Skip to main content
SpringerLink
Log in
Book cover

Simulation Training in Laparoscopy and Robotic Surgery pp 75–89Cite as

Clinical and Educational Benefits of Surgical Telementoring

  • Chapter
  • First Online:

Abstract

Background: Videoconference technology has substantially improved making surgical telementoring more feasible. However, evidence of potential benefits is missing.

Objective: To present evidence of benefits and highlight major barriers, as well as reporting own experience.

Methods: A systematic review was performed; studies were classified as technology-driven, clinical, or educational.

Results: Three hundred and ninety-two surgical procedures were performed by 179 surgeons in 11 surgical specialties. The most common telementored procedure was laparoscopic cholecystectomy (56 cases, 14%), endovascular treatment of aortic aneurysm (48 cases, 12%), and laparoscopic colectomy (24 cases, 6%). One hundred and eleven (27%) cases had a laparoscopic approach; 6 cases (5%) were converted to open surgery. Ten complications (2%) were reported (liver bleeding, trocar port bleeding, bile collection, postoperative ileus, wound infection, serosal tears, iliac artery rupture). Seven surveys (27%) focus on education of surgeons; all these report improved surgical performance. Sixty-three medical students, 48 general surgeons, and 24 surgical residents participated. Telementoring was combined with simulator training in two cases and robotics in three cases. Thirteen surveys (50%) were cross institutional and 7 surveys (27%) were intercountry or intercontinental. Perceived usefulness of surgical telementoring was high among 83% of surgeons; however, only 5 (19%) surveys had a systematic evaluation of surgeon’s technology satisfaction.

Conclusion: There is an acceptable rate of conversion and complications. Surgical telementoring is commonly used for education of surgeons and has huge potential to offer patients the best expertise despite long distances.

*Knut Magne Augestad, M.D. (Norwegian Center for Telemedicine and Integrated Care, University Hospital North Norway, Tromsø, Norway), Taridzo Chomutare, M.Sc. (Norwegian Center for Telemedicine and Integrated Care and Tromsø Telemedicine Labaratory, University Hospital North Norway, Tromsø, Norway), Johan Gustav Bellika M.Sc., Ph.D. (Medical Informatics and Telemedicine Group, Department of Computer Science, University of Tromsø, Tromsø, Norway), Rolf Ole Lindsetmo M.D., MPH, Ph.D. (Professor and Chief, Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, Norway), Gunnar Hartvigsen Ph.D. (Professor, Department of Computer Science, Faculty of Science, University of Tromsø, Norway), Per Hasvold M.Sc. (Research Fellow, Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway), Richard Wootton D.Sc., Ph.D. (Editor in Chief Journal of Telemedicine and Telecare and Head of Research Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway), Stig Muller M.D., Ph.D. (Consultant, Department of Surgery, University Hospital North Norway, Tromsø; Norway), Hiten Patel BMSc.Hons, BM, BCh, MRCS, PhD, FRCS (Urol), FRCS (Eng). (Professor of Surgery & Urology, University of North Norway, Tromsø, Norway), Conor Delaney M.D., Ph.D. (Professor of Surgical Education and Chief Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA), Alexander Horsch Ph.D. (Professor Institute for Medical Statistics and Epidemiology, University of Technology, Munich, Germany), Ole Edvard Gabrielsen M.D. (Consultant, Department of Surgery, Narvik Local Hospital, University Hospital North Norway), Kim Mortensen M.D., Ph.D. (Consultant, Department of Surgery, University Hospital North Norway, Tromsø Norway), Sture Pettersen M.Sc. (Head Tromsø Telemedicine Laboratory, Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway)

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Aucar JA, Doarn CR, Sargsyan A, Samuelson DA, Odonnell MJ, DeBakey ME. Use of the Internet for long-term clinical follow-up. Telemed J. 1998;4(4):371–4.

