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Danys D, Marcinkeviciute K, Cereska V, Miknevicius P, Poskus T, Osorio J. Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Obes Surg 2024; 34:1983-1986. [PMID: 38530550 DOI: 10.1007/s11695-024-07200-w] [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: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.
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Affiliation(s)
- Donatas Danys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania.
| | | | - Vaidas Cereska
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Povilas Miknevicius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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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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Youssef SC, Sabbubeh B, Haram K, Noël J, Aydın A, Challacombe B, Reeves F, Hachach-Haram N, Dasgupta P. Augmented reality robot-assisted radical prostatectomy with PROXIMIE: Preliminary clinical experience. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Lessons from the COVID-19 pandemic: remote coaching in bariatric surgery. Langenbecks Arch Surg 2022; 407:2763-2767. [PMID: 35854047 PMCID: PMC9296117 DOI: 10.1007/s00423-022-02612-7] [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: 01/28/2022] [Accepted: 07/13/2022] [Indexed: 12/02/2022]
Abstract
Background The development of fast internet connection has stimulated different types of video-assisted teaching programs. However, a remote mentoring with the proctor not on site has never been reported in bariatric surgery. We described our experiences with remote telementoring for laparoscopic sleeve gastrectomy. Methods A qualified general surgeon at the beginning of his bariatric practice performed a series of 8 laparoscopic sleeve gastrectomies (LSG) while tutored by an experienced bariatric surgeon connected from a different city through a specific videoconferencing platform. Data on demographics at baseline, operative time, hospital stay, intraoperative early, and late complications were collected. Results Mean age and BMI of patients were 36.9 ± 9.6 years old and 41.8 ± 1.7 kg/m2. All procedures were carried out without conversion to open or complications. Mean operative time was 112.4 ± 21.9 min while the hospital stay was 3.5 ± 0.5 days. Operative time significantly decreased after the fourth operation. Conclusions Remote coaching appears to be possible and safe for LSG.
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Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship. Ann Surg 2022; 276:e6-e15. [PMID: 34171862 DOI: 10.1097/sla.0000000000005014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains. SUMMARY OF BACKGROUND DATA During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas. METHODS The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations. RESULTS Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel. CONCLUSION The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.
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Thrumurthy S, Htet HMT, Denesh D, Kandiah K, Mohammed N, Gulati S, Emmanuel A, Bhandari P, Haji A, Hayee B. High burden of polyp mischaracterisation in tertiary centre referrals for endoscopic resection may be alleviated by telestration. Frontline Gastroenterol 2022; 14:32-37. [PMID: 36561787 PMCID: PMC9763650 DOI: 10.1136/flgastro-2022-102161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Endoscopic resection (ER) often involves referral to tertiary centres with high volume practices. Lesions can be subject to prior manipulation and mischaracterisation of features required for accurate planning, leading to prolonged or cancelled procedures. As potential solutions, repeating diagnostic procedures is burdensome for services and patients, while even enriched written reports and still images provide insufficient information to plan ER. This project sought to determine the frequency and implications of polyp mischaracterisation and whether the use of telestration might prevent it. DESIGN/METHOD A retrospective data analysis of ER referrals to four tertiary centres was conducted for the period July-December 2019. Prospective telestration with a novel digital platform was then performed between centres to achieve consensus on polyp features and ER planning. RESULTS 163 lesions (163 patients; mean age 67.9±12.2 y; F=62) referred from regional hospitals, were included. Lesion site was mismatched in 11 (6.7%). Size was not mentioned in the referral in 27/163 (16.6%) and incorrect in 81/136 (51.5%), more commonly underestimated by the referring centre (<0.0001), by a mean factor of 1.85±0.79. Incurred procedure time (in units of 20 min) was significantly greater than that allocated (p=0.0085). For 10 cases discussed prospectively, rapid consensus on lesion features was achieved, with agreement between experts on time required for ER. CONCLUSIONS Polyp mischaracterisation is a frequent feature of ER referrals, but could be corrected by the use of telestration between centres. Our study involved expert-to-expert consensus, so extending to 'real-world' referring centres would offer additional learning for a digital pathway.
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Affiliation(s)
- Sri Thrumurthy
- Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Deepa Denesh
- Endoscopy, St James's University Hospital, Leeds, West Yorkshire, UK
| | - Kesavan Kandiah
- Endoscopy, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Noor Mohammed
- Gastroenterology, St James's University Hospital, Leeds, UK,Endoscopy, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Shraddha Gulati
- Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Andrew Emmanuel
- Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Pradeep Bhandari
- Gastoenterology, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Amyn Haji
- Endoscopy, King's College Hospital, London, UK
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Mulita F, Verras GI, Anagnostopoulos CN, Kotis K. A Smarter Health through the Internet of Surgical Things. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22124577. [PMID: 35746359 PMCID: PMC9231158 DOI: 10.3390/s22124577] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 05/14/2023]
Abstract
(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.
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Affiliation(s)
- Francesk Mulita
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Department of Surgery, General University Hospital of Patras, 26504 Rio, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
| | | | | | - Konstantinos Kotis
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
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Pfennig M, Lee A, Mi M. How does telementoring impact medical education within the surgical field? A scoping review. Am J Surg 2022; 224:869-880. [PMID: 35545476 PMCID: PMC9417933 DOI: 10.1016/j.amjsurg.2022.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Background Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. Methods A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. Results The overall consensus of telementoring experience among all 25 studies was generally positive, citing “positive experience,” “increased confidence,” and “increased surgical skill.” Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. Conclusions The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.
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Affiliation(s)
- Mitchell Pfennig
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Andrew Lee
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1948-1964. [PMID: 34059480 PMCID: PMC8894132 DOI: 10.1016/j.jsurg.2021.05.001] [Citation(s) in RCA: 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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Froylich D, Gerszman E, Khatib E, Daigle CR, Eldar SM, Hazzan D. Do Early Outcomes of Sleeve Gastrectomy Improve the First Year After Completing a Bariatric Surgery Fellowship? Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dvir Froylich
- Department of Surgery B, Carmel Medical Center, Haifa, Israel
| | - Eden Gerszman
- Department of Surgery B, Carmel Medical Center, Haifa, Israel
| | - Edress Khatib
- Department of Surgery B, Carmel Medical Center, Haifa, Israel
| | - Christopher R. Daigle
- Department of General Surgery, Bariatric Center, Akron General, Clevelant Clinic, Akron, Ohio, USA
| | - Shai M. Eldar
- Department of Surgery B, Bariatric Unit, The Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Hazzan
- Department of Surgery B, Carmel Medical Center, Haifa, Israel
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Huang EY, Knight S, Guetter CR, Davis CH, Moller M, Slama E, Crandall M. Telemedicine and telementoring in the surgical specialties: A narrative review. Am J Surg 2019; 218:760-766. [PMID: 31350010 DOI: 10.1016/j.amjsurg.2019.07.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology. DATA SOURCES A search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients. CONCLUSIONS Telemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.
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Affiliation(s)
- Eunice Y Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N. Dunlap St., Second Floor, Memphis, TN, 38105, USA.
| | - Samantha Knight
- Southern Illinois School of Medicine, 701 N. First Street, PO Box 19638, Springfield, IL, 62702, USA.
| | - Camila Roginski Guetter
- Federal University of Parana, Medical School. Rua Padre Camargo, 285. Alto da Glória, Curitiba, PR, 80060-240, Brazil.
| | | | - Mecker Moller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, Fl, 33131, USA.
| | - Eliza Slama
- Department of Surgery, St. Agnes Hospital, 900 S. Caton Avenue, Baltimore, MD, 21229, USA.
| | - Marie Crandall
- University of Florida College of Medicine, Jacksonville 655 W. 8th Street Jacksonville, FL, 32209, USA.
