Wearable Technology for Global Surgical Teleproctoring.
OBJECTIVE
In underserved communities around the world, inguinal hernias represent a significant burden of surgically-treatable disease. With traditional models of international surgical assistance limited to mission trips, a standardized framework to strengthen local healthcare systems is lacking. We established a surgical education model using web-based tools and wearable technology to allow for long-term proctoring and assessment in a resource-poor setting. This is a feasibility study examining wearable technology and web-based performance rating tools for long-term proctoring in an international setting.


METHODS
Using the Lichtenstein inguinal hernia repair as the index surgical procedure, local surgeons in Paraguay and Brazil were trained in person by visiting international expert trainers using a formal, standardized teaching protocol. Surgeries were captured in real-time using Google Glass and transmitted wirelessly to an online video stream, permitting real-time observation and proctoring by mentoring surgeon experts in remote locations around the world. A system for ongoing remote evaluation and support by experienced surgeons was established using the Lichtenstein-specific Operative Performance Rating Scale.


RESULTS
Data were collected from 4 sequential training operations for surgeons trained in both Paraguay and Brazil. With continuous internet connectivity, live streaming of the surgeries was successful. The Operative Performance Rating Scale was immediately used after each operation. Both surgeons demonstrated proficiency at the completion of the fourth case.


CONCLUSIONS
A sustainable model for surgical training and proctoring to empower local surgeons in resource-poor locations and "train trainers" is feasible with wearable technology and web-based communication. Capacity building by maximizing use of local resources and expertise offers a long-term solution to reducing the global burden of surgically-treatable disease.
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California.
Néha
N
Datta
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California.
Ian T
IT
MacQueen
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
Alexander D
AD
Schroeder
The Medical School for International Health, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Jessica J
JJ
Wilson
Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
Juan C
JC
Espinoza
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California.
Justin P
JP
Wagner
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
Charles J
CJ
Filipi
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California. Electronic address: dcchen@mednet.ucla.edu.
David C
DC
Chen
D000328:Adult; D000368:Aged; D004503:Education, Medical, Graduate / Q000379:methods*; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000193:education; D006801:Humans; D020407:Internet / Q000295:instrumentation*; D008297:Male; D013043:Specialties, Surgical / Q000193:education*; D017216:Telemedicine
Google Glass; Practice-Based Learning and Improvement; Systems-Based Practice; global surgery; internet; telementoring; teleproctoring; wearable technology