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Nakanoko T, Oki E, Ota M, Ikenaga N, Hisamatsu Y, Toshima T, Kanno T, Tadano K, Kawashima K, Ohuchida K, Morohashi H, Ebihara Y, Mimori K, Nakamura M, Yoshizumi T, Hakamada K, Hirano S, Ikeda N, Mori M. Real-time telementoring with 3D drawing annotation in robotic surgery. Surg Endosc 2023; 37:9676-9683. [PMID: 37935920 DOI: 10.1007/s00464-023-10521-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND In telementoring, differences in teaching methods affect local surgeons' comprehension. Because the object to be operated on is a three-dimensional (3D) structure, voice or 2D annotation may not be sufficient to convey the instructor's intention. In this study, we examined the usefulness of telementoring using 3D drawing annotations in robotic surgery. METHODS Kyushu University and Beppu Hospital are located 140 km apart, and the study was conducted using a Saroa™ surgical robot by RIVERFIELD Inc. using a commercial guarantee network on optical fiber. Twenty medical students performed vertical mattress suturing using a swine intestinal tract under surgical guidance at the Center for Advanced Medical Innovation Kyushu University. Surgical guidance was provided by Beppu Hospital using voice, 2D, and 3D drawing annotations. All robot operations were performed using 3D images, and only the annotations were independently switched between voice and 2D and 3D images. The operation time, needle movement, and performance were also evaluated. RESULTS The 3D annotation group tended to have a shorter working time than the control group (25.6 ± 63.2 vs. - 36.7 ± 65.4 min, P = 0.06). The 3D annotation group had fewer retries than the control group (1.3 ± 1.7 vs. - 1.1 ± 0.7, P = 0.006), and there was a tendency for fewer needle drops (0.4 ± 0.7 vs. - 0.5 ± 0.9, P = 0.06). The 3D annotation group scored significantly higher than the control group on the Global Evaluate Assessment of Robot Skills (16.8 ± 2.0 vs. 22.8 ± 2.4, P = 0.04). The 3D annotation group also scored higher than the voice (13.4 ± 1.2) and 2D annotation (16.2 ± 1.8) groups (3D vs. voice: P = 0.03, 3D vs. 2D: P = 0.03). CONCLUSION Telementoring using 3D drawing annotation was shown to provide good comprehension and a smooth operation for local surgeons.
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Affiliation(s)
- Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takeo Toshima
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | | | - Kotaro Tadano
- RIVERFIELD Inc, Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- RIVERFIELD Inc, Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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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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Shabir D, Abdurahiman N, Padhan J, Anbatawi M, Trinh M, Balakrishnan S, Al-Ansari A, Yaacoub E, Deng Z, Erbad A, Mohammed A, Navkar NV. Preliminary design and evaluation of a remote tele-mentoring system for minimally invasive surgery. Surg Endosc 2022; 36:3663-3674. [PMID: 35246742 PMCID: PMC9001542 DOI: 10.1007/s00464-022-09164-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/18/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tele-mentoring during surgery facilitates the transfer of surgical knowledge from a mentor (specialist surgeon) to a mentee (operating surgeon). The aim of this work is to develop a tele-mentoring system tailored for minimally invasive surgery (MIS) where the mentor can remotely demonstrate to the mentee the required motion of the surgical instruments. METHODS A remote tele-mentoring system is implemented that generates visual cues in the form of virtual surgical instrument motion overlaid onto the live view of the operative field. The technical performance of the system is evaluated in a simulated environment, where the operating room and the central location of the mentor were physically located in different countries and connected over the internet. In addition, a user study was performed to assess the system as a mentoring tool. RESULTS On average, it took 260 ms to send a view of the operative field of 1920 × 1080 resolution from the operating room to the central location of the mentor and an average of 132 ms to receive the motion of virtual surgical instruments from the central location to the operating room. The user study showed that it is feasible for the mentor to demonstrate and for the mentee to understand and replicate the motion of surgical instruments. CONCLUSION The work demonstrates the feasibility of transferring information over the internet from a mentor to a mentee in the form of virtual surgical instruments. Their motion is overlaid onto the live view of the operative field enabling real-time interactions between both the surgeons.
