Telementoring: An Important Enabling Tool for the Community Surgeon

Abstract

This study evaluated the efficacy of telementoring as an enabling tool for community general surgeons to perform advanced laparoscopic surgical procedures. We present a series of 19 patients who underwent advanced laparoscopic surgical procedures in two community hospitals, between November 2002 and July 2003, by four community surgeons with no formal advanced laparoscopic training. Each surgeon was telementored by an expert surgeon from a tertiary care hospital. Telementoring was achieved with real-time two-way audio-video communications over Internet Protocol or Integrated Services Digital Network lines with bandwidths from 385 kbps to 1.2 mbps. The procedures included 10 bowel resections, 5 Nissen fundoplications, 2 splenectomies, 1 reversal of a Hartmann procedure, and 1 ventral hernia repair. Two of the 19 procedures (11%) were converted to open. There were no intraoperative complications and two postoperative complications (11%). The primary surgeon considered telementoring useful in all cases (median score, 4 of 5). The mentor was also comfortable with the quality of the laparoscopic surgery performed (median score, 4 of 5). Telecommunication bandwidth for audio and video transmission was found to be a critical factor in the quality of telementoring process. Telementoring is safe and feasible. It allows community surgeons with no formal advanced laparoscopic training to benefit from expert intraoperative advice during the performance of advanced laparoscopic procedures. It may also reduce health-care costs by avoiding the need to refer and transfer patients to tertiary care centers.

A comprehensive review of telementoring applications in laparoscopic general surgery

“…The literature search identified a total of 75 articles; 10 studies were considered eligible [11,[15][16][17][18][19][20][21][22][23] (Table 1). Reasons for exclusion were that the studies were of other disciplines (n = 35), they were other than original articles (n = 29), and duplicate cases (n = 1).…”

“…The largest prospective study on telementoring in general surgery approaches a realistic concept of current health-care delivery needs in remote areas [11]. Through a telementoring project that included two community hospitals over 400 km from Ontario, Canada, two surgeons with no formal advanced laparoscopic training performed a variety of colorectal procedures, fundoplications, and splenectomies.…”

Reaching the rural world through robotic surgical programs

“…In Canada, a telementoring and remote telesurgery network has successfully been implemented, enabling community surgeons in Northern Ontario to safely learn advanced laparoscopic procedures with outcomes similar to those observed in major centres [4,11]. The establishment of similar telementoring and telepresence surgical networks between teaching centres and rural hospitals could enable community surgeons to offer high-quality surgical care even in the face of rapid changes in techniques and technology.…”

“…At the Centre for Minimal Access Surgery in Hamilton (CMAS), Ontario, the Surgical Support Network was established in 2002 to provide surgeons in two rural communities with telementoring support from an expert laparoscopic surgeon practicing at a tertiary care centre in Hamilton [11]. With real-time guidance from the remote surgeon, several community surgeons with minimal experience in laparoscopic surgery have successfully performed laparoscopic Nissen fundoplications, colon resections, splenectomies, and hernia repairs.…”

“…Studies have shown that short courses alone are insufficient to gain proficiency in laparoscopic techniques, leading to higher complication rates for surgeons who attempt a new laparoscopic procedure without any additional proctoring or mentoring [9]. Telementoring can effectively be used to provide surgeons in rural or remote areas with access to the advice and assistance of more experienced surgeons without leaving their local communities [10,11]. The use of telestration devices, which allow annotation on video images, and robotic arms that allow the mentoring surgeon to control the endoscope are particularly beneficial, as they allow the expert surgeon to take a more active role in the procedure.…”