Design and implementation of a web-based system for intraoperative consultation.

BACKGROUND: With the use of electronic information distribution and telecommunication technologies, surgical teleconsultation is possible as a vehicle for consulting with experts remotely without their physical presence in the operating room (OR). This study evaluated real-time teleconsultation from the OR to remote consultants in the Russian Research Center of Surgery, Moscow, Russia and the Fundeni Clinical Hospital, Bucharest, Romania. METHODS: We evaluated the effectiveness of teleconsultation using a secure website interface where consultants could navigate through multimedia-based electronic documentation of a surgical procedure and identify the anatomic landmarks underlying the need for consultation. Additionally, management of a remote camera view by consultants was evaluated. RESULTS: Fifteen thyroidectomies and parathyroidectomies were studied to confirm by teleconsultation the identity of 22 recurrent laryngeal nerves (RLNs). There was no Internet connectivity interruption or dropped signal, and the bandwidth was consistently greater than 1 Mbps. Consultants spent an average of 6 min to review an average of 35 min of surgical records to identify the 22 RLNs. CONCLUSIONS: This study validated a system for real-time teleconsultation using web-based surgical records. In addition, the ability of the consultant to manage the camera view remotely without interrupting the surgical procedure was confirmed.

Objective assessment of training surgical skills using simulated tissue interface with real-time feedback.

OBJECTIVE: We have shown previously that achieving competent performance of basic laparoscopic skills is possible in difficult conditions. We hypothesize that real-time performance feedback adds to the quality of proficiency-based simulator training for performance and forces applied to conventional surgical tools while tying square knots and running suture throws. DESIGN: A silk suture was preplaced on a simulated skin pad to assess incision closure by tying square knots and in separate trials to evaluate closure with the task of placing a running suture. The order of task performance was assigned randomly, and each task was repeated 5 times before switching to the second task. In all, 10 repetitions per task were performed by each student. After completion of the second surgical task, the cycle was repeated to test adaptation and retention of motor-skill capabilities. Half the participants were provided with a graphic display in dial format to indicate applied force. SETTING: Bench-top setup of apparatus was performed in a laboratory at Virginia Commonwealth University, Department of Surgery. PARTICIPANTS: Twelve second-year medical students with no surgical skills background participated in the study. RESULTS: Results from the knot-tying task indicated that the average force exerted on tissue forceps by the left hand in the blinded group who performed simple knots actually increased over repeated trials, as opposed to what was achieved by the group that had real-time feedback of their forces being applied. For the running suture, the task average force exerted on surgical tools by both hands was greater in the blind group relative to those viewing real-time graphic feedbacks of forces generated over repeated trials. CONCLUSION: Inclusion of real-time objective assessment in evaluation of surgical skills minimizes subjective evaluation of performance capabilities. A direct correlation between real-time feedback regarding force exerted and extent of surgical task completion was noted.

A surgical telemedicine clinic in a correctional setting.

The telemedicine network between Virginia Commonwealth University Health System (VCUHS) and the Department of Corrections in Virginia has seen a steady increase in the number of disciplines involved in consultation. Hardware integration and methodologies between VCUHS and correctional facilities were supported by Polycom videoconferencing technology. During consults, a VCUHS-based surgeon was provided with patient records, picture archiving and communication system images, and laboratory data or text reports sent by fax. A registered nurse at the correctional site assisted the surgeon at VCUHS. Electronic stethoscope and dermascope were also used for physical examination of inmates. Preoperative encounters included physical examination and informed consent from video. Electronic scheduling and preoperative orders were issued at the time of consultation. Of the 55 consultations completed this past year, 27 were followed by surgical procedures. In one case, the referral diagnosis was corrected and one case required minor change in diagnosis at an in-person examination on the day of surgery. Twenty patients had postoperative examination by telemedicine, and five of these required a second follow-up telemedicine visit. All patients confirmed their informed consent and acknowledged their surgeon upon first meeting face to face at the hospital. Telemedicine consultation for general surgery is an effective asset and can limit patient transfer.

Remote video management for intraoperative consultation and surgical telepresence.

Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration.

Microgravity effects on fine motor skills: tying surgical knots during parabolic flight.

INTRODUCTION: The health provider on a space exploration mission cannot evacuate a patient to Earth. Contingency plans for medical intervention must be designed for autonomy. This study measured the effect of microgravity on performance of fine motor skills such as basic surgical tasks. METHODS: Eight subjects, six with medical and two with non-medical backgrounds, were evaluated during parabolic microgravity flights aboard NASA's KC-135. We evaluated their skill in tying surgical knots on simulated skin made of silicone using standard techniques for minimally invasive surgery. LabView software was developed to archive forces applied to the laparoscopic tool handles during knot-tying. Studies were controlled for medication (ScopeDex) and the aircraft environment. RESULTS: All participants completed the tests successfully. The data indicated that increased force was applied to the instruments and knot quality decreased during flight compared with ground control sessions. CONCLUSION: Specific metrics of surgical task performance are essential in developing education modules for providers of medical care during exploration-class missions.

Evolution of telemedicine in Russia: the influence of the space program on modern telemedicine programs.

Telemedicine education and application throughout Russia has its roots in Russia's space program. The concepts of telemedicine have evolved during the course of 40 years of space exploration. This paper reviews the evolution of telemedicine and the achievements of the Soviet/Russian Space Program.