Telementoring History

The first reported case of interactive real-time surgical teaching from a distant location was in 1965 when DeBakey utilized broadband satellite to transmit guidance in cardiothoracic surgery to Europe from the United States (2). However, rapid communication developments during the 1990s have been, at least in part, behind the recently expanding body of literature reporting telementoring to be a safe and feasible option for surgical teaching.

In 1994, Kavoussi et al. (3) reported use of the AESOPĀ® arma, a robotic arm capable of holding and manipulating the laparoscopic camera to perform three telementored surgeries in which the instructing surgeon was located in a separate room. Aside from the robotic arm repeatedly detaching from the camera, the procedures were performed successfully. In a series of 23 urologic procedures performed at the Baltimore Medical School, 22 were successfully completed laparoscopically by a junior surgeon with mentoring from an expert surgeon located in a separate building (4). Rosser et al. evaluated the role of telementoring in the teaching of advanced laparoscopic procedures. In a two-phase study, phase 1 involved four colonic resections during which the mentoring surgeon was present in the operating room and four colonic resections performed with the mentor located in a truck on the hospital grounds. Phase 2 involved two Nissen fundoplications mentored from within the operating room and two during which the mentor was located five miles away. In phase 1, audio and visual signals were transmitted via coaxial cable and in phase 2, coding and decoding algorithm-mediated compression technology and existing T-1 landlines were used. The authors reported no significant difference in mean operating times or surgical outcomes for the telementored procedures as compared to those in which the mentor was physically present (5). Early reports on the use of long-distance telementoring include an adrenalectomy performed in 1998 between Austria and the United States (6), and a series of five laparoscopic herniorrhaphies, completed on board an American aircraft carrier by the ship's surgeon while under the guidance of an experienced surgeon located in the United States. The surgeons were linked via the Battle Group Telemedicine System, which provided real-time audio and visual information (7).

Lee et al. reported results of transcontinental trial involving the United States and both Thailand and Austria in 1998 in which an electrocautery instrument could be controlled by the telementor. All surgeries, which included a nephrectomy, a varicocelectomy, and an adrenalectomy, were completed without complications (8). Since this time, numerous groups have reported successful telementoring of a wide range of procedures over substantial distances (9-13).

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