title: Feasibility of Telementoring for Microneurosurgical Procedures Using a Microscope: A Proof-of-Concept Study.
abstract: BACKGROUND
  Our pilot study evaluated the effectiveness of our telementoring-telescripting model to facilitate seamless communication between surgeons while the operating surgeon is using a microscope.
  
  
  METHODS
  As a first proof of concept, 4 students identified 20 anatomic landmarks on a dry human skull with or without telementoring guidance. To assess the ability to communicate operative information, a senior neurosurgery resident evaluated the student's ability and timing to complete a stepwise craniotomy on a cadaveric head, with and without telementoring guidance; a second portion included exposure of the anterior circulation. The mentor was able to annotate directly onto the operator's visual field, which was visible to the operator without looking away from the binocular view.
  
  
  RESULTS
  The students showed that they were familiar with half (50% ± 10%) of the structures for identification and none was familiar with the steps to complete a craniotomy before using our system. With the guidance of a remote surgeon projected into the visual field of the microscope, the students were able to correctly identify 100% of the structures and complete a craniotomy. Our system also proved effective in guiding a more experienced neurosurgery resident through complex operative steps associated with exposure of the anterior circulation.
  
  
  CONCLUSIONS
  Our pilot study showed a platform feasible in providing effective operative direction to inexperienced operators while operating using a microscope. A remote mentor was able to view the visual field of the microscope, annotate on the visual stream, and have the annotated stream appear in the binocular view for the operating mentee.
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: laddx035@umn.edu.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Ladd
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Tackla
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Gupte
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: David
authors.initials: D
authors.lastname: Darrow
authors.affiliation: Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Sorenson
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Zuccarello
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Grande
mesh_terms: D002102:Cadaver; D003399:Craniotomy; D005240:Feasibility Studies; D006801:Humans; D000071252:Mentoring; D008853:Microscopy; D008866:Microsurgery; D019635:Neurosurgical Procedures; D010865:Pilot Projects; D013685:Telecommunications
keywords: Neurosurgery; Telementoring; Telescripting