56: Robotic telementoring: expanding the reach of advanced surgical expertise

Abstract

To meet the increasing need for advanced robotic expertise, we used telemedicine technology to develop a system for telementoring that allows a remote expert surgeon to provide surgical mentoring to an on-site surgeon. This system allows the expert surgeon to see the operating room table, the hands of the surgeon at the robotic console, and the surgical field and provides a continuous two-way audio feed. Initial testing consisted of a trainee suturing on a Da Vinci robot simulator while an expert surgeon provided telementoring feedback. Testing was then performed in a cadaver lab, where gynecology residents and fellows performed laparoscopic entry, robotic docking, and robotic hysterectomy under telementoring guidance. Finally, the telementoring system was utilized to proctor a surgeon undergoing formalized surgical mentoring during a robotic hysterectomy on a live person. Here, the expert robotic surgeon utilized telementoring but was available on-site for concerns. After optimizing the technology in simulator and cadaver labs, a robotic hysterectomy was successfully performed using telementoring with high satisfaction of both the expert surgeon and the mentee. In both the cadaver lab and the robotic hysterectomy, docking the robot was found to be the most challenging aspect to telementor as it requires an intricate set up and visualization of the details of the entire room. We successfully used this innovative technology to telementor a robotic hysterectomy and to identify areas for technologic improvement. Telestration, the ability to overlay markings from the expert surgeon on the robotically visualized field, was identified as a useful next step. Future plans also include comparison of telementoring versus in-person mentoring of robotic hysterectomies. We anticipate that telementoring will allow us to extend advanced surgical expertise far beyond where we can physically reach.