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Affiliation(s)
- Dehlela Shabir
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Nihal Abdurahiman
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Jhasketan Padhan
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Malek Anbatawi
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - May Trinh
- Department of Computer Science, University of Houston, Houston, TX, USA
| | - Shidin Balakrishnan
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abdulla Al-Ansari
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Elias Yaacoub
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Zhigang Deng
- Department of Computer Science, University of Houston, Houston, TX, USA
| | - Aiman Erbad
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Amr Mohammed
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Nikhil V Navkar
- Department of Surgery, Surgical Research Section, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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85-Year-Old Postsurgical Complex Patient Successfully Managed Remotely at the Novel Mayo Clinic’s Hospital at Home. Case Rep Vasc Med 2022; 2022:1439435. [PMID: 35251735 PMCID: PMC8896952 DOI: 10.1155/2022/1439435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
An 85-year-old male presented to the podiatry clinic following a 1st to 5th left toe amputation as a complication of severe peripheral arterial disease and nonhealing wound despite endovascular intervention with an angiogram. At the visit, cellulitis with gangrene of the surgical site was noted. The patient was admitted to the brick and mortar (BAM) hospital and taken to surgery for a transmetatarsal amputation of the left limb. In the immediate postoperative period, the incisional margins appeared dusky creating concern for flap viability. The medical team recommended a vascular bypass versus a below-knee amputation. However, given the age, comorbidities, and nutritional status, the family refused further surgical intervention. As such, Mayo Clinic's home hospital program, Advanced Care at Home (ACH), was consulted for continued nonsurgical acute management at home. The patient was transferred to ACH and transported home three days after BAM admission to continue IV antibiotic therapy and wound care. Discharge from ACH occurred 11 days after admission to the BAM hospital. This case highlights the importance of developing health care alternatives to traditional hospitalization and demonstrates that ACH can manage highly complex, elder postoperative patients from the comfort of their homes.
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Jin ML, Brown MM, Patwa D, Nirmalan A, Edwards PA. Telemedicine, telementoring, and telesurgery for surgical practices. Curr Probl Surg 2021; 58:100986. [PMID: 34895561 DOI: 10.1016/j.cpsurg.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Man Li Jin
- Resident in Ophthalmology, Henry Ford Hospital, Detroit, MI.
| | - Meghan M Brown
- Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Dhir Patwa
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Aravindh Nirmalan
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Paul A Edwards
- Chairman, Department of Ophthalmology, Henry Ford Hospital, Detroit, MI
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In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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Beqari J, Seymour NE. Application of technology to educational needs in surgery. J Surg Oncol 2021; 124:181-192. [PMID: 34245576 DOI: 10.1002/jso.26512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023]
Abstract
Innovations in surgical education follow advancing clinical technology. New surgical methods have prompted demand for systematic methods to leverage computing power and internet tools to achieve proficiency-based training goals. Virtual reality, high-fidelity patient simulation, web-based resources to facilitate performance assessment, and telementoring have become mainstream practices, although patient outcomes benefits are not well studied. Remote virtual meeting and mentoring have had transformative effects on resident experiences, the full effects of which remain to be seen.
