title: Telemedicine: teleproctored endoscopic sinus surgery.
abstract: OBJECTIVE
  Teleproctored surgery projects a surgeon's expertise to remote locations. The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current standard of care.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  A study was conducted in a residency training program comparing conventionally proctored endoscopic sinus surgery cases with teleproctored cases, with the faculty surgeon supervising through audiovisual teleconferencing (VTC) in a control room 15 seconds from the operating room.
  
  
  RESULTS
  Forty-two control patients (83 sides) and 45 teleproctored patients (83 sides) were evaluated. There were no internal differences between groups regarding extent of polypoid disease, revision status, procedures per case, degree of difficulty, general or local anesthesia, or microdebrider use. There were no cases of visual disturbance, orbital ecchymosis or hematoma, or cerebrospinal fluid leak. Orbital fat herniation and blood loss were equal between groups. Three teleproctored cases required faculty intervention: two for surgical difficulty, one for VTC problems. Teleproctored cases took 3.87 minutes longer per side (28.54 vs. 24.67 min, P <.024), a 16% increase. This was thought to be a result of nuances of VTC proctoring. Residents had a positive learning experience, with nearly full control of the operating suite combined with remote supervision through telepresence. Faculty thought such supervision was safe but had concerns regarding personal skills maintenance.
  
  
  CONCLUSIONS
  Teleproctored endoscopic sinus surgery can be safely performed on selected cases with an acceptable increase in time. Teleproctored surgery with remote sites may continue to be safely investigated. Incorporating remote supervision through telepresence into the curriculum of surgical residency training requires further study.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 96859-1000, USA. burgessL001@hawaii.rr.com
authors.forename: Lawrence P A
authors.initials: LP
authors.lastname: Burgess
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Syms
authors.forename: Michael R
authors.initials: MR
authors.lastname: Holtel
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Birkmire-Peters
authors.forename: Robert E
authors.initials: RE
authors.lastname: Johnson
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Ramsey
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010256:Paranasal Sinuses / Q000503:physiopathology / Q000601:surgery*; D011336:Probability; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000601:surgery*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014741:Video Recording / Q000295:instrumentation