title: Transcontinental telementoring with pediatric surgeons: proof of concept and technical considerations.
abstract: OBJECTIVE
  To evaluate different technologies that can facilitate telementoring in a variety of pediatric surgical procedures.
  
  
  METHODS
  Two different telementoring technologies were used to provide two-way audio and visual communication between experienced pediatric surgeon mentors located in another city and less experienced trainees performing a surgical procedure. The first technology consisted of store-bought equipment that connected the operating room laparoscope to a Skype™ (Microsoft, Redmond, WA) connection (used in 1 case), whereas the second was a proprietary telementoring robot, Karl Storz Endoscopy-America, Inc. VisitOR1(®) (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) (used in 5 cases). The procedures included a video-assisted thoracic surgery lower lobectomy, a temporary and two permanent gastric stimulator placements, and two laparoscopic inguinal hernia repairs and were performed by pediatric surgeons (3 cases), a pediatric gastroenterologist (1 case), and a general surgeon (2 cases) under the guidance of pediatric surgeon mentors.
  
  
  RESULTS
  All procedures were completed successfully in a time-efficient manner, without loss of transmission and without complications. Although the Skype technology was less costly, it lacked telestrator capacity and was not adequately secure. The VisitOR1 telementoring robot enabled high-resolution video communication, had telestrator capacity, and allowed pointing during the procedure. The mentors assisted with trocar placement, modifying the surgical technique, identifying planes of dissection, and indicating locations of device and suture placement.
  
  
  CONCLUSIONS
  Telementoring is a useful adjunct in the field of pediatric surgery that can aid in the transfer of surgical skills remotely and shorten the time to implementation of new surgical techniques into practice. Optimal telementoring technology should have a secure wireless connection, high video resolution, and minimal bandwidth latency.
authors.affiliation: 1 Akron Children's Hospital , Akron, Ohio.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
authors.forename: Iuliana D
authors.initials: ID
authors.lastname: Bobanga
authors.forename: Marc
authors.initials: M
authors.lastname: Schwachter
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Stathos
authors.forename: Michael
authors.initials: M
authors.lastname: Rosen
authors.forename: Robert
authors.initials: R
authors.lastname: Parry
authors.forename: Margaret
authors.initials: M
authors.lastname: Nalugo
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
mesh_terms: D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D061108:Social Media; D066231:Surgeons; D013686:Telemetry / Q000379:methods*