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Affiliation(s)
- Jorind Beqari
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Neal E Seymour
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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8
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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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9
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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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Figueroa-Gutiérrez L. Educación quirúrgica durante la pandemia de COVID-19: primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
He leído con interés el artículo “Educación quirúrgica durante la pandemia de COVID-19: primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía” , publicado en el último número de la Revista Colombiana de Cirugía. En primer lugar se debe resaltar el papel protagónico que la División de Educación de la Asociación Colombiana de Cirugía y el Comité editorial de la Revista han tenido durante todo el desarrollo de la pandemia, lo que ha permito la elaboración y publicación de diversos documentos y recomendaciones encaminadas a que, desde las diferentes especialidades de la cirugía, se tengan instrumentos de trabajo basados en la mejor evidencia disponible sobre esta nueva condición clínica, que permitan dar respuesta a las necesidades de los pacientes, velando por la protección del personal de la salud
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Liu P, Li C, Xiao C, Zhang Z, Ma J, Gao J, Shao P, Valerio I, Pawlik TM, Ding C, Yilmaz A, Xu R. A Wearable Augmented Reality Navigation System for Surgical Telementoring Based on Microsoft HoloLens. Ann Biomed Eng 2020; 49:287-298. [PMID: 32504141 DOI: 10.1007/s10439-020-02538-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
This paper reports a new type of augmented reality (AR) system that integrates a Microsoft HoloLens device with a three-dimensional (3D) point tracking module for medical training and telementored surgery. In this system, a stereo camera is used to track the 3D position of a scalpel and transfer its coordinates wirelessly to a HoloLens device. In the scenario of surgical training, a virtual surgical scene with pre-recorded surgical annotations is superimposed with the actual surgical scene so that the surgical trainee is able to operate following virtual instructions. In the scenario of telementored surgery, the virtual surgical scene is co-registered with the actual surgical scene so that the virtual scalpel remotely mentored by an experienced surgeon provides the AR guidance for the inexperienced on-site operator. The performance characteristics of the proposed AR telementoring system are verified by benchtop experiments. The clinical applicability of the proposed system in telementored skin grafting surgery and fasciotomy is validated in a New Zealand rabbit model. Our benchtop and in vivo experiments demonstrate the potential to improve surgical performance and reduce healthcare disparities in remote areas with limited resources.
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Affiliation(s)
- Peng Liu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenmeng Li
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China.,Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Changlin Xiao
- Photogrammetric Computer Vision Laboratory, The Ohio State University, Columbus, USA
| | - Zeshu Zhang
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China.,Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Junqi Ma
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Jian Gao
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Pengfei Shao
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
| | - Ian Valerio
- Department of Surgery, The Ohio State University, Columbus, USA
| | | | - Chengbiao Ding
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Alper Yilmaz
- Photogrammetric Computer Vision Laboratory, The Ohio State University, Columbus, USA.
| | - Ronald Xu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, Anhui, China. .,Department of Biomedical Engineering, The Ohio State University, Columbus, USA.
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12
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Rojas-Muñoz E, Cabrera ME, Lin C, Sánchez-Tamayo N, Andersen D, Popescu V, Anderson K, Zarzaur B, Mullis B, Wachs JP. Telementoring in Leg Fasciotomies via Mixed-Reality: Clinical Evaluation of the STAR Platform. Mil Med 2020; 185:513-520. [PMID: 32074347 DOI: 10.1093/milmed/usz234] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Point-of-injury (POI) care requires immediate specialized assistance but delays and expertise lapses can lead to complications. In such scenarios, telementoring can benefit health practitioners by transmitting guidance from remote specialists. However, current telementoring systems are not appropriate for POI care. This article clinically evaluates our System for Telementoring with Augmented Reality (STAR), a novel telementoring system based on an augmented reality head-mounted display. The system is portable, self-contained, and displays virtual surgical guidance onto the operating field. These capabilities can facilitate telementoring in POI scenarios while mitigating limitations of conventional telementoring systems.
Methods
Twenty participants performed leg fasciotomies on cadaveric specimens under either one of two experimental conditions: telementoring using STAR; or without telementoring but reviewing the procedure beforehand. An expert surgeon evaluated the participants’ performance in terms of completion time, number of errors, and procedure-related scores. Additional metrics included a self-reported confidence score and postexperiment questionnaires.
Results
STAR effectively delivered surgical guidance to nonspecialist health practitioners: participants using STAR performed fewer errors and obtained higher procedure-related scores.
