title: Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy.
abstract: BACKGROUND
  Telementoring is a video-conferencing tool which can deliver expert opinion to physicians and their patients in remote locations. We report our experience with the use of telementoring as a technique to instruct in the performance of posterior retroperitoneoscopic adrenalectomy (PRA). Issues regarding utility, regulation, and future directions of telementoring are addressed.
  
  
  METHODS
  Two consecutive PRAs conducted at Yale New Haven Hospital, New Haven, Connecticut, with telementored guidance from MD Anderson Cancer Center, Houston, Texas, are presented. Practical points in implementing cross-institutional telementoring are presented. A review of the current literature was done to discuss medicolegal issues, regulations and a proposal for future implementation of this technique.
  
  
  RESULTS
  The PRAs were performed after careful preparation of appropriate issues regarding cross-institutional telementoring. The procedures were performed quickly and safely. Loss of transmission occurred once, but was reestablished within seconds and was not disruptive to the surgical procedure. Patients were discharged within 48 hours and without complications. In our experience, telementoring was convenient and effective in helping with the execution of a new surgical technique.
  
  
  CONCLUSIONS
  Telementoring is a technical application with utility in remotely helping and guiding another surgeon through the execution of a novel surgical approach. The cyberspace consultation is safe and enhances patient care through a real-time collaborative approach which extends beyond the confines of one institution and one surgeon. Aspects concerning improvement in both implementation and regulation of telementoring mandate further research and creation of nationwide guidelines.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Treter
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrier
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Sosa
authors.forename: Sanziana
authors.initials: S
authors.lastname: Roman
mesh_terms: D000315:Adrenalectomy / Q000193:education / Q000379:methods; D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019114:Remote Consultation / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery; D049269:Videoconferencing