    Article  PubMed  CAS  Google Scholar 

  2. DeBakey ME. Telemedicine has now come of age. Telemed J. 1995;1(1):3–4.

    Article  Google Scholar 

  3. Merrell RC, Doarn CR. In Memoriam Michael E. DeBakey, MD. 1908–2008. Telemed J E Health. 2008;14(6):503–4.

    Article  PubMed  Google Scholar 

  4. Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed J E Health. 2008;14(7):720–5.

    Article  PubMed  Google Scholar 

  5. Doarn CR. The power of video conferencing in surgical practice and education. World J Surg. 2009;33(7):1366–7.

    Article  PubMed  Google Scholar 

  6. Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB. Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg. 2010;252(6):943–51.

    Article  PubMed  Google Scholar 

  7. Doarn CR. Telemedicine in tomorrow’s operating room: a natural fit. Semin Laparosc Surg. 2003;10(3):121–6.

    PubMed  Google Scholar 

  8. Rothenberg SS, Yoder S, Kay S, Ponsky T. Initial experience with surgical telementoring in pediatric laparoscopic surgery using remote presence technology. J Laparoendosc Adv Surg Tech A. 2009;19 Suppl 1:S219–22.

    Article  PubMed  Google Scholar 

  9. Damore LJ, Johnson JA, Dixon RS, Iverson MA, Ellison EC, Melvin WS. Transmission of live laparoscopic surgery over the Internet2. Am J Surg. 1999;178(5):415–7.

    Article  PubMed  Google Scholar 

  10. Matsumoto E, Lee L, Warren J, Caumartin Y, Shetty A, Touma N, et al. Long-distance tele-mentoring: prospective trial in training laparoscopic radical prostatectomy. J Urol. 2009;181(4, Supplement 1):822–3.

    Article  Google Scholar 

  11. Agarwal R, Levinson AW, Allaf M, Markov D, Nason A, Su LM. The RoboConsultant: telementoring and remote presence in the operating room during minimally invasive urologic surgeries using a novel mobile robotic interface. Urology. 2007;70(5):970–4.

    Article  PubMed  Google Scholar 

  12. Anvari M. Telesurgery: remote knowledge translation in clinical surgery. World J Surg. 2007;31(8):1545–50.

    Article  PubMed  Google Scholar 

  13. Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc. 2002;16(10):1389–402.

    Article  PubMed  CAS  Google Scholar 

  14. Augestad KM, Lindsetmo RO. Overcoming distance: video-conferencing as a clinical and educational tool among surgeons. World J Surg. 2009;33(7):1356–65.

    Article  PubMed  Google Scholar 

  15. Merrell RC, Doarn CR. Is it time for a telemedicine breakthrough? Telemed J E Health. 2008;14(6):505–6.

    Article  PubMed  Google Scholar 

  16. Lim EC, Seet RC. In-house medical education: redefining tele-education. Teach Learn Med. 2008;20(2):193–5.

    Article  PubMed  Google Scholar 

  17. Dickson-Witmer D, Petrelli NJ, Witmer DR, England M, Witkin G, Manzone T, et al. A statewide community cancer center videoconferencing program. Ann Surg Oncol. 2008;15(11):3058–64.

    Article  PubMed  CAS  Google Scholar 

  18. Wood D. No surgeon should operate alone: how telementoring could change operations. Telemed J E Health. 2011;17(3):150–2.

    Article  PubMed  Google Scholar 

  19. Friedman CP. Where’s the science in medical informatics? J Am Med Inform Assoc. 1995;2(1):65–7.

    Article  PubMed  CAS  Google Scholar 

  20. Vuolio S, Winblad I, Ohinmaa A, Haukipuro K. Videoconferencing for orthopaedic outpatients: one-year follow-up. J Telemed Telecare. 2003;9(1):8–11.

    Article  PubMed  Google Scholar 

  21. Wallace P, Haines A, Harrison R, Barber J, Thompson S, Jacklin P, et al. Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial. Lancet. 2002;359(9322):1961–8.

    Article  PubMed  CAS  Google Scholar 

  22. Ohinmaa A, Vuolio S, Haukipuro K, Winblad I. A cost-minimization analysis of orthopaedic consultations using videoconferencing in comparison with conventional consulting. J Telemed Telecare. 2002;8(5):283–9.

    Article  PubMed  Google Scholar 

  23. Camara JG, Zabala RR, Henson RD, Senft SH. Teleophthalmology: the use of real-time telementoring to remove an orbital tumor. Ophthalmology. 2000;107(8):1468–71.

    Article  PubMed  CAS  Google Scholar 

  24. Schulam PG, Docimo SG, Saleh W, Breitenbach C, Moore RG, Kavoussi L. Telesurgical ­mentoring. Initial clinical experience. Surg Endosc. 1997;11(10):1001–5.

    Article  PubMed  CAS  Google Scholar 

  25. Rosser JC, Wood M, Payne JH, Fullum TM, Lisehora GB, Rosser LE, et al. Telementoring. A practical option in surgical training. Surg Endosc. 1997;11(8):852–5.

    Article  PubMed  CAS  Google Scholar 

  26. Augestad KM, Chomutare T, Bellika G, Patel HRH, Lindsetmo RO, Delaney CP, Mobile Medical Mentor Group (M3). Education of Surgeons and Risk of Complications During Surgical Telemetoring. Surgical Innovation 2011.

    Google Scholar 

  27. Rodas EB, Latifi R, Cone S, Broderick TJ, Doarn CR, Merrell RC. Telesurgical presence and consultation for open surgery. Arch Surg. 2002;137(12):1360–3; discussion 1363.

    Article  PubMed  Google Scholar 

  28. Bauer J. International surgical telementoring using a robotic arm: our experience. Telemed J. 2000;6(1):25–31.

    Article  Google Scholar 

  29. Bruschi M, Micali S, Porpiglia F, Celia A, De Stefani S, Grande M, et al. Laparoscopic telementored adrenalectomy: the Italian experience. Surg Endosc. 2005;19(6):836–40.

    Article  PubMed  CAS  Google Scholar 

  30. Byrne JP, Mughal MM. Telementoring as an adjunct to training and competence-based assessment in laparoscopic cholecystectomy. Surg Endosc. 2000;14(12):1159–61.

    Article  PubMed  CAS  Google Scholar 

  31. Challacombe B, Kandaswamy R, Dasgupta P, Mamode N. Telementoring facilitates independent hand-assisted laparoscopic living donor nephrectomy. Transplant Proc. 2005;37(2):613–6.

    Article  PubMed  CAS  Google Scholar 

  32. Ereso AQ, Garcia P, Tseng E, Gauger G, Kim H, Dua MM, et al. Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons. J Am Coll Surg. 2010;211(3):400–11.

    Article  PubMed  Google Scholar 

  33. Ewers R, Schicho K, Wagner A, Undt G, Seemann R, Figl M, et al. Seven years of clinical experience with teleconsultation in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2005;63(10):1447–54.

    Article  PubMed  Google Scholar 

  34. Gambadauro P, Magos A. NEST (network enhanced surgical training): a PC-based system for telementoring in gynaecological surgery. Eur J Obstet Gynecol Reprod Biol. 2008;139(2):222–5.

    Article  PubMed  Google Scholar 

  35. Gandsas A, McIntire K, Montgomery K, Bumgardner C, Rice L. The personal digital assistant (PDA) as a tool for telementoring endoscopic procedures. Stud Health Technol Inform. 2004;98:99–103.

    PubMed  Google Scholar 

  36. Mendez I, Hill R, Clarke D, Kolyvas G. Robotic long-distance telementoring in neurosurgery. Neurosurgery. 2005;56(3):434–40; discussion 434–40.

    Article  PubMed  Google Scholar 

  37. Rodrigues Netto Jr N, Mitre AI, Lima SV, Fugita OE, Lima ML, Stoianovici D, et al. Telementoring between Brazil and the United States: initial experience. J Endourol. 2003;17(4):217–20.

    Article  PubMed  Google Scholar 

  38. Panait L, Rafiq A, Tomulescu V, Boanca C, Popescu I, Carbonell A, et al. Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc. 2006;20(1):113–8.