Conclusions
This work validates STAR as a viable surgical telementoring platform, which could be further explored to aid in scenarios where life-saving care must be delivered in a prehospital setting.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
| | - Maria Eugenia Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, 185 East Stevens Way NE, Seattle, WA 98195
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Natalia Sánchez-Tamayo
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
| | - Dan Andersen
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Voicu Popescu
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Kathryn Anderson
- Sydney and Lois Eskenazi Hospital, 720 Eskenazi Ave, Indianapolis, IN 46202
| | - Ben Zarzaur
- School of Medicine, Indiana University, 340 West 10th St., Suite 6200, Indianapolis, IN 46202
| | - Brian Mullis
- School of Medicine, Indiana University, 340 West 10th St., Suite 6200, Indianapolis, IN 46202
| | - Juan P Wachs
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
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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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14
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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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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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Bogen EM, Schlachta CM, Ponsky T. White paper: technology for surgical telementoring-SAGES Project 6 Technology Working Group. Surg Endosc 2019. [PMID: 30617422 DOI: 10.1007/s00464-00018-06631-00468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recent advances in telecommunication technology and video conferencing systems have opened a new avenue for surgical instruction called "surgical telementoring." This report from the Technology Working Group of the SAGES Project 6 Summit reviews the telementoring technology that currently exists and proposes recommendations for minimum technology requirements and future technology development. While also providing insight in regulatory considerations, this review offers what prospective surgical telementoring participants need to know about the underlying technology with a specific focus on safety, reliability, transmission quality, ease of use, and cost. METHODS Content experts from around the world, in minimally invasive surgery, surgical mentoring and telementoring, surgical education, business development, healthcare innovation, and regulation were invited to attend a 2-day summit in Los Angeles, USA to outline the current state of surgical telementoring and chart the challenges and opportunities going forward. This article summarizes the discussion, conclusions, and recommendation of the technology group with regard to telementoring technology. RESULTS This article reviews the technical requirements which can be divided into the following categories: (1) safety, (2) reliability, (3) transmission quality, (4) ease of use, and (5) cost. CONCLUSION Telementoring applications are technology driven. Given the pace of change of technology, guiding principles in technology design and selection are warranted (Table 4). Telementoring technologies require two basic components, video capturing and display devices at the transmitting and receiving end, and a telecommunication link between them. Many additional features can be added to this basic setup including multiple cameras or video sources, remote camera zoom and pan, recording and storage of videos and images, and telestration capabilities to mention just a few. In general, the cost of these technologies is feature driven. The education framework for each specific application should determine the need for these features (Schlachta in Surg Endosc https://doi.org/10.1007/s00464-016-4988-5 ).
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Affiliation(s)
- Etai M Bogen
- Department of Clinical Medicine, Faculty of Health Sciences - University of Tromsø, Tromsø, Norway.
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Todd Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital Akron, One Perkins Square, Akron, OH, 44308, USA
- Department of Pediatric Surgery, Cincinnati Children's Hospital, Cincinnati, USA
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Bogen EM, Schlachta CM, Ponsky T. White paper: technology for surgical telementoring—SAGES Project 6 Technology Working Group. Surg Endosc 2019; 33:684-690. [DOI: 10.1007/s00464-018-06631-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
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Bergström H, Larsson LG, Stenberg E. Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons: a cohort study. BMC Surg 2018; 18:92. [PMID: 30400860 PMCID: PMC6219023 DOI: 10.1186/s12893-018-0428-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of perioperative surgical complications is a worldwide issue: In many cases, these events are preventable. Audio-video recording during laparoscopic surgery provides useful information for the purposes of education and event analyses, and may have an impact on the focus of the surgeons operating. The aim of the present study was to investigate how audio-video recording in the operating room during laparoscopic surgery affects the focus of the surgeon and his/her assistant. Methods A group of laparoscopic procedures where video recording only was performed was compared to a group where both audio and video recordings were made. All laparoscopic procedures were performed at Lindesberg Hospital, Sweden, during the period August to September 2017. The primary outcome was conversation not relevant to the ongoing procedure. Secondary outcomes were intra- and postoperative adverse events or complications, operation time and number of times the assistant was corrected by the surgeon. Results The study included 41 procedures, 20 in the video only group and 21 in the audio-video group. The material comprised laparoscopic cholecystectomies, totally extraperitoneal inguinal hernia repairs and bariatric surgical procedures. Irrelevant conversation time fell from 4.2% of surgical time to 1.4% when both audio and video recordings were made (p = 0.002). No differences in perioperative adverse event or complication rates were seen. Conclusion Audio-video recording during laparoscopic abdominal surgery reduces irrelevant conversation time and may improve intraoperative safety and surgical outcome. Trial registration Available at FOU Sweden (ID: 232771) and retrospectively at Clinical trials.gov (ID: NCT03425175; date of registration 7/2 2018).
