title: Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons.
abstract: BACKGROUND
  Certain clinical environments, including military field hospitals or rural medical centers, lack readily available surgical subspecialists. We hypothesized that telementoring by a surgical subspecialist using a robotic platform is feasible and can convey subspecialty knowledge and skill to a remotely located general surgeon.
  
  
  METHODS
  Eight general surgery residents evaluated the effect of remote surgical telementoring by performing 3 operative procedures, first unproctored and then again when teleproctored by a surgical subspecialist. The clinical scenarios consisted of a penetrating right ventricular injury requiring suture repair, an open tibial fracture requiring external fixation, and a traumatic subdural hematoma requiring craniectomy. A robotic platform consisting of a pan-and-tilt camera with laser pointer attached to an overhead surgical light with integrated audio allowed surgical subspecialists the ability to remotely teleproctor residents. Performance was evaluated using an Operative Performance Scale. Satisfaction surveys were given after performing the scenario unproctored and again after proctoring.
  
  
  RESULTS
  Overall mean performance scores were superior in all scenarios when residents were proctored than when they were not (4.30 +/- 0.25 versus 2.43 +/- 0.20; p < 0.001). Mean performance scores for individual metrics, including tissue handling, instrument handling, speed of completion, and knowledge of anatomy, were all superior when residents were proctored (p < 0.001). Satisfaction surveys showed greater satisfaction and comfort among residents when proctored. Proctored residents believed the robotic platform facilitated learning and would be feasible if used clinically.
  
  
  CONCLUSIONS
  This study supports the use of surgical teleproctoring in guiding remote general surgeons by a surgical subspecialist in the care of a wounded patient in need of an emergency subspecialty operation.
authors.affiliation: University of California, San Francisco-East Bay, Oakland, CA, USA.
authors.forename: Alexander Q
authors.initials: AQ
authors.lastname: Ereso
authors.forename: Pablo
authors.initials: P
authors.lastname: Garcia
authors.forename: Elaine
authors.initials: E
authors.lastname: Tseng
authors.forename: Grant
authors.initials: G
authors.lastname: Gauger
authors.forename: Hubert
authors.initials: H
authors.lastname: Kim
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Victorino
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
mesh_terms: D000328:Adult; D000818:Animals; D002102:Cadaver; D002417:Cattle; D002983:Clinical Competence; D006259:Craniocerebral Trauma / Q000150:complications / Q000601:surgery; D056424:Decompressive Craniectomy; D004630:Emergencies; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D005597:Fractures, Open / Q000601:surgery; D013502:General Surgery; D006352:Heart Ventricles / Q000293:injuries / Q000601:surgery; D006408:Hematoma, Subdural / Q000209:etiology / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009048:Motor Skills; D011597:Psychomotor Performance; D012371:Robotics / Q000295:instrumentation; D012495:San Francisco; D013043:Specialties, Surgical / Q000193:education*; D013537:Sutures; D013552:Swine; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D017216:Telemedicine; D013978:Tibial Fractures / Q000601:surgery; D014947:Wounds and Injuries / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery