Abstract
Combat trauma injuries require urgent and specialized care. When patient evacuation is infeasible, critical life-saving care must be given at the point of injury in real-time and under austere conditions associated to forward operating bases. Surgical telementoring allows local generalists to receive remote instruction from specialists thousands of miles away. However, current telementoring systems have limited annotation capabilities and lack of direct visualization of the future result of the surgical actions by the specialist. The System for Telementoring with Augmented Reality (STAR) is a surgical telementoring platform that improves the transfer of medical expertise by integrating a full-size interaction table for mentors to create graphical annotations, with augmented reality (AR) devices to display surgical annotations directly onto the generalist's field of view. Along with the explanation of the system's features, this paper provides results of user studies that validate STAR as a comprehensive AR surgical telementoring platform. In addition, potential future applications of STAR are discussed, which are desired features that state-of-the-art AR medical telementoring platforms should have when combat trauma scenarios are in the spotlight of such technologies.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, 315N. Grant St., West Lafayette, IN
| | - Dan Andersen
- Department of Computer Science, Purdue University, 305N. University St., West Lafayette, IN
| | - Maria Eugenia Cabrera
- School of Industrial Engineering, Purdue University, 315N. Grant St., West Lafayette, IN
| | - Voicu Popescu
- Department of Computer Science, Purdue University, 305N. University St., West Lafayette, IN
| | - Sherri Marley
- Indiana University School of Medicine, 340 West 10th St., Suite 6200, Indianapolis, IN
| | - Ben Zarzaur
- Indiana University School of Medicine, 340 West 10th St., Suite 6200, Indianapolis, IN
| | - Brian Mullis
- Indiana University School of Medicine, 340 West 10th St., Suite 6200, Indianapolis, IN
| | - Juan P Wachs
- School of Industrial Engineering, Purdue University, 315N. Grant St., West Lafayette, IN
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21
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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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Kakisaka Y, Jin K, Fujikawa M, Kitazawa Y, Nakasato N. Teleconference-based education of epileptic seizure semiology. Epilepsy Res 2018; 145:73-76. [PMID: 29913406 DOI: 10.1016/j.eplepsyres.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/22/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate whether a teleconference-based lecture provides similar understanding of seizure semiology to a face-to-face lecture for physicians. METHODS Subjects were 66 physicians consisting of adult and pediatric neurologists, neurosurgeons, psychiatrists, and general practitioners. All attended the 30-minute lecture to introduce various types of seizure semiology using video-clips by one of the authors (Yo.K.) and then joined the comprehensive case conference which discussed three cases in 1.5 h. Group A received the lecture and conference using a teleconference system (N = 43) and Group B attended in person (N = 23) for geographical reasons. After the conference, 32 subjects (23 in Group A and nine in Group B) scored their own post-lecture understanding of seizure semiology using the four-point Likert scale from 1 (not at all) to 4 (very well) as well as the estimated pre-lecture score. Data was analyzed to assess whether their understanding was improved after the lecture. RESULTS No significant difference was found in improvement of understanding after the lecture between Group A (43%) and Group B (22%; p = 0.42). Pre-lecture score of subjects with improved understanding was significantly lower (2.3 +/- 0.2) than those without improvement (3.7 +/- 0.1) (p < 0.05). SIGNIFICANCE Teleconference-based lectures can be a useful tool to educate seizure semiology for physicians, especially at the inexperienced level, by overcoming geographical limitations.
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Affiliation(s)
- Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yu Kitazawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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23
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Laparoscopic versus robotic adrenalectomy: a review of the national inpatient sample. J Robot Surg 2018; 13:69-75. [PMID: 29696591 DOI: 10.1007/s11701-018-0808-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions. Recently, robotic-assisted adrenalectomy (RA) has become an option, however, short-term outcomes for RA have not been well studied and benefits over LA are debatable. The aim of this study was to explore differences in short-term outcomes between LA and RA using the national inpatient sample (NIS) database. METHODS Patient data were collected from the NIS. All patients undergoing LA or RA from January 2009 to December 2012 were included. Univariate analysis and propensity matching were performed to look for differences between the groups. RESULTS A total of 1006 patients (66.4% in LA group and 33.6% in RA group) were identified. Patient age group, gender, race, risk of mortality, severity of illness or indication for adrenalectomy did not differ significantly between the LA or RA cohorts. Insurance type predicted procedure type (45% of medicare patients underwent RA versus 29% of patients with private insurance, p < 0.0001). Patients living in the highest income areas were more likely to receive the laparoscopic approach (31.7 versus 17.4%, p < 0.0001). Hospital volume, bed size and teaching status of the hospital were not significant factors in the decision of RA versus LA. There was no difference in complication and conversion rates between RA versus LA. The mean length of stay was shorter in the RA group (2.2 versus 1.9 days, p = 0.03). Total charges were higher in the RA group ($42,659 versus $33,748, p < 0.0001). There was a significant trend towards more adrenalectomies being performed robotic assisted by year. Only 22% of adrenalectomies were performed robotic-assisted in 2009 compared with 48% in 2012. CONCLUSIONS The overall benefit for RA remains small and higher total charges for RA may currently outweigh the benefits. These findings may change as more cases are performed robotically assisted and robotic technology improves.
