JACS: Surgical telemonitoring is a viable solution
The use of telemonitoring to guide remote general surgeons in the care of a wounded patient who needs an emergency subspecialty operation is clinically feasible, found a study published Oct. 21 in the Journal of the American College of Surgeons.
Alexander Q. Ereso, MD, from the University of California, San Francisco-East Bay in Oakland, Calif. and his colleagues noted, “Certain clinical environments, including military field hospitals or rural medical centers, lack readily available surgical subspecialists.” The researchers hypothesized that surgical teleproctoring by a surgical subspecialist can enable the conveyance of subspecialty knowledge and skills for the remote general surgeon in real time.
The authors selected eight general surgery residents with no formal subspecialist training for inclusion in the study, which entailed three mock operations using animal cadavers. Each resident was allotted 20 minutes to complete each surgery and completed the first round of operations unproctored, followed by a second round of the same procedures teleproctored by a surgical subspecialist.
According to Ereso and colleagues, the procedures consisted of a penetrating right ventricular injury requiring suture repair simulating a puncture wound to the chest, an open tibial fracture requiring external fixation simulating an injury consistent with a fall and a traumatic subdural hematoma requiring craniectomy simulating an injury caused by a traumatic fall.
During the second attempt at each procedure, a robotic platform consisting of a pan-and-tilt camera with laser pointer attached to an overhead surgical light with integrated audio facilitated the surgical subspecialists in remotely telemonitoring the residents. Performance of the residents for each operation was evaluated using an Operative Performance Scale, and satisfaction surveys were administered after performing the scenario unproctored and again after proctoring.
“Overall average performance scores were superior in all scenarios when residents were proctored than when they were not (approximately 4.30 vs. 2.43),” noted the researchers. Additionally, average performance scores for individual metrics, including tissue handling, instrument handling, speed of completion and knowledge of anatomy, were all determined to be superior when residents were proctored.
Moreover, residents reported greater satisfaction and comfort regarding the possibility of completing the surgical objectives in a similar real-world clinical setting when proctored. The proctored residents indicated that the robotic platform facilitated learning and would be feasible if used clinically, the authors wrote.
In addition to military settings, the researchers believe that telementoring has the potential for wide-ranging applications for general surgeons in rural medical centers.
“The findings of the study support the use of surgical teleproctoring in guiding remote general surgeons by a surgical subspecialist in the care of a wounded patient in need of an emergency subspecialty operation,” concluded Ereso and colleagues.
Alexander Q. Ereso, MD, from the University of California, San Francisco-East Bay in Oakland, Calif. and his colleagues noted, “Certain clinical environments, including military field hospitals or rural medical centers, lack readily available surgical subspecialists.” The researchers hypothesized that surgical teleproctoring by a surgical subspecialist can enable the conveyance of subspecialty knowledge and skills for the remote general surgeon in real time.
The authors selected eight general surgery residents with no formal subspecialist training for inclusion in the study, which entailed three mock operations using animal cadavers. Each resident was allotted 20 minutes to complete each surgery and completed the first round of operations unproctored, followed by a second round of the same procedures teleproctored by a surgical subspecialist.
According to Ereso and colleagues, the procedures consisted of a penetrating right ventricular injury requiring suture repair simulating a puncture wound to the chest, an open tibial fracture requiring external fixation simulating an injury consistent with a fall and a traumatic subdural hematoma requiring craniectomy simulating an injury caused by a traumatic fall.
During the second attempt at each procedure, a robotic platform consisting of a pan-and-tilt camera with laser pointer attached to an overhead surgical light with integrated audio facilitated the surgical subspecialists in remotely telemonitoring the residents. Performance of the residents for each operation was evaluated using an Operative Performance Scale, and satisfaction surveys were administered after performing the scenario unproctored and again after proctoring.
“Overall average performance scores were superior in all scenarios when residents were proctored than when they were not (approximately 4.30 vs. 2.43),” noted the researchers. Additionally, average performance scores for individual metrics, including tissue handling, instrument handling, speed of completion and knowledge of anatomy, were all determined to be superior when residents were proctored.
Moreover, residents reported greater satisfaction and comfort regarding the possibility of completing the surgical objectives in a similar real-world clinical setting when proctored. The proctored residents indicated that the robotic platform facilitated learning and would be feasible if used clinically, the authors wrote.
In addition to military settings, the researchers believe that telementoring has the potential for wide-ranging applications for general surgeons in rural medical centers.
“The findings of the study support the use of surgical teleproctoring in guiding remote general surgeons by a surgical subspecialist in the care of a wounded patient in need of an emergency subspecialty operation,” concluded Ereso and colleagues.