2022 General Surgery Presentations

Gordon G Wisbach, MD MBA FACS; Jesse Bandle, MD; Hunter J Faris, MD; Cyril J Harfouche, MD; Naval Medical Readiness and Training Command - San Diego

Introduction: The Military Health System (MHS) has long recognized the value and strategic importance of telehealth services in supporting the medically ready force and a ready medical force. Surgical telementoring will leverage technology to project surgical expertise with the primary goals of improving readiness and patient outcomes. We postulate that use of this technology will have a positive effect on surgeon satisfaction, procedural competence, the timeliness of operative intervention, surgical procedure efficiency, and key intra-operative decision-making. We performed a pilot study utilizing a tele-mentoring and telepresence interface during robotic-assisted surgery.

Methods: An IRB-approved prospective feasibility study to determine the safety and efficacy of providing remote surgical consultation to local surgeons utilizing robotic surgery technology. The fields of general surgery, urology, gynecology and thoracic surgery were included. Study participants of the surgical team were provided with a face-to-face orientation by the mentoring surgeon. The mentoring surgeon was located at the same institution in a separate tele-mentoring room equipped with audio and 2D video communication established with the operative team. A six-question evaluations was completed before and after the operation by the staff surgeon, residents, operative team members and the mentor. Evaluations assessed the perceived effect of surgical telementoring on the range of surgical services offered, satisfaction of operative team members, improvement in patient outcomes, reliability and connectivity of audio/video connection and whether the leadership/administrative support needed for surgical tele-mentoring will provide an obstacle or positive influence. Answers were scaled on a Likert Scale that ranged from 1-5. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test and sign test of matched pairs.

Results: Fifteen operative cases participated in the study with 7 general surgery, 3 urology, 2 gynecology and 3 thoracic surgery. There were a total of 86 paired evaluation responses: 43 pre-operation and 43 post-operation. With a strong degree of confidence (p<.05), participation in the operation had a positive effect on the participants responses with regards to all questions surveyed. Participant perception of leadership/administrative support was varied.

Conclusion: Surgical Tele-mentoring is safe and efficacious in providing remote surgical consultation to local surgeons utilizing robotic surgery technology in a military institution. Operative teams perceived this capability as beneficial and reliable audiovisual connectivity was demonstrated between the main operative room and the Virtual Medical Center. Further study is needed to develop surgical tele- mentoring capability to improve patient care without geographic limitations during times of peace, war and pandemic outbreaks.