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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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Kaijser MA, van Ramshorst GH, Emous M, Veeger NJGM, van Wagensveld BA, Pierie JPEN. A Delphi Consensus of the Crucial Steps in Gastric Bypass and Sleeve Gastrectomy Procedures in the Netherlands. Obes Surg 2018; 28:2634-2643. [PMID: 29633151 PMCID: PMC6132743 DOI: 10.1007/s11695-018-3219-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Bariatric procedures are technically complex and skill demanding. In order to standardize the procedures for research and training, a Delphi analysis was performed to reach consensus on the practice of the laparoscopic gastric bypass and sleeve gastrectomy in the Netherlands. METHODS After a pre-round identifying all possible steps from literature and expert opinion within our study group, questionnaires were send to 68 registered Dutch bariatric surgeons, with 73 steps for bypass surgery and 51 steps for sleeve gastrectomy. Statistical analysis was performed to identify steps with and without consensus. This process was repeated to reach consensus of all necessary steps. RESULTS Thirty-eight participants (56%) responded in the first round and 32 participants (47%) in the second round. After the first Delphi round, 19 steps for gastric bypass (26%) and 14 for sleeve gastrectomy (27%) gained full consensus. After the second round, an additional amount of 10 and 12 sub-steps was confirmed as key steps, respectively. Thirteen steps in the gastric bypass and seven in the gastric sleeve were deemed advisable. Our expert panel showed a high level of consensus expressed in a Cronbach's alpha of 0.82 for the gastric bypass and 0.87 for the sleeve gastrectomy. CONCLUSIONS The Delphi consensus defined 29 steps for gastric bypass and 26 for sleeve gastrectomy as being crucial for correct performance of these procedures to the standards of our expert panel. These results offer a clear framework for the technical execution of these procedures.
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Affiliation(s)
- Mirjam A. Kaijser
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
- Medical Centre Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
| | - Gabrielle H. van Ramshorst
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marloes Emous
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
| | - Nic J. G. M. Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bart A. van Wagensveld
- QURO Obesity Centers – Middle East, Dubai, United Arab Emirates
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - Jean-Pierre E. N. Pierie
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
- Medical Centre Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
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Alcántara-Aragón V, Rodrigo-Cano S, Lupianez-Barbero A, Martinez MJ, Martinez C, Tapia J, Iniesta JM, Tenes S, Urgell E, Navarro G, Hernando ME, Merino-Torres JF, de Leiva A, Gonzalez C. Web Support for Weight-Loss Interventions: PREDIRCAM2 Clinical Trial Baseline Characteristics and Preliminary Results. Diabetes Technol Ther 2018; 20:380-385. [PMID: 29620918 DOI: 10.1089/dia.2017.0456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An ongoing clinical trial is testing the efficacy of web telematic support in a structured program for obesity treatment and diabetes prevention. Participants were recruited from two tertiary-care hospitals and randomized to receive either a telematic intervention (TI) supported by PREDIRCAM2 web platform or a non-telematic intervention (NTI). All receive 1-year follow-up. Both interventions consist of tailored dietary and exercise prescriptions, based on a Mediterranean dietary pattern and general WHO exercise recommendations for adults. At 6 months, both groups have received 7 contacts, 3 exclusively telematic for the TI group. This is a preliminary result intention-to-treat analysis. One hundred eighty-three participants were recruited, with a mean body mass index of 34.75 ± 2.75 kg/m2. General dropout rate at 6 months was 26.8%. Weight changes were statistically significant at months 3 and 6 compared to baseline, -2.915 ± 0.24 kg, -3.29 ± 0.36 kg, respectively (P < 0.001), but not statistically significant between the 3- and 6-month time points -0.37 ± 0.21 kg (P = 0.24). Mean group differences showed that the TI group lost 1.61 ± 1.88 kg more than the NTI group (P = 0.39). Waist, waist/hip ratio, resting heart rate, blood pressure, HbA1c, and low-density lipoprotein cholesterol also showed statistically significant changes at 6 months, with no significant differences between groups. Weight loss in the TI group shows similar results as the usual care NTI group for weight loss and control of obesity comorbidities. At completion of the clinical trial, these results will be reevaluated to assess the potential role of web support in weight-loss maintenance and its cost-effectiveness.
