MSS002: SURGICAL TELE-MENTORING DURING MINIMALLY INVASIVE CHOLECYSTECTOMY: A VALIDATION STUDY IN MILITARY INSTITUTIONS
Hunter J Faris, MD1; Jian Li, BS2; Kyle Gadbois, MD3; Gordon Wisbach, MD3; 1Trihealth Good Samaritan Hospital; 2SUNY Upstate Medical University; 3Navy Medical Readiness & Training Command San Diego
Objectives: Surgical telementoring bridges the gap in access to expertise with the goal of improving safety, efficiency and quality of care delivery. Recently, we published a pilot study that established a proof-of-concept for surgical telementoring and this system was deemed safe and efficacious in providing remote surgical consultation to local surgeons in a military institution. To build on this work, we performed a follow-on study to validate the image fidelity, video telecommunications quality, workload effect as well as mentor and mentee value assessment of the surgical telementoring system.
Methods: An IRB-approved prospective validation study was performed of a surgical telementoring system used during minimally invasive cholecystectomy operations between two military treatment facilities. A pre-operative virtual face-to-face surgical telementoring orientation took place between the Mentor (remote surgeon) and Mentee (local surgeon) to establish communication, terminology and methodology. Intraoperatively, these surgeons were in reciprocal hospitals and completed a checklist during the operation to compare identification of landmark anatomy relevant to performing a safe cholecystectomy. Postoperatively, the mentor and mentee completed an evaluation to subjectively assess fidelity of image transmission, audio and video quality, system reliability, impact on workload, and overall satisfaction.
Results: Nine Mentors and 16 Mentees were enrolled during 15 laparoscopic and robotic-assisted cholecystectomy operations in two different military treatment facilities. Statistical analyses included one-sample t-tests against a Likert midpoint of 3 and pairwise mentor–mentee comparisons. Image fidelity achieved a mean Likert score of 4.92 ± 0.47, significantly greater than the moderate benchmark (p < 0.001). Video quality was rated 4.70 ± 0.55 and audio quality 4.62 ± 0.66, both highly significant (p < 0.001). Overall system performance was rated 4.56 ± 0.61. System reliability was high, with only 8% disconnections and 19 instances where instructions required repetition. Mentors consistently reported higher audio ratings compared with mentees (p = 0.006), though video quality differences were not significant. Workload scores averaged 3.46 ± 1.25, with mentees reporting non-significant differences from baseline workload expectations, suggesting no increase in operative stress.
Conclusions: Our surgical telementoring system was validated as delivering image congruence of relevant surgical anatomy, system reliability, limited impact on workload and provided excellent user satisfaction. Further study of this system is needed in various general surgery procedures and surgical specialties and may provide a scalable and sustainable approach to improve access to expertise and delivery of surgical care.
Key words: remote mentor, surgical tele-mentoring, laparoscopy, robotic surgery, cholecystectomy