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24
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Vrielink OM, Engelsman AF, Hemmer PHJ, de Vries J, Vorselaars WMCM, Vriens MR, Karakatsanis A, Hellman P, Sywak MS, van Leeuwen BL, El Moumni M, Kruijff S. Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. Br J Surg 2018; 105:544-551. [PMID: 29493779 DOI: 10.1002/bjs.10740] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 09/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. METHODS The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team. RESULTS A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures. CONCLUSION In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.
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Affiliation(s)
- O M Vrielink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A F Engelsman
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - P H J Hemmer
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J de Vries
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W M C M Vorselaars
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M R Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Karakatsanis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - P Hellman
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - M S Sywak
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M El Moumni
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Kruijff
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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25
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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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Ladd BM, Tackla RD, Gupte A, Darrow D, Sorenson J, Zuccarello M, Grande AW. Feasibility of Telementoring for Microneurosurgical Procedures Using a Microscope: A Proof-of-Concept Study. World Neurosurg 2017; 99:680-686. [DOI: 10.1016/j.wneu.2016.11.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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Andersen D, Popescu V, Cabrera ME, Shanghavi A, Gomez G, Marley S, Mullis B, Wachs JP. Medical telementoring using an augmented reality transparent display. Surgery 2016; 159:1646-1653. [DOI: 10.1016/j.surg.2015.12.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 11/24/2022]
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Gunter RL, Chouinard S, Fernandes-Taylor S, Wiseman JT, Clarkson S, Bennett K, Greenberg CC, Kent KC. Current Use of Telemedicine for Post-Discharge Surgical Care: A Systematic Review. J Am Coll Surg 2016; 222:915-27. [PMID: 27016900 PMCID: PMC5660861 DOI: 10.1016/j.jamcollsurg.2016.01.062] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Rebecca L Gunter
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Skyler Chouinard
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - Jason T Wiseman
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Sam Clarkson
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Kyla Bennett
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - K Craig Kent
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI.
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Ellimoottil C, Skolarus T, Gettman M, Boxer R, Kutikov A, Lee BR, Shelton J, Morgan T. Telemedicine in Urology: State of the Art. Urology 2016; 94:10-6. [PMID: 27109596 DOI: 10.1016/j.urology.2016.02.061] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
Whereas telemedicine is recognized as one of the fastest-growing components of the healthcare system, the status of telemedicine use in urology is largely unknown. In this narrative review, we detail studies that investigate the use of televisits and teleconsultations for urologic conditions. Moreover, we discuss current regulatory and reimbursement policies. Finally, we discuss the significant barriers to widespread dissemination and implementation of telemedicine and reasons why the field of urology may be positioned to become a leader in the provision of telemedicine services.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
| | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Matthew Gettman
- Department of Urology, Mayo Clinic College of Medicine, Rochester, MN
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, CA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Benjamin R Lee
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jeremy Shelton
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Todd Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
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Ibrahim AM, Varban OA, Dimick JB. Novel Uses of Video to Accelerate the Surgical Learning Curve. J Laparoendosc Adv Surg Tech A 2016; 26:240-2. [PMID: 27031876 DOI: 10.1089/lap.2016.0100] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementoring. Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.
