The impact of latency on surgical precision and task completion during robotic-assisted remote telepresence surgery.

OBJECTIVE: It has been suggested that robotic-assisted remote telepresence surgery with a signal transmission latency of greater than 300 ms may not be possible. METHODS: We evaluated the impact of four different latencies of up to 500 ms on task completion and error rate in five surgeons after completion of three different surgical tasks. RESULTS: The surgeons were able to complete all tasks with a latency of 500 ms. However, higher latency was associated with higher error rates and task completion time (TCT). There were significant variations between surgeons and different tasks. CONCLUSION: Surgeons are able to complete tasks with a signal transmission latency of up to 500 ms. The clinical impact of slower TCT and increased error rates encountered at higher latency needs to be established.

Preceptorship and proctorship as an effective way to learn laparoscopic sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy has rapidly gained popularity as a procedure for morbidly obese patients. The goal of this project is to evaluate a training program for the laparoscopic sleeve gastrectomy (LSG), given to a group of surgeons by a specialized consultant in bariatric surgery. METHODS: The training process is divided in two parts. First, bringing the trainee surgeons to a specialized bariatric center to observe and take part in bariatric procedures with an experienced bariatric surgeon (preceptorship). Second, the consulting surgeon offers on-site training to all surgeons within their own hospital (proctorship). The support personnel (bariatric nurse, OR nurse, nutritionist) accompany the surgeon and are included in the training process. Finally, preoperative, intraoperative and postoperative data are compiled and analyzed. RESULTS: This study included 31 patients operated for LSG by the two newly trained surgeons after proctorship. Median age was 43 and mean BMI was 45.9. No leak, stricture, or mortality was found after the surgery. Mean surgical time was 94 min, and mean hospital length of stay was 3.9 days. Minor complications were seen during the follow-up at 1 to 3-6 months with excessive weight loss (EWL) of 62 % at 6 month. CONCLUSIONS: This study showed the effectiveness of training provided through preceptorship/proctorship with a specialized consulting surgeon. The low complication rate and the weight loss achieved in only 6 months demonstrate the safety and efficacy of this learning method.

Telementoring: an important enabling tool for the community surgeon.

This study evaluated the efficacy of telementoring as an enabling tool for community general surgeons to perform advanced laparoscopic surgical procedures. We present a series of 19 patients who underwent advanced laparoscopic surgical procedures in two community hospitals, between November 2002 and July 2003, by four community surgeons with no formal advanced laparoscopic training. Each surgeon was telementored by an expert surgeon from a tertiary care hospital. Telementoring was achieved with real-time two-way audio-video communications over Internet Protocol or Integrated Services Digital Network lines with bandwidths from 385 kbps to 1.2 mbps. The procedures included 10 bowel resections, 5 Nissen fundoplications, 2 splenectomies, 1 reversal of a Hartmann procedure, and 1 ventral hernia repair. Two of the 19 procedures (11%) were converted to open. There were no intraoperative complications and two postoperative complications (11%). The primary surgeon considered telementoring useful in all cases (median score, 4 of 5). The mentor was also comfortable with the quality of the laparoscopic surgery performed (median score, 4 of 5). Telecommunication bandwidth for audio and video transmission was found to be a critical factor in the quality of telementoring process. Telementoring is safe and feasible. It allows community surgeons with no formal advanced laparoscopic training to benefit from expert intraoperative advice during the performance of advanced laparoscopic procedures. It may also reduce health-care costs by avoiding the need to refer and transfer patients to tertiary care centers.