Patient privacy is a matter of concern and HIPAA compliant tools must be utilised. All these issues have to be addressed before we can use surgical telementoring as an educational tool as well as a tool to bridge the availability gap.
By Vikram Thaploo
Telementoring is a subset of telemedicine that has evolved over the last few years, but is yet to be utilised to its full potential. It has special significance in India, where there is a critical shortage of trained medical professionals, not to mention large pockets that lack availability to quality medical care. We stand to face a 10% shortage in the general surgical workforce by 2030, and subspecialty services will be particularly hard hit.
Can surgical telemedicine help?
Surgical telemedicine is a novel concept in telemedicine where an expert surgeon guides a general surgeon, intern or a novice at a different physical location. Just like traditional mentoring, it plays the dual role of educating and providing medical care to patients. Studies have shown there is no difference in knowledge and skill acquisition between onsite mentoring and telementoring of novice surgeons. The telementoring applications can be expanded across surgical subspecialties and can be strategised to increase surgical expertise access.
Where does the technology stand?
Current advancements allow for high transmission speeds with almost no time delay. High definition viewing systems have made it easier for remote surgeons to zoom into small anatomical details. Interactive add-ons like telestration, laser pointing and greater control over the visual field have played a role in enhancing the teaching capabilities of remote surgeons. Let us look at the three most used tech applications.
Videoconferencing techniques: Many free and commercially available applications allow HD video conferencing. They are the most used telementoring methods. They can be used on a number of devices and their use precludes planning or hardware and software preparation. The ability to study anatomical structures in detail decreases with screen size, but more research is needed to see if it is statistically significant.
Wearable tech: Google Glass is an example of a wearable computer. It resembles a conventional glass and has an integrated display screen along with a microphone, HD camera, bone conduction audio transducer and wireless connectivity. The video quality is high and is more than enough to document the relevant clinical findings. While the image stream applications in surgery have been successful, the existing technology might require further modifications before it can be deployed in more complex and difficult operations. We need more research to determine the efficacy of wearable tech for telementoring.
Robotic platforms: Robotic platforms have made it easier for remote surgeons to maintain greater control in the operating room. The robot is connected to the remote surgeon’s laptop and provides internal views via direct connection and external views of the operation via built-in HD cameras. The surgeon gets to control the external camera and it also comes with telestration and laser pointing features. The high visual field maneuverability combined with optical zoom allows the surgical subspecialist to visualise the anatomical structures in detail.
The way forward
Even though the technology needed to implement surgical telementoring is available, its advancements depends on a number of other hurdles that limit the expansion. For instance, licensure problems persist because telementoring is often done across organisational borders. Financial models need to be determined regarding telepresence in surgery and decisions need to be made as to who will pay for the costs. Distribution of liability between the mentor and on-site surgeon also is unclear. Patient privacy is a matter of concern and HIPAA compliant tools must be utilised. All these issues have to be addressed before we can use surgical telementoring as an educational tool as well as a tool to bridge the availability gap.
The writer is CEO, Apollo Telehealth