White paper: technology for surgical telementoring-SAGES Project 6 Technology Working Group.

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 ).

Trans-Atlantic Telementoring with Pediatric Surgeons: Technical Considerations and Lessons Learned.

PURPOSE: Although surgical residency training is a structured, regulated system for surgical skill acquisition, after residency or fellowship, no good method exists for practicing surgeons to learn new, developing techniques. Because 1-2-day simulation courses are probably inadequate for teaching a new technique and because it is often unrealistic for a practicing surgeon to leave his or her practice for an extended period of time, surgical telementoring may be a solution by allowing an expert to support a trained surgeon through the learning curve of a new procedure while overcoming geographic distance. In the past we have presented 6 cases of transcontinental telementoring with pediatric surgeons in the United States. We have since expanded the concept to trans-Atlantic telementoring and performed 2 cases with pediatric surgeons in France. MATERIALS AND METHODS: The two telementors and one of the two telementees had previously met through a professional society but had never operated together before this experience. The first procedure was an interval laparoscopic appendectomy to test the process. The second procedure was a thoracoscopic total thymectomy. The technology consisted of the VisitOR1® telementoring robot (Karl Storz GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Both procedures were completed successfully with high satisfaction from both the telementors and telementees. Latency was low, and there was no loss of connection. The telestration and laser pointer features of the robot facilitated the telementoring experience. Challenges included lack of a prior surgical relationship between the mentees and mentors that limited the depth of advice but did not impair the quality of the surgery, as well as poor audio quality that was overcome using headsets. CONCLUSIONS: From this experience, several challenges were identified and addressed. Telementoring may be an effective means of improving adoption of new surgical techniques, ultimately improving patient care.

Telementoring in education of laparoscopic surgeons: An emerging technology.

Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these advanced procedures. We highlight in the review several key emerging technologies such as the telementoring and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.

Telemedical technologies in urological cancer care: past, present and future applications.

Since the initial development of telegraphy by Sir Charles Wheatstone in 1837 and the telephone by Alexander Graham Bell in 1875, doctors have been able to convey medical information across great distances. The exchange and sharing of medical information has evolved and adapted to suit the vast array of today's medicine. Early adopters of telemedicine within clinical practice have gained significant health economic benefits. The arrival of wireless connections has further enhanced the possibilities for all clinical work with focus on diagnosis, treatment and management of urological cancers, as highlighted in this article.