International surgical telementoring using a robotic arm: Our experience

To determine the clinical utility of delivering remote subspecialty surgical care using a novel telesurgical mentoring system with current telemedicine technology. A personal computer-based system was developed to immerse a surgical specialist into a distant operating room utilizing public telephone lines. This system incorporates standard video conferencing (VTC) hardware with live video telestration (white boarding) capability and remote robotic control of a laparoscope camera. From Baltimore, Maryland, multiple laparoscopic surgical procedures were conducted to demonstrate the ability to telementor less experienced surgeons placed at remote locations in Austria, Thailand, Italy, and Singapore. Telecommunications links were successfully established to these remote locations that ranged in distance from approximately 4500 to 11,000 miles. There was no perceptible impact of time delay on the surgical procedures. All procedures were successfully completed without complications. This successful demonstration of international telementoring suggests that remote mentoring is a viable method of instructing less experienced surgeons through potentially complex surgical procedures. This novel approach in projecting expert surgical care may improve patient access to specialty care on a worldwide basis.