Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Department of Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
Surg Endosc. 2018 Feb;32(2):682-687. doi: 10.1007/s00464-017-5721-8. Epub 2017 Jul 17.
Sleeve gastrectomy is a relatively new procedure that developed as a result of rapid innovation in the field of bariatric surgery. As with any newly developed operation, there is a learning curve that potentially can be associated with higher morbidity. Real-time surgical mentoring reduces the learning curve effect but can be time intensive for the mentor. The aim of this initiative was to evaluate the feasibility, effectiveness, and satisfaction of surgical telementoring for laparoscopic sleeve gastrectomy. This is the first national specialty society effort to determine if the "remote presence" of an expert surgeon (mentor) can help practicing surgeons improve skills.
The experience of 15 surgical trainees (mentees) who performed laparoscopic sleeve gastrectomy under real-time telementoring by 7 mentors was reviewed. Telementoring was implemented using the Visitor1 remote presence system with two-way live audio and video communication. The receiving platform utilized a conventional laptop, iPad, or iPhone. The mentee followed a structured telementoring program including didactic learning, live case teleobservation, and telementoring of 2-3 cases. A survey on the quality of the telecommunication and effectiveness of the mentoring was performed by the mentor and mentee on a scale of "exceeded," "met," "almost met," or "failed to meet" expectations. The overall telementoring experience was rated on a scale of 1 for "poor" to 5 for "excellent."
Based on the mentees' survey, the overall telementoring experience was rated as 4.8. Despite the mentees having experience with laparoscopic sleeve gastrectomy, most commented that the telementoring experience was an excellent educational tool and they learned some new techniques they plan to apply it in their practice. Based on the mentors' survey, the overall telementoring experience was rated as 4.7. All mentors stated that they were satisfied with the telementoring sessions and there were no unexpected intraoperative occurrences. There were some logistical limitations including difficulties in scheduling of cases or the delay of cases.
Surgical instruction by telementoring was shown to be feasible, practical, and successful, and was highly rated in this study by both the mentors and mentees. The currently utilized telementoring platform is thus an effective educational tool that can facilitate acquisition of surgical skills and assist with the conventional on-site surgical mentoring model.
袖状胃切除术是一种相对较新的手术，它是在减重手术领域快速创新的基础上发展起来的。与任何新开发的手术一样，它都有一个可能与更高发病率相关的学习曲线。实时手术指导可以减少学习曲线的影响，但对导师来说可能需要大量时间。本研究的目的是评估腹腔镜袖状胃切除术实时远程指导的可行性、有效性和满意度。这是首个专门评估全国性专业学会是否可以通过专家外科医生（导师）的“远程存在”帮助执业外科医生提高技能的研究。
对 15 名接受 7 名导师实时远程指导进行腹腔镜袖状胃切除术的外科受训者（受训者）的经验进行了回顾。使用双向实时音频和视频通信的 Visitor1 远程呈现系统实施远程指导。接收平台使用传统笔记本电脑、iPad 或 iPhone。受训者遵循一个结构化的远程指导计划，包括理论学习、实时手术远程观察以及 2-3 例远程指导。导师和受训者根据“超出”、“满足”、“几乎满足”或“未满足”期望的标准，对远程通信质量和指导效果进行了调查。整体远程指导体验的评分范围为 1（差）至 5（优）。
根据受训者的调查，整体远程指导体验的评分为 4.8。尽管受训者有腹腔镜袖状胃切除术的经验，但大多数人表示，远程指导体验是一种极好的教育工具，他们学习了一些新技术，计划在实践中应用。根据导师的调查，整体远程指导体验的评分为 4.7。所有导师都表示对远程指导会议感到满意，并且没有出现意外的手术中情况。存在一些后勤方面的限制，包括手术时间安排困难或手术延迟。
本研究表明，远程指导的外科教学是可行、实用且成功的，在本研究中，导师和受训者都对其给予了高度评价。因此，目前使用的远程指导平台是一种有效的教育工具，可以帮助获取手术技能，并辅助传统的现场手术指导模式。