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Affiliation(s)
- Valeria Alcántara-Aragón
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Susana Rodrigo-Cano
- 3 Endocrinology and Nutrition Department, Hospital Universitari i Politècnic La Fe , Valencia, Spain
- 4 Unidad Mixta de Investigación Endocrinología, Nutrición y Dietética, Instituto Investigación Sanitaria La Fe-Universitat de Valencia , Spain
| | - Ascension Lupianez-Barbero
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
| | - María José Martinez
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
| | - Carmen Martinez
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
| | - José Tapia
- 5 Centro de Tecnología Biomédica, ETSI de Telecommunicación, Universidad Politécnica , de Madrid, Spain
| | - José Manuel Iniesta
- 5 Centro de Tecnología Biomédica, ETSI de Telecommunicación, Universidad Politécnica , de Madrid, Spain
| | - Susana Tenes
- 3 Endocrinology and Nutrition Department, Hospital Universitari i Politècnic La Fe , Valencia, Spain
- 4 Unidad Mixta de Investigación Endocrinología, Nutrición y Dietética, Instituto Investigación Sanitaria La Fe-Universitat de Valencia , Spain
| | - Eulalia Urgell
- 6 Biochemistry Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
| | - Gemma Navarro
- 7 Nutrition and Dietetics Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
| | - M Elena Hernando
- 5 Centro de Tecnología Biomédica, ETSI de Telecommunicación, Universidad Politécnica , de Madrid, Spain
- 8 Centro de Investigación Biomédica en Red en Bioingeniería , Biomateriales y Nanomedicina (CIBER-BBN), EDUAB-HSP, Barcelona, Spain
| | - Juan Francisco Merino-Torres
- 3 Endocrinology and Nutrition Department, Hospital Universitari i Politècnic La Fe , Valencia, Spain
- 4 Unidad Mixta de Investigación Endocrinología, Nutrición y Dietética, Instituto Investigación Sanitaria La Fe-Universitat de Valencia , Spain
| | - Alberto de Leiva
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
- 8 Centro de Investigación Biomédica en Red en Bioingeniería , Biomateriales y Nanomedicina (CIBER-BBN), EDUAB-HSP, Barcelona, Spain
| | - Cintia Gonzalez
- 1 Endocrinology and Nutrition Department, Hospital de la Santa Creu I Sant Pau , Barcelona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
- 8 Centro de Investigación Biomédica en Red en Bioingeniería , Biomateriales y Nanomedicina (CIBER-BBN), EDUAB-HSP, Barcelona, Spain
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15
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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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16
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Cain SM, Moore R, Sturm L, Mason T, Fuhrman C, Smith R, Bojicic I, Carter B. Clinical assessment and management of general surgery patients via synchronous telehealth. J Telemed Telecare 2016; 23:371-375. [PMID: 26936865 DOI: 10.1177/1357633x16636245] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This paper describes how a clinical team at Landstuhl Regional Medical Center (LRMC) successfully integrated synchronous telehealth (TH) into their routine clinical practice. Methods and materials Synchronous TH encounters were performed using Polycom® software on surgeons' computers with high-definition (HD) cameras on monitors at distant sites and PolyCom HDX9000® Telehealth Practitioner Carts at originating sites. Patients provided consented and were presented to general surgeons by nurses and medical technicians at Army health clinics throughout the European Theater. Results In calendar year (CY) 2014, five general surgeons and two surgical physician assistants (PAs) at Landstuhl Regional Medical Center along with registered nurses (RNs) at six originating clinic sites throughout Europe completed 130 synchronous TH encounters for 101 general surgery patients resulting in 73 completed and 16 recommended surgeries. Eighty-eight percent of patients had a completed or recommended surgery. No surgeries or procedures planned after initial TH evaluation were cancelled. Originating site clinics ranged in distance from 68 miles to 517 miles. Acceptance by providers, patients and clinic staff was high. Conclusion Synchronous TH was effective and safe in evaluating common general surgical conditions. We excluded sensitive and complex conditions requiring a nuanced physical examination. The TH efforts of the general surgery staff have resulted in high-quality, seamless and predictable TH activities that continue to expand into other surgical and medical specialties beyond general surgery. Seven surgeons and two PAs use synchronous TH regularly serving patients over a broad geographic area.
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Affiliation(s)
| | - Robert Moore
- United States Army Regional Medical Center, Germany
| | - Lauren Sturm
- United States Army Regional Medical Center, Germany
| | - Travis Mason
- United States Army Regional Medical Center, Germany
| | | | - Robin Smith
- United States Army Regional Medical Center, Germany
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