title: Surgical telepresence: the usability of a robotic communication platform.
abstract: BACKGROUND
  The benefits of telepresence in trauma and acute surgical care exist, yet its use in a live, operating room (OR) setting with real surgical cases remains limited.
  
  
  METHODS
  We tested the use of a robotic telepresence system in the OR of a busy, level 1 trauma center. After each case, both the local and remote physicians completed questionnaires regarding the use of the system using a five point Likert scale. For trauma cases, physicians were asked to grade injury severity according to the American Association for the Surgery of Trauma (AAST) Scaling System.
  
  
  RESULTS
  We collected prospective, observational data on 50 emergent and elective cases. 64% of cases were emergency surgery on trauma patients, almost evenly distributed between penetrating (49%) and blunt injuries (51%). 40% of non-trauma cases were hernia-related. A varied distribution of injuries was observed to the abdomen, chest, extremities, small bowel, kidneys, spleen, and colon. Physicians gave the system high ratings for its audio and visual capabilities, but identified internet connectivity and crowding in the operating room as potential challenges. The loccal clinician classified injuries according to the AAST injury grading system in 63% (n=22) of trauma cases, compared to 54% (n=19) of cases by the remote physicians. The remote physician cited obstruction of view as the main reason for the discrepancy. 94% of remote physicians and 74% of local physicians felt comfortable communicating via the telepresence system. For 90% of cases, both the remote and local physicians strongly agreed that a telepresence system for consultations in the OR is more effective than a telephone conversation.
  
  
  CONCLUSIONS
  A telepresence system was tested on a variety of surgical cases and demonstrated that it can be an appropriate solution for use in the operating room. Future research should determine its impact on processes of care and surgical outcomes.
authors.affiliation: University of Miami Miller School of Medicine Surgery Department (D40), PO Box 016960 Miami, FL 33101, USA. fkuchkarian@med.miami.edu.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marttos
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: Kuchkarian
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Palaios
authors.forename: Daniel
authors.initials: D
authors.lastname: Rojas
authors.forename: Phillipe
authors.initials: P
authors.lastname: Abreu-Reis
authors.forename: Carl
authors.initials: C
authors.lastname: Schulman