title: Safe introduction of a new surgical technique: remote telementoring for posterior retroperitoneoscopic adrenalectomy.
abstract: BACKGROUND
  Posterior retroperitoneoscopic adrenalectomy (PRA) is a safe and effective approach to adrenalectomy, offering less pain and faster recovery than open or laparoscopic surgery. Although the popularity of PRA is increasing, few surgical centres have extensive experience with the procedure. The ideal approach to achieve proficiency with any new technique involves on-site observation of an experienced surgeon-mentor, followed by mentored hands-on experience of the surgeon-learner. However, it is not always feasible for a surgeon-mentor to offer on-site supervision to the surgeon-learner in his or her home institution. Advances in Internet applications have made remote telementoring a viable alternative to on-site mentoring in selected situations.
  
  
  METHODS
  We describe our experience in safely introducing PRA to Melbourne, Australia, where no highly experienced surgeon-mentors were available. A surgeon with experience of 12 PRA procedures attended from interstate, along with live telementoring via Skype video link by an overseas surgeon who had performed more than 200 PRA procedures, to mentor the surgeon-learner performing her first three cases.
  
  
  RESULTS
  The operating surgeon's first three PRA procedures proceeded uneventfully, with no complications, relatively short operative times and one-night hospital stays for all three patients. Twenty-two more have been performed since, without complications.
  
  
  CONCLUSIONS
  Remote telementoring is a safe and feasible way to assist surgeons in safely introducing new techniques. This strategy is particularly applicable in centres where no surgeon-mentor is locally available. It is important that the surgeon-learner has the skills and experience to complete the procedure using alternative techniques in the case of complications or technical failure.
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia. julie.miller@mh.org.au
authors.forename: Julie A
authors.initials: JA
authors.lastname: Miller
authors.forename: David S
authors.initials: DS
authors.lastname: Kwon
authors.forename: Amira
authors.initials: A
authors.lastname: Dkeidek
authors.forename: Ming
authors.initials: M
authors.lastname: Yew
authors.forename: An
authors.initials: A
authors.lastname: Hisham Abdullah
authors.forename: Martin K
authors.initials: MK
authors.lastname: Walz
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000315:Adrenalectomy / Q000193:education* / Q000379:methods*; D020375:Education, Distance; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D008611:Mentors; D017216:Telemedicine