    Article  PubMed  CAS  Google Scholar 

  39. Rafiq A, Moore JA, Zhao X, Doarn CR, Merrell RC. Digital video capture and synchronous consultation in open surgery. Ann Surg. 2004;239(4):567–73.

    Article  PubMed  Google Scholar 

  40. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum. 2001;44(2):217–22.

    Article  PubMed  CAS  Google Scholar 

  41. Sawyer MA, Lim RB, Wong SY, Cirangle PT, Birkmire-Peters D. Telementored laparoscopic cholecystectomy: a pilot study. Stud Health Technol Inform. 2000;70:302–8.

    PubMed  CAS  Google Scholar 

  42. Schlachta CM, Lefebvre KL, Sorsdahl AK, Jayaraman S. Mentoring and telementoring leads to effective incorporation of laparoscopic colon surgery. Surg Endosc. 2010;24(4):841–4.

    Article  PubMed  Google Scholar 

  43. Schlachta CM, Sorsdahl AK, Lefebvre KL, McCune ML, Jayaraman S. A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surg Endosc. 2009;23(7):1634–8.

    Article  PubMed  Google Scholar 

  44. Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M. Telementoring: an important enabling tool for the community surgeon. Surg Innov. 2005;12(4):327–31.

    Article  PubMed  Google Scholar 

  45. Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M. The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc. 2006;20(9):1389–93.

    Article  PubMed  CAS  Google Scholar 

  46. Schneider A, Wilhelm D, Doll D, Rauschenbach U, Finkenzeller M, Wirnhier H, et al. Wireless live streaming video of surgical operations: an evaluation of communication quality. J Telemed Telecare. 2007;13(8):391–6.

    Article  PubMed  Google Scholar 

  47. Sereno S, Mutter D, Dallemagne B, Smith CD, Marescaux J. Telementoring for minimally invasive surgical training by wireless robot. Surg Innov. 2007;14(3):184–91.

    Article  PubMed  CAS  Google Scholar 

  48. Snyder CW, Vandromme MJ, Tyra SL, Hawn MT. Proficiency-based laparoscopic and endoscopic training with virtual reality simulators: a comparison of proctored and independent approaches. J Surg Educ. 2009;66(4):201–7.

    Article  PubMed  Google Scholar 

  49. Tamariz F, Merrell R, Popescu I, Onisor D, Flerov Y, Boanca C, et al. Design and implementation of a web-based system for intraoperative consultation. World J Surg. 2009;33(3):448–54.

    Article  PubMed  Google Scholar 

  50. Di Valentino M, Alerci M, Bogen M, Tutta P, Sartori F, Marty B, et al. Telementoring during endovascular treatment of abdominal aortic aneurysms: a prospective study. J Endovasc Ther. 2005;12(2):200–5.

    Article  PubMed  Google Scholar 

  51. Parker A, Rubinfeld I, Azuh O, Blyden D, Falvo A, Horst M, et al. What ring tone should be used for patient safety? Early results with a Blackberry-based telementoring safety solution. Am J Surg. 2010;199(3):336–40; discussion 340–1.

    Article  PubMed  Google Scholar 

  52. Seemann R, Guevara G, Undt G, Ewers R, Schicho K. Clinical evaluation of tele-endoscopy using UMTS cellphones. Surg Endosc. 2010;24(11):2855–9.

    Article  PubMed  Google Scholar 

  53. Bauer JJ, Lee BR, Stoianovici D, Bishoff JT, O’Kelley S, Cadeddu JA, et al. Remote Telesurgical Mentoring: Feasibility and Efficacy. Proceedings of the 33rd Hawaii International Conference on System Sciences-Volume 5—Volume 5: IEEE Computer Society, 2000.

    Google Scholar 

  54. Etzioni DA, Finlayson SR, Ricketts TC, Lynge DC, Dimick JB. Getting the science right on the surgeon workforce issue. Arch Surg. 2011;146(4):381–4.

    Article  PubMed  Google Scholar 

  55. Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY. Elderly patients in surgical workloads: a population-based analysis. Am Surg. 2003;69(11):961–5.

