Category: Education, Simulation & Virtual Reality

MP19-3 - Improving surgical training using telementoring: TRans Urethral Surgery Telestration training (TRUST) Pilot study

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Surgical telementoring by videoconferencing was first described in the sixties.
There is renewed interest in telemedicine solutions in surgical training with evidence that telementoring is cost-effective and safe, leading to the launch of a national US research initiative. Nonetheless, there is still insufficient data on educational outcomes.
Recently, a telemedical device (Omnistrator™, Omnitivity Inc, Boston, USA) has allowed surgeons to bi-directionally annotate over a delay free video stream and communicate with audio.
Our aim was to assess telementoring techniques for training surgeons performing Transurethral Resection of Bladder Tumour (TURBT).

Methods :

A trainee surgeon was given instructions on the steps of surgery and randomly assigned either traditional (verbal), or telementoring supervision (verbal + visual annotation).

Inclusion criteria: elective cases for primary or follow up single TURBT with a size of up to 3cms; and exclusion criteria: non-elective/emergency cases, multiple tumours, or tumour over 3 cms. The TURBT procedure was performed in a modular/step-wise manner to allow comparison of outcomes. 

Set up: A tablet device (Mentor controlled) was wirelessly and securely connected to the secondary operating screen Omnistrator™. Bidirectional audio, video and annotation was then available for mentor and trainee.
Outcome measure: we compared surgical performance of a trainee surgeon, with and without telementoring.
Study size: we evaluated 10 traditionally supervised and 10 telementored TURBT as a pilot study.

Results : Telestration during TURBT statistically improved (see table) the superficial (p<0.001) and deep bladder  (p<0.001) resection; bladder biopsy (p<0.04); knowledge of anatomy (p<0.0002); and overall precision of the procedure (p<0.0001). There was no difference in complications or safety. Trainees reported a preference for telestration, as the surgical area of interest on the operating screen was highlighted by annotation, allowing time to assess and plan the next surgical step. The supervising surgeon did not need to physically operate in any telestrated case (n=10); but did so in traditional cases (n=4). 

Conclusions : Our initial experience shows telestration using an Omnistrator is safe and effective for improving training of TURBT and was well received by our trainees.

Alberto Coscione

Urology Registrar
Ipswich Hospital
Fulbourn, England, United Kingdom

Hiten Patel

Professor of Urology
London, England, United Kingdom