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Affiliation(s)
- Hannah Bergström
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Lars-Göran Larsson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
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Remote Supervision in Short-Term Global Health Experiences. J Trop Med 2018; 2018:5629109. [PMID: 30369952 PMCID: PMC6189672 DOI: 10.1155/2018/5629109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/26/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
The global health development community is increasingly examining the phenomenon of short-term experiences in global health (STEGH), with an aim to mitigate the negative impacts of such activities on host communities. Appropriate supervision is one strategy, but various barriers (e.g., institutional requirements) limit the availability of qualified supervisors. Remote supervision represents one potential model to provide supervision that may mitigate the negative impacts of STEGH. This paper reports observed outcomes from a description of a pilot remote supervision program employed in a global health program for Canadian undergraduate students. Benefits for learners included greater confidence and independence, greater perceived effectiveness in conducting their project abroad, and reassurance of remote support from their supervisor, supplemented with day-to-day guidance from the local partner. Host communities reported greater trust in the bidirectional nature of partnership with the visiting institution, empowerment through directing students' work, and improved alignment of projects with community needs. Finally, faculty noted that remote supervision provided greater flexibility and freedom when compared to traditional in-person supervision, allowing them to maintain professional duties at home. Collectively, this pilot suggests that remote supervision demonstrates a potential solution to mitigating the harms of STEGHs undertaken by learners by providing adequate and appropriate remote supervision.
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Marttos AC, Juca Moscardi MF, Alvim Fiorelli RK, Pust GD, Ginzburg E, Schulman CI, Grant AA, Namias N. Use of Telemedicine in Surgical Education: A Seven-Year Experience. Am Surg 2018. [DOI: 10.1177/000313481808400831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Uniformity in surgical education is challenging because surgical experience is based on rotation assignments. With work hour restrictions, the likelihood of residents being exposed to rare or unusual cases is diminished. Telemedicine may create a new learning paradigm for surgical education and supplement exposure for rare or unusual cases. A retrospective review (2010–2016) of teleconferences involving trauma centers worldwide was conducted. Participating hospitals included centers from underdeveloped countries to first world nations. Trauma cases were discussed among surgeons with different levels of experience and resource availability. Data collected included types of cases, anatomic injury patterns, hospital location, and the number of telemedicine centers and viewers participating. Seventy-three hospitals in 64 cities, spanning 27 countries, participated in 276 telemedicine grand round conferences. Cases discussed included penetrating trauma (47%), blunt trauma (42%), and blast injury (4%). The anatomic regions included were the thorax (28%), abdomen (26%), thoracoabdominal region (13%), neck (7%), and pelvis (6%). The most common injury discussed was vascular in nature (18%), followed by the lung, liver, diaphragm, and heart. The most common vascular lesion was in the aorta (18%), followed by the iliac vessels (8%) and the vena cava (7%). Telemedicine is a valuable tool, allowing the dissemination of diverse experiences. Most cases presented evaluated rare injuries or complex surgical approaches, which are not commonly seen on trauma sites. Learning different approaches in the management of complex trauma will make surgeons more prepared to deal with challenging cases.
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Affiliation(s)
- Antonio C. Marttos
- Jackson Memorial Hospital, Miami, Florida
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Gerd Daniel Pust
- Jackson Memorial Hospital, Miami, Florida
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Enrique Ginzburg
- Jackson Memorial Hospital, Miami, Florida
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Carl Ivan Schulman
- Jackson Memorial Hospital, Miami, Florida
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Nicholas Namias
- Jackson Memorial Hospital, Miami, Florida
- Miller School of Medicine, University of Miami, Miami, Florida
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Managing Emergencies in Rural North Queensland: The Feasibility of Teletraining. Int J Telemed Appl 2018; 2018:8421346. [PMID: 29849606 PMCID: PMC5937413 DOI: 10.1155/2018/8421346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/13/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Historically, the use of videoconference technologies in emergency medicine training has been limited. Whilst there are anecdotal reports of the use of teletraining for emergency medicine by rural doctors in Australia, minimal evidence exists in the literature. This paper aimed to explore the use of teletraining in the context of managing emergency presentations in rural hospitals. Methods Using a qualitative approach, a mixture of junior and senior doctors were invited to participate in semistructured interviews. Data were transcribed and analysed line by line. Applying the grounded theory principles of open and axial coding, themes and subthemes were generated. Results A total of 20 interviews were conducted with rural doctors, rural doctors who are medical educators, and emergency medicine specialists. Two major themes—(1) teletraining as education and (2) personal considerations—and ten subthemes were evident from the data. Most participants had some previous experience with teletraining. Access to peer teaching over videoconference was requested by rural generalist registrars. There was a preference for interactive training sessions, over didactic lectures with little mention of technical barriers to engagement. The ability of teletraining to reduce professional isolation was a major benefit for doctors practicing in remote locations. Discussion For these rural doctors, teletraining is a feasible method of education delivery. Wider application of teletraining such as its use in peer teaching needs to be explored. The benefits of teletraining suggest that teletraining models need to be core business for health services and training providers, including specialist colleges.