    PubMed  Google Scholar 

  56. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238(2):170–7.

    PubMed  Google Scholar 

  57. Williams Jr TE, Satiani B, Thomas A, Ellison EC. The impending shortage and the estimated cost of training the future surgical workforce. Ann Surg. 2009;250(4):590–7.

    PubMed  Google Scholar 

  58. Demartines N, Mutter D, Marescaux J, Harder F. Preliminary assessment of the value and effect of expert consultation in telemedicine. J Am Coll Surg. 2000;190(4):466–70.

    Article  PubMed  CAS  Google Scholar 

  59. Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7(11):935–43.

    Article  PubMed  Google Scholar 

  60. Demartines N, Mutter D, Vix M, Leroy J, Glatz D, Rosel F, et al. Assessment of telemedicine in surgical education and patient care. Ann Surg. 2000;231(2):282–91.

    Article  PubMed  CAS  Google Scholar 

  61. Demartines N, Otto U, Mutter D, Labler L, von Weymarn A, Vix M, et al. An evaluation of telemedicine in surgery: telediagnosis compared with direct diagnosis. Arch Surg. 2000;135(7):849–53.

    Article  PubMed  CAS  Google Scholar 

  62. Holland AJ, Soundappan SV, Oldmeadow W. Videoconferencing surgical tutorials: bridging the gap. ANZ J Surg. 2008;78(4):297–301.

    Article  PubMed  Google Scholar 

  63. Hadley GP, Mars M. Postgraduate medical education in paediatric surgery: videoconferencing – a possible solution for Africa? Pediatr Surg Int. 2008;24(2):223–6.

    Article  PubMed  Google Scholar 

  64. Stain SC, Mitchell M, Belue R, Mosley V, Wherry S, Adams CZ, et al. Objective assessment of videoconferenced lectures in a surgical clerkship. Am J Surg. 2005;189(1):81–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Norwegian Center for Telemedicine and Integrated Care, University Hospital North Norway, Tromsø, Norway

    Knut Mague Augestad M.D.

  2. Norwegian Center for Telemedicine and Integrated Care and Tromsø Telemedicine Labaratory, University Hospital of North Norway, Tromsø, Norway

    Taridzo Chomutare M.Sc.

  3. Medical Informatics and Telemedicine Group, Department of Computer Science, University of Tromsø, Tromsø, Norway

    Johan G. Bellika Ph.D.

  4. Norwegian Centre for Integrated Care and Telemedicine, Tromsø, Norway

    Andrius Budrionis M.Sc.

  5. Department of Computer Science, Carolina State University, Raleigh, USA

    Andrius Budrionis M.Sc.

  6. Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, N-9036, Norway

    Rolv-Ole Lindsetmo M.D., Ph.D., MPH

  7. Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave., 44106-5047, Cleveland, OH, USA

    Conor P. Delaney MB, MCh, Ph.D., FRCSI, FACS, FASCRS

Authors
  1. Knut Mague Augestad M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taridzo Chomutare M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johan G. Bellika Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrius Budrionis M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rolv-Ole Lindsetmo M.D., Ph.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Conor P. Delaney MB, MCh, Ph.D., FRCSI, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Mobile Medical Mentor (M3) Project Group*

Corresponding author

Correspondence to Knut Mague Augestad M.D. .

Editor information

Editors and Affiliations

  1. Department of Surgery, University Hospital of North Norway, Tromsø, 9019, Norway

    Hitendra R.H. Patel

  2. , Urology and Wilmot Cancer Center, University of Rochester Medical Center, Elmwood Avenue 601, Rochester, 14642, New York, USA

    Jean V. Joseph

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London

About this chapter

Cite this chapter

Augestad, K.M. et al. (2012). Clinical and Educational Benefits of Surgical Telementoring. In: Patel, H., Joseph, J. (eds) Simulation Training in Laparoscopy and Robotic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-2930-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2930-1_9

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2929-5

  • Online ISBN: 978-1-4471-2930-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation