Ismail Mustafa, Muthana Ahmed, Al-Ageely Teeba A, Ahmed Fatimah Oday, Al-Taie Rania H, Al-Khafaji Aktham O, Al-Zaidy Mahmood F, Salih Hayder R, Alrawi Mohammed A, Aktham Awfa, Al-Jehani Hosam, Hoz Samer S
Department of Neurosurgery, University of Baghdad, Baghdad, Iraq.
Department of Neurosurgery, University of Al-Mustansiriyah, Baghdad, Iraq.
Surg Neurol Int. 2024 Aug 9;15:280. doi: 10.25259/SNI_440_2024. eCollection 2024.
Proctoring in neuroendovascular surgery is one of the potential solutions for the shortage of personnel and experience, particularly in unstable and limited-resource areas such as Iraq.
The study was conducted at the Baghdad Neurovascular Center (BNC), the first Hybrid neurovascular institution in Iraq, where sequential online zoom-based meetings between the BNC team and the expert from the Kingdom of Saudi Arabia were used for teleproctoring for neurointerventional procedures.
A total of 28 sessions were conducted, four sessions for each case. Seven cases with various intracranial vascular lesions were operated for neuroendovascular procedures from July/2021 to March/2022. The teleproctoring for each case included four sequential sessions: (1) preoperative planning, (2) device selection and preparation, (3) intraoperative live-stream proctoring, and (4) postoperative reflection and follow-up planning. The procedures include coiling for dural arteriovenous fistula; preoperative tumor embolization; preoperative, partial, and staged embolization for arteriovenous malformation; coiling for intracranial aneurysm; and attempted Giant aneurysm flow-diversion. Major complications were avoided through teleproctoring, and all patients had good outcomes. In addition, the teleproctoring provided an effective training experience to the local neuroendovascular team that is otherwise not feasible.
Teleproctoring is an effective and feasible tool to improve patient outcomes and provide a training experience to the local neuroendovascular teams in resource-limited regions.
神经血管内手术的远程指导是解决人员短缺和经验不足问题的潜在方案之一，尤其是在伊拉克等不稳定和资源有限的地区。
该研究在伊拉克首个混合神经血管机构巴格达神经血管中心（BNC）进行，BNC团队与沙特阿拉伯王国的专家通过一系列基于在线Zoom的会议对神经介入手术进行远程指导。
共进行了28次会议，每个病例4次会议。2021年7月至2022年3月期间，对7例患有各种颅内血管病变的患者进行了神经血管内手术。每个病例的远程指导包括四个连续的会议：（1）术前规划，（2）设备选择和准备，（3）术中实时远程指导，以及（4）术后反思和随访规划。手术包括硬脑膜动静脉瘘的栓塞治疗；术前肿瘤栓塞；动静脉畸形的术前、部分和分期栓塞；颅内动脉瘤的栓塞治疗；以及尝试的巨大动脉瘤血流导向治疗。通过远程指导避免了重大并发症，所有患者均取得了良好的治疗效果。此外，远程指导为当地神经血管内团队提供了有效的培训经验，否则这是不可行的。
远程指导是一种有效且可行的工具，可改善患者治疗效果，并为资源有限地区的当地神经血管内团队提供培训经验。
