title: Initial experience with surgical telementoring in pediatric laparoscopic surgery using remote presence technology.
abstract: OBJECTIVE
  To evaluate the efficacy of remote presence technology in surgical mentoring.
  
  
  METHODS
  A self-propelled robot, which is controlled from a wireless remote control station (Laptop computer)and provides two-way audio and visual communication, was used to allow an experienced endoscopic surgeon to provide mentoring during three unique laparoscopic cases. This first was a laparoscopic exploration in a 9-month-old child with clinical evidence of intermittent obstruction but nondiagnostic imaging studies.The second was a 4-day-old, 3-kg infant with a congenital diaphragmatic hernia, and the third was a 1-day-old child with duodenal atresia. The robot was used to visualize the patient and radiologic studies, telestrate suggestions for trocar placement, visualize the laparoscopic procedure, and provide advice during the procedure.In the second case, another surgeon at a remote site control station watched the surgery and asked questions.
  
  
  RESULTS
  The procedures were completed successfully in 90, 30, and 90 minutes. The first case included identification of the obstructing lesion (internal jejunal polyp) and intestinal resection and anastomosis. The second case involved resection of the hernia sac and repair of the congenital diaphragmatic hernia. The third consisted of identification of the site of atresia and identification of the site for the proximal and distal enterotomy. The robot allowed excellent visualization of the procedures and direct communication between the surgeon and mentor was uninterrupted throughout the case. Both surgeon and mentor felt the telementoring assisted in the case.
  
  
  CONCLUSIONS
  While this is a limited series, the initial evaluation of this remote presence technology in the operating room suggests that it may be extremely usefully in adding surgical experience and expertise in minimally invasive surgery.
authors.affiliation: Rocky Mountain Hospital for Children, Denver, Colorado, USA. steverberg@aol.com
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
authors.forename: Suzanne
authors.initials: S
authors.lastname: Yoder
authors.forename: Saundra
authors.initials: S
authors.lastname: Kay
authors.forename: Todd
authors.initials: T
authors.lastname: Ponsky
mesh_terms: D004386:Duodenum / Q000002:abnormalities / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000601:surgery; D010535:Laparoscopy; D019114:Remote Consultation; D012371:Robotics