title: Design and implementation of a web-based system for intraoperative consultation.
abstract: BACKGROUND
  With the use of electronic information distribution and telecommunication technologies, surgical teleconsultation is possible as a vehicle for consulting with experts remotely without their physical presence in the operating room (OR). This study evaluated real-time teleconsultation from the OR to remote consultants in the Russian Research Center of Surgery, Moscow, Russia and the Fundeni Clinical Hospital, Bucharest, Romania.
  
  
  METHODS
  We evaluated the effectiveness of teleconsultation using a secure website interface where consultants could navigate through multimedia-based electronic documentation of a surgical procedure and identify the anatomic landmarks underlying the need for consultation. Additionally, management of a remote camera view by consultants was evaluated.
  
  
  RESULTS
  Fifteen thyroidectomies and parathyroidectomies were studied to confirm by teleconsultation the identity of 22 recurrent laryngeal nerves (RLNs). There was no Internet connectivity interruption or dropped signal, and the bandwidth was consistently greater than 1 Mbps. Consultants spent an average of 6 min to review an average of 35 min of surgical records to identify the 22 RLNs.
  
  
  CONCLUSIONS
  This study validated a system for real-time teleconsultation using web-based surgical records. In addition, the ability of the consultant to manage the camera view remotely without interrupting the surgical procedure was confirmed.
authors.affiliation: Virginia Commonwealth University, Richmond, VA 23284, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Tamariz
authors.forename: Ronald
authors.initials: R
authors.lastname: Merrell
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
authors.forename: Daniel
authors.initials: D
authors.lastname: Onisor
authors.forename: Y
authors.initials: Y
authors.lastname: Flerov
authors.forename: Cosmin
authors.initials: C
authors.lastname: Boanca
authors.forename: Vladimir
authors.initials: V
authors.lastname: Lavrentyev
authors.forename: Azhar
authors.initials: A
authors.lastname: Rafiq
mesh_terms: D003199:Computer Systems / Q000592:standards; D006801:Humans; D020407:Internet / Q000592:standards; D009873:Operating Rooms; D016105:Parathyroidectomy; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D019114:Remote Consultation / Q000379:methods*; D013965:Thyroidectomy; D013997:Time Factors; D049269:Videoconferencing