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Affiliation(s)
- Andrew M Ibrahim
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Justin B Dimick
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
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Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg 2015; 260:740-7; discussion 747-8. [PMID: 25243546 DOI: 10.1097/sla.0000000000000982] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To test if posterior retroperitoneoscopic adrenalectomy (PRA) is superior to lateral transperitoneal laparoscopic adrenalectomy (LTLA). BACKGROUND Most popular LTLA has been recently challenged by an increasing popularity of PRA, which is believed by many surgeons (not evidence-based) as superior to LTLA in the treatment of small and benign adrenal tumors. METHODS Participants were assigned randomly to PRA or LTLA and followed for 5 years after surgery. The primary endpoint was the duration of surgery. Secondary endpoints were blood loss, conversion rate, postoperative recovery, morbidity, and costs. RESULTS Sixty-five patients were included, of whom 61 (PRA 30, LTLA 31) completed the 5-year follow-up. The following differences were identified in favor of PRA vs LTLA: shorter duration of surgery (50.8 vs 77.3 minutes), lower intraoperative blood loss (52.7 vs 97.8 mL), diminished pain intensity within 48 hours postoperatively, lower prevalence of shoulder-tip pain (3.0% vs 37.5%), shorter time to oral intake (4.4 vs 7.3 hours), shorter time to ambulation (6.1 vs 11.5 hours), shorter length of hospital stay, and lower cost (1728 € vs 2315 €), respectively (P<0.001 for all). No differences were noted in conversion rate or morbidity except for herniation occurring more often after LTLA than PRA (16.1% vs 0%, P=0.022) and need for hernia repair (12.9% vs 0%, P=0.050), respectively. CONCLUSIONS Both approaches were equally safe. However, outcomes of PRA operations were superior to LTLA in terms of shorter surgery duration, lower blood loss, lower postoperative pain, faster recovery, improved cost-effectiveness, and abolished risk of surgical access site herniation. REGISTRATION NUMBER NCT01959711 (http://www.clinicaltrials.gov).
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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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Ponsky TA, Bobanga ID, Schwachter M, Stathos TH, Rosen M, Parry R, Nalugo M, Rothenberg SS. Transcontinental Telementoring with Pediatric Surgeons: Proof of Concept and Technical Considerations. J Laparoendosc Adv Surg Tech A 2014; 24:892-6. [DOI: 10.1089/lap.2014.0363] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Michael Rosen
- University Hospital Case Medical Center, Cleveland, Ohio
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Bogen EM, Augestad KM, Patel HRH, Lindsetmo RO. Telementoring in education of laparoscopic surgeons: An emerging technology. World J Gastrointest Endosc 2014; 6:148-55. [PMID: 24944728 PMCID: PMC4024487 DOI: 10.4253/wjge.v6.i5.148] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/31/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these advanced procedures. We highlight in the review several key emerging technologies such as the telementoring and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.
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35
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Cabalag MS, Mann GB, Gorelik A, Miller JA. Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases. ANZ J Surg 2014; 85:478-82. [PMID: 24438017 DOI: 10.1111/ans.12508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative approach to minimally invasive adrenalectomy, potentially offering less pain and faster recovery compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their first 50 cases. METHODS Data were prospectively collected for 50 consecutive PRAs performed by the same surgeon. Patient demographics, tumour characteristics, analgesia use, operative and preparation time, length of stay, and complications were recorded. RESULTS Fifty adrenalectomies were performed in 49 patients. The median (range) age was 58.5 years (30-83) and the majority of patients were female (n = 33, 66.0%). The median (interquartile range (IQR)) preparation time was 35.5 (28.5-50.0) and median operation time was 70.5 (54-85) min, which decreased during the study period. After a learning curve of 15 cases, median operative time reached 61 min. PRA patients required minimal post-operative analgesia, with a median (IQR) of 0 (0-5) mg of intravenous morphine equivalent used. The median (IQR) length of stay was 1 (1-1) day, with 8 (16.0%) same-day discharges. There were four complications: one blood pressure lability from a phaeochromocytoma, one reintubation, one self-limited bleed and one temporary subcostal neuropraxia. There were no conversions to open surgery or deaths. CONCLUSION Our results support previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in minimal post-operative analgesia use and short length of hospital stay.
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Affiliation(s)
- Miguel S Cabalag
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Epworth Freemasons Hospital, Victoria, Australia
| | - G Bruce Mann
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
| | | | - Julie A Miller
- Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.,Epworth Freemasons Hospital, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
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36
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Chai YJ, Kwon H, Yu HW, Kim SJ, Choi JY, Lee KE, Youn YK. Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy. Int J Endocrinol 2014; 2014:918346. [PMID: 25587275 PMCID: PMC4281398 DOI: 10.1155/2014/918346] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/05/2014] [Indexed: 02/06/2023] Open
Abstract
Background. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. Recently, however, laparoscopic posterior retroperitoneal adrenalectomy (PRA) has been more popular as an alternative method. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy. Methods. PubMed, Embase, and ISI Web of Knowledge databases were searched systematically for studies comparing surgical outcomes of laparoscopic LTA versus PRA and laparoscopic versus robotic adrenalectomy. The studies were evaluated according to the PRISMA statement. Results. Eight studies comparing laparoscopic PRA and LTA showed that laparoscopic PRA was superior or at least comparable to laparoscopic LTA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. Six studies comparing robotic and laparoscopic adrenalectomy found that outcomes and complications were similar. Conclusion. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy.
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Affiliation(s)
- Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-70, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Hyungju Kwon
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Hyeong Won Yu
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Su-jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - June Young Choi
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, Republic of Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- *Kyu Eun Lee:
| | - Yeo-Kyu Youn
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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