title: Telesurgical mentoring. Initial clinical experience.
abstract: BACKGROUND
  Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure.
  
  
  METHODS
  We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis.
  
  
  RESULTS
  Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications.
  
  
  CONCLUSIONS
  These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.
authors.affiliation: Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD 21224, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Schulam
authors.forename: S G
authors.initials: SG
authors.lastname: Docimo
authors.forename: W
authors.initials: W
authors.lastname: Saleh
authors.forename: C
authors.initials: C
authors.lastname: Breitenbach
authors.forename: R G
authors.initials: RG
authors.lastname: Moore
authors.forename: L
authors.initials: L
authors.lastname: Kavoussi
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted; D010535:Laparoscopy; D019114:Remote Consultation / Q000379:methods; D012449:Safety; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry / Q000379:methods*