Keith Chae Kim (ed.)Robotics in General Surgery201410.1007/978-1-4614-8739-5_33
© Springer Science+Business Media New York 2014
33. Professional Education: Telementoring and Teleproctoring
(1)
Intuitive Surgical International, Sunnyvale, CA, USA
(2)
Department of Digestive Surgery, University Hospital Geneva, 14, rue Gabrielle-Perret-Gentil, Geneva, 1211, Switzerland
(3)
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
Abstract
Modern technology enables the remote guidance through surgical procedures via telementoring, which is particularly well suited to minimally invasive surgeries. Telementoring for robotic procedures might be carried over long distances as well as dual console mode using the da Vinci Surgical System with a proctor in the same room. This chapter discusses the current state of telementoring for robotic surgery and examines the pros and cons of this technology at the present time.
Background
The change in modern technique for general surgery from traditional open procedures to minimally invasive techniques has been driven by technological advances, which require effort to master on the part of trainee surgeons [1, 2]. Besides learning the technical aspects of these new technologies for routine standard surgery, new approaches to the anatomy and even entirely new procedures might be necessary when applying minimally invasive techniques. Examples include changing to a medial to lateral dissection during laparoscopic colonic mobilization or the work in new anatomical spaces for procedure such as minimally invasive totally extraperitoneal hernia repair. Therefore, the technical mastering of laparoscopic instruments is often insufficient for the successful performance of procedures that are already mastered with an open approach and each individual laparoscopic procedure requires specific learning.
While a pool of experienced senior surgeons are usually available in large tertiary hospitals to monitor and mentor their inexperienced colleagues as they learn how to use new technologies or even new procedures, this process can be a bottleneck in the dissemination of new techniques and their availability to the general population. As a result, telementoring or teleproctoring is becoming an increasingly familiar and welcome part of the modern surgical milieu [3, 4].
The goal of telementoring is to provide surgeons with real-time, “over-the-shoulder” guidance from distant, more experienced colleagues as they perform unfamiliar or challenging procedures or use new technology [5]. Using Internet-enabled cameras, microphones, telestration (technology to draw illustrations on the surgeon’s monitor), and speakers in the operating theater, telementors are able to observe and guide their mentees as necessary. This approach is particularly well suited to minimally invasive procedures, which already mostly rely on cameras to visualize the operating field; thus, there is less situational awareness to be gained by the physical presence of the mentor. When efficiently scheduled, telementoring might maximize the number of procedures mentors are able to proctor, increasing the overall training rate. This is particularly important for uncommon or newly developed surgical procedures using new tools and techniques such as robotics where the global supply of sufficiently experienced mentors may be limited.
Value and Limitations of Telementoring
The major advantages of telementoring are in convenience and throughput. A telementor does not need to scrub in or move from one operating room to another; they can remain in their office with all their reference material. Their time is used only when it is needed—thus increasing the efficiency of supervision. Trainee surgeons anywhere around the world with equipment and bandwidth can perform telementored surgery. This can drastically increase the availability of procedures at community and rural hospitals equipped for telementoring and decreases the distances that patients are forced to travel in order to receive the best care. Most importantly, telementoring allows training in and enhances performance of complex surgeries when mentors are not physically present. Telementoring also makes it easier to extend the period of mentoring; a trainee might go from needing a great deal of attention in the beginning to only calling in their telementor for particularly difficult presentations. Because mentors’ time is not wasted in transit or scrubbing, their attention costs less and they are able to spend more time with their own patients.
Telementoring does have its disadvantages. A mentor who is physically present is able to step in and complete the procedure if there is a complication; obviously this is not possible in telementoring. This underscores the need for strong preparation of the trainee beforehand. Telementors also must address issues around licensing, credentialing, and privileging ahead of time. Additionally, relying on two-dimensional images can make it difficult to detect or indicate anatomical features. Some or all of these problems may be rendered irrelevant in the future.
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