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Porretta AP, Alerci M, Wyttenbach R, Antonucci F, Cattaneo M, Bogen M, Toderi M, Guerra A, Sartori F, Di Valentino M, Tutta P, Limoni C, Gallino A, von Segesser LK. Long-term Outcomes of a Telementoring Program for Distant Teaching of Endovascular Aneurysm Repair. J Endovasc Ther 2017; 24:852-858. [DOI: 10.1177/1526602817730841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alessandra Pia Porretta
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Division of Cardiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mario Alerci
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Rolf Wyttenbach
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- University of Bern, Switzerland
| | - Francesco Antonucci
- Department of Radiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Mattia Cattaneo
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcel Bogen
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marco Toderi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Adriano Guerra
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Fabio Sartori
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcello Di Valentino
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Paolo Tutta
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Costanzo Limoni
- University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Augusto Gallino
- Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Ludwig K. von Segesser
- Cardiovascular Research Division, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Bilgic E, Turkdogan S, Watanabe Y, Madani A, Landry T, Lavigne D, Feldman LS, Vassiliou MC. Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review. Surg Innov 2017; 24:379-385. [PMID: 28494684 DOI: 10.1177/1553350617708725] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. METHODS A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. RESULTS A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. CONCLUSION Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.
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Affiliation(s)
- Elif Bilgic
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Sena Turkdogan
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Yusuke Watanabe
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada.,2 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Amin Madani
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Tara Landry
- 3 Montreal General Hospital Medical Library, McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Lavigne
- 3 Montreal General Hospital Medical Library, McGill University Health Centre, Montréal, QC, Canada
| | - Liane S Feldman
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Melina C Vassiliou
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, QC, Canada
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Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:51. [PMID: 28567070 PMCID: PMC5426099 DOI: 10.4103/jrms.jrms_809_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.
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Affiliation(s)
- Antonello Forgione
- Department of Surgical Oncology and Minimally Invasive Surgery, AIMS Academy, Niguarda Hospital, Milan, Italy
| | - Salman Y Guraya
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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Mastering minimally invasive esophagectomy requires a mentor; experience of a personal mentorship. Ann Med Surg (Lond) 2017; 13:38-41. [PMID: 28070329 PMCID: PMC5219610 DOI: 10.1016/j.amsu.2016.12.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 12/03/2022] Open
Abstract
Since the first laparoscopic procedure, there has been an steady increase in advanced minimally invasive surgery. These procedures include oncological colorectal, hepatobiliary and upper gastrointestinal surgery. Implementation of these procedures requires different and new skills for the surgeons who wish to perform these procedures. To accomplish this surgical teaching program, a mentorship seems the most ideal method to teach the apprentice surgeon these specific skills. At the VU medical center a teaching program for a minimally-invasive esophagectomy for esophageal cancer started in 2009. At first it started in different centers in the Netherlands and later on we also started mentoring other institutes throughout Europe, Latin America and India. In this article we describe our experience and the outcomes of this mentorship in advanced minimally invasive surgery. Not all residency programs include a teaching program with the guidance of dedicated mentors. Teaching minimally invasive surgery requires a mentor. A dedicated team should be set up for learning new minimally invasive techniques.
