Robotic long-distance telementoring in neurosurgery.
OBJECTIVE
To test the feasibility of long-distance telementoring in neurosurgery by providing subspecialized expertise in real time to another neurosurgeon performing a surgical procedure in a remote location.


METHODS
A robotic telecollaboration system (Socrates; Computer Motion, Inc., Santa Barbara, CA) capable of controlling the movements of a robotic arm, of handling two-way video, and of audio communication as well as transmission of neuronavigational data from the remote operating room was used for the telementoring procedures. Four integrated services digital network lines with a total speed of transmission of 512 kilobytes per second provided telecommunications between a large academic center (Halifax, Nova Scotia) and a community-based center (Saint John, New Brunswick) located 400 km away.


RESULTS
Long-distance telementoring was used in three craniotomies for brain tumors, a craniotomy for an arteriovenous malformation, a carotid endarterectomy, and a lumbar laminectomy. There were no surgical complications during the procedures, and all patients had uneventful outcomes. The neurosurgeons in the remote location believed that the input from the mentors was useful in all of the cases and was crucial in the removal of a mesial temporal lobe glioma and resection of an occipital arteriovenous malformation.


CONCLUSIONS
Our initial experience with long-distance robotic-assisted telementoring in six cases indicates that telementoring is feasible, reliable, and safe. Although still in its infancy, telementoring has the potential to improve surgical care, to enhance neurosurgical training, and to have a major impact on the delivery of neurosurgical services throughout the world.
Mendez
Ivar
I
Division of Neurosurgery, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. mendez@dal.ca
Hill
Ron
R
Clarke
David
D
Kolyvas
George
G
Walling
Simon
S
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery; D003199:Computer Systems; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods; D016894:Endarterectomy, Carotid / Q000295:instrumentation / Q000379:methods; D005260:Female; D005910:Glioma / Q000601:surgery; D006764:Hospitals, Community; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008611:Mentors; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods*; D012371:Robotics; D013130:Spinal Stenosis / Q000601:surgery; D015173:Supratentorial Neoplasms / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery