title: Trans-Atlantic Telementoring with Pediatric Surgeons: Technical Considerations and Lessons Learned.
abstract: OBJECTIVE
  Although surgical residency training is a structured, regulated system for surgical skill acquisition, after residency or fellowship, no good method exists for practicing surgeons to learn new, developing techniques. Because 1-2-day simulation courses are probably inadequate for teaching a new technique and because it is often unrealistic for a practicing surgeon to leave his or her practice for an extended period of time, surgical telementoring may be a solution by allowing an expert to support a trained surgeon through the learning curve of a new procedure while overcoming geographic distance. In the past we have presented 6 cases of transcontinental telementoring with pediatric surgeons in the United States. We have since expanded the concept to trans-Atlantic telementoring and performed 2 cases with pediatric surgeons in France.
  
  
  METHODS
  The two telementors and one of the two telementees had previously met through a professional society but had never operated together before this experience. The first procedure was an interval laparoscopic appendectomy to test the process. The second procedure was a thoracoscopic total thymectomy. The technology consisted of the VisitOR1® telementoring robot (Karl Storz GmbH & Co. KG, Tuttlingen, Germany).
  
  
  RESULTS
  Both procedures were completed successfully with high satisfaction from both the telementors and telementees. Latency was low, and there was no loss of connection. The telestration and laser pointer features of the robot facilitated the telementoring experience. Challenges included lack of a prior surgical relationship between the mentees and mentors that limited the depth of advice but did not impair the quality of the surgery, as well as poor audio quality that was overcome using headsets.
  
  
  CONCLUSIONS
  From this experience, several challenges were identified and addressed. Telementoring may be an effective means of improving adoption of new surgical techniques, ultimately improving patient care.
authors.affiliation: 1 Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio.
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Bruns
authors.affiliation: 2 Department of Pediatric Surgery, Trousseau Hospital , Paris, France .|3 Sorbonnes Universités, Pierre and Marie Curie University, University of Paris 06 , Paris, France .
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: 4 Department of Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
authors.affiliation: 5 Department of Gastrointestinal Surgery, University Hospital of Northern Norway , Tromsø, Norway .
authors.forename: Etai M
authors.initials: EM
authors.lastname: Bogen
authors.affiliation: 2 Department of Pediatric Surgery, Trousseau Hospital , Paris, France .
authors.forename: Henri
authors.initials: H
authors.lastname: Kotobi
authors.affiliation: 1 Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
mesh_terms: D001062:Appendectomy / Q000193:education / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D007391:International Cooperation; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D008611:Mentors; D010372:Pediatrics / Q000193:education*; D013043:Specialties, Surgical / Q000193:education*; D017216:Telemedicine / Q000379:methods*; D013934:Thymectomy / Q000193:education / Q000379:methods; D014481:United States