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Paterson C, McLuckie S, Yew-Fung C, Tang B, Lang S, Nabi G. Videotaping of surgical procedures and outcomes following extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer. J Surg Oncol 2016; 114:1016-1023. [DOI: 10.1002/jso.24484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Catherine Paterson
- Academic Section of Urology; School of Medicine; University of Dundee; Dundee, Scotland
| | | | - Chin Yew-Fung
- Academic Section of Urology; School of Medicine; University of Dundee; Dundee, Scotland
| | - Benjie Tang
- Cuscheiri Skills Centre; School of Medicine; University of Dundee; Dundee, Scotland
| | - Stephen Lang
- Academic Section of Urology; School of Medicine; University of Dundee; Dundee, Scotland
| | - Ghulam Nabi
- Academic Section of Urology; School of Medicine; University of Dundee; Dundee, Scotland
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Jarc AM, Stanley AA, Clifford T, Gill IS, Hung AJ. Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study. World J Urol 2016; 35:957-965. [PMID: 27671899 PMCID: PMC5486541 DOI: 10.1007/s00345-016-1944-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose In this study, we examine three-dimensional (3D) proctoring tools (i.e., semitransparent ghost tools overlaid on the surgeon’s field of view) on realistic surgical tasks. Additionally, we develop novel, quantitative measures of whether proctors exploit the additional capabilities offered by ghost tools. Methods Seven proctor–trainee pairs completed realistic surgical tasks such as tissue dissection and suturing in a live porcine model using 3D ghost tools on the da Vinci Xi Surgical System. The usability and effectiveness of 3D ghost tools were evaluated using objective measures of proctor performance based on proctor hand movements and button presses, as well as post-study questionnaires. Results Proctors exploited the capabilities of ghost tools, such as 3D hand movement (p < 0.001), wristedness (p < 0.001), finger pinch gestures (p < 0.001), and bimanual hand motions (p < 0.001). The median ghost tool excursion distances across proctors in the x-, y-, and z-directions were 57.6, 31.9, and 50.7, respectively. Proctors and trainees consistently evaluated the ghost tools as effective across multiple categories of mentoring. Trainees found ghost tools more helpful than proctors across all categories (p < 0.05). Conclusions Proctors exploit the augmented capabilities of 3D ghost tools during clinical-like training scenarios. Additionally, both proctors and trainees evaluated ghost tools as effective mentoring tools, thereby confirming previous studies on simple, inanimate tasks. Based on this preliminary work, advanced mentoring technologies, such as 3D ghost tools, stand to improve current telementoring and training technologies in robot-assisted minimally invasive surgery. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1944-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Thomas Clifford
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew J Hung
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Glenn IC, Bruns NE, Hayek D, Hughes T, Ponsky TA. Rural surgeons would embrace surgical telementoring for help with difficult cases and acquisition of new skills. Surg Endosc 2016; 31:1264-1268. [PMID: 27444835 DOI: 10.1007/s00464-016-5104-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical telementoring, consisting of an expert surgeon guiding a less experienced surgeon through advanced or novel cases from a remote location, is an evolving technology which has potential to become an integral part of surgical practice. This study sought to apprise the attitudes of rural general surgeons toward the possible benefits and applications of surgical telementoring in their practices. METHODS A survey assessing demographics and attitudes toward telementoring was e-mailed to members of the American College of Surgeons (ACS) Advisory Council for Rural Surgery and posted to the ACS website in areas targeting rural surgeons. A link to a webpage with a description of surgical telementoring and brief demonstrative video were included with the survey. RESULTS There were 159 respondents, with 82.3 % of them practicing in communities smaller than 50,000 people. Overall, 78.6 % felt that telementoring would be useful to their practice, and 69.8 % thought it would benefit their hospitals. There was no correlation between years of practice and perceived usefulness of surgical telementoring. When asked the single most useful, or primary, application of surgical telementoring there was a split between learning new techniques (46.5 %) and intraoperative assistance with unexpected findings (39.0 %). When asked to select all applications in which they would be interested in using telementoring from a list of possible uses, surgeons most frequently selected: intraoperative consultation for unexpected findings (67.7 %), trauma consultation (32.9 %), and laparoscopic colectomy (32.9 %). CONCLUSIONS Surgical telementoring is on the verge of widespread use but industry and surgical societies remain ambivalent about supporting its implementation due to concerns over lack of interest. This study demonstrates interest among rural surgeons. While there are differing opinions regarding compensation of the telementoring, the most common, single interest in the use of surgical telementoring was for learning new techniques or skill sets.
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Affiliation(s)
- Ian C Glenn
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Nicholas E Bruns
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Danial Hayek
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | | | - Todd A Ponsky
- Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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Brunckhorst O, Volpe A, van der Poel H, Mottrie A, Ahmed K. Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology. Eur Urol Focus 2016; 2:10-18. [DOI: 10.1016/j.euf.2016.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
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Snyderman CH, Gardner PA, Lanisnik B, Ravnik J. Surgical telementoring: A new model for surgical training. Laryngoscope 2016; 126:1334-8. [DOI: 10.1002/lary.25753] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Carl H. Snyderman
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Paul A. Gardner
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Bostjan Lanisnik
- Department of Otolaryngology; University of Maribor; Maribor Slovenia
| | - Janez Ravnik
- Department of Neurological Surgery; University of Maribor; Maribor Slovenia
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Joo S, Xu T, Makary MA. Video transparency: a powerful tool for patient safety and quality improvement. BMJ Qual Saf 2016; 25:911-913. [PMID: 26821797 DOI: 10.1136/bmjqs-2015-005058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Sarah Joo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tim Xu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Singh S, Sharma V, Patel P, Anuragi G, Sharma RG. Telementoring: an Overview and Our Preliminary Experience in the Setting Up of a Cost-effective Telementoring Facility. Indian J Surg 2016; 78:70-3. [PMID: 27186048 DOI: 10.1007/s12262-015-1429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Telementoring as a subset of telemedicine has evolved over the past few years, but it is yet to be utilized to its full potential. The technology holds promise in bridging divides of distance and enables far-flung areas to be mentored in operative advances. It thus has a special bearing in countries like India where health care is short staffed and many areas lack availability of quality care. We describe the setting up of a telementoring facility at our centre. As against a 'routine' facility with dedicated equipments which cost heavily, our facility was set up using mostly equipments commonly available in an operating room. The facility is presently functional and allows telementoring through an encrypted Web-based service. Our set-up design can be emulated in centres with financial constraint and can help raise the standard of surgical care.
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Affiliation(s)
- Suresh Singh
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Vivekanand Sharma
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Pinakin Patel
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Gajendra Anuragi
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Raj Govind Sharma
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
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A Multicenter Cardiovascular MR Network for Tele-Training and Beyond: Setup and Initial Experiences. J Am Coll Radiol 2015; 12:876-83. [DOI: 10.1016/j.jacr.2015.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 12/21/2022]
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Undurraga Perl V, Diggs B, Ham B, Schreiber M. Does surgery residency prepare residents to work at critical access hospitals? Am J Surg 2015; 209:828-32; discussion 832-3. [PMID: 25817397 DOI: 10.1016/j.amjsurg.2015.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Operations performed by surgeons working at Critical Access Hospitals (CAHs) and surgery residents have not been compared. METHODS Procedure codes logged by general surgery residents graduating from our institution in 2013 and 2014 were obtained. Procedure codes were obtained for all CAHs in our state for 2012 to 2013. Clinically relevant categories were compared among residents and general surgeons at CAHs. RESULTS A total of 34,246 procedures logged by general surgeons at CAHs were compared with 31,977 procedures logged by surgery residents. Endoscopy comprised 56.1% of cases done by general surgeons versus 9.1% of cases by residents (P < .001). Excluding endoscopy, rural surgeons had higher percentages in hernia, skin/soft tissue, cholecystectomy/common bile duct, rectal/anal, and breast cases. Residents who completed a rural surgery rotation had higher numbers in small/large bowel, hernia, breast, and endoscopy. CONCLUSIONS Surgery residency provides less exposure to endoscopy compared with a general surgery practice at CAHs. A rural rotation increases endoscopic exposure.
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Affiliation(s)
- Vicente Undurraga Perl
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Brian Diggs
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Bruce Ham
- Division of Trauma, Critical Care & Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Martin Schreiber
- Division of Trauma, Critical Care & Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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