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Sleeve gastrectomy telementoring: a SAGES multi-institutional quality improvement initiative

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Abstract

Background

Sleeve gastrectomy is a relatively new procedure that developed as a result of rapid innovation in the field of bariatric surgery. As with any newly developed operation, there is a learning curve that potentially can be associated with higher morbidity. Real-time surgical mentoring reduces the learning curve effect but can be time intensive for the mentor. The aim of this initiative was to evaluate the feasibility, effectiveness, and satisfaction of surgical telementoring for laparoscopic sleeve gastrectomy. This is the first national specialty society effort to determine if the “remote presence” of an expert surgeon (mentor) can help practicing surgeons improve skills.

Methods

The experience of 15 surgical trainees (mentees) who performed laparoscopic sleeve gastrectomy under real-time telementoring by 7 mentors was reviewed. Telementoring was implemented using the Visitor1® remote presence system with two-way live audio and video communication. The receiving platform utilized a conventional laptop, iPad, or iPhone. The mentee followed a structured telementoring program including didactic learning, live case teleobservation, and telementoring of 2–3 cases. A survey on the quality of the telecommunication and effectiveness of the mentoring was performed by the mentor and mentee on a scale of “exceeded,” “met,” “almost met,” or “failed to meet” expectations. The overall telementoring experience was rated on a scale of 1 for “poor” to 5 for “excellent.”

Results

Based on the mentees’ survey, the overall telementoring experience was rated as 4.8. Despite the mentees having experience with laparoscopic sleeve gastrectomy, most commented that the telementoring experience was an excellent educational tool and they learned some new techniques they plan to apply it in their practice. Based on the mentors’ survey, the overall telementoring experience was rated as 4.7. All mentors stated that they were satisfied with the telementoring sessions and there were no unexpected intraoperative occurrences. There were some logistical limitations including difficulties in scheduling of cases or the delay of cases.

Conclusions

Surgical instruction by telementoring was shown to be feasible, practical, and successful, and was highly rated in this study by both the mentors and mentees. The currently utilized telementoring platform is thus an effective educational tool that can facilitate acquisition of surgical skills and assist with the conventional on-site surgical mentoring model.

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Funding

This SAGES sleeve gastrectomy initiative was supported by a Grant from the Foundation for Advanced Medical Education, a division of the American Medical Foundation for Peer Review and Education.

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Authors and Affiliations

  1. Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA

    Ninh T. Nguyen & Brian Smith

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Allan Okrainec

  3. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Mehran Anvari

  4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Oz Meireles & Denise Gee

  5. American Medical Foundation for Peer Review and Education, Philadelphia, PA, USA

    Evelyn Baram-Clothier

  6. Department of Surgery, Albert Einstein College of Medicine, New York, NY, USA

    Erin Moran-Atkin & Diego R. Camacho

  7. Department of Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA

    Ninh T. Nguyen

Authors
  1. Ninh T. Nguyen
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  2. Allan Okrainec
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  3. Mehran Anvari
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  4. Brian Smith
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  5. Oz Meireles
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  6. Denise Gee
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  7. Erin Moran-Atkin
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  8. Evelyn Baram-Clothier
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  9. Diego R. Camacho
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Corresponding author

Correspondence to Ninh T. Nguyen.

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Disclosures

Ninh T. Nguyen, Allan Okrainec, Mehran Anvari, Brian Smith, Oz Meireles, Denise Gee, Erin Moran-Atkin, Evelyn Baram-Clothier, and Diego R. Camacho have no conflicts of interest or financial ties to disclose.

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Nguyen, N.T., Okrainec, A., Anvari, M. et al. Sleeve gastrectomy telementoring: a SAGES multi-institutional quality improvement initiative. Surg Endosc 32, 682–687 (2018). https://doi.org/10.1007/s00464-017-5721-8

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  • DOI: https://doi.org/10.1007/s00464-017-5721-8

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