Telementoring Brings Expert Help to Remote Communities


Canada’s increasing rural and remote populations are losing access to surgical services because of a decrease in the number of surgeons practicing in rural areas. The Centre for Minimal Access Surgery (CMAS) at St. Joseph’s Healthcare Hamilton has developed a response to improve the availability of surgical care to Canadians living in those isolated communities.

Minimal access surgery, or laparoscopy, is revolutionizing surgical practice by offering patients the opportunity to undergo major operations without the need for large incisions, minimizing scarring, reducing post-operative pain, and shortening recovery times and hospital stays. However, due to the unequal distribution of laparoscopically trained surgeons, these procedures are often not available to Canadians living outside major cities.

CMAS’s Surgical Support Network is designed to increase the availability of those minimal access surgical procedures to Canadians in geographically remote areas. Over the past four years, hundreds of surgeons from all over Canada and the U.S. have received education and training in those techniques in Hamilton. Now a surgeon telementoring initiative is extending that expert help by providing a significantly higher range and quality of laparoscopic procedures in general surgery, urology and gynecology to such communities as North Bay, Yellowknife and Chicoutimi.

“The primary purpose of telementoring is to support surgeons at remote hospitals in the development and use of newly acquired skills,” says CMAS founding director Dr. Mehran Anvari. “By providing expert advice through two-way telecommunication during live surgery, the expert mentor is able to be at a separate location. This eliminates the need for travel and increases the mentor’s availability to work with several different learning surgeons.”

The telementoring initiative hopes to have a direct impact on health-care delivery. It aims at increasing the retention of surgeons in rural areas by providing access to continuing education opportunities, improving surgeons’ skills and teaching them the latest techniques, and expanding the number of procedures surgeons are comfortable performing. It’s an important tool for enhancing health care delivery, particularly in rural and remote areas where health-care resources and expertise are often scarce or non-existent.

This use of advanced technologies helps connect Dr. Patrick Trudeau, practicing in a small city in Quebec, with expert help.

“I think telementoring is the way to go. I do get experts to travel here to Chicoutimi, but it’s cumbersome and time consuming. It is so much easier to push a button and have an expert there to help,” says Trudeau. “After taking courses in Hamilton, telementoring provides the same kind of assistance as having an expert on hand. There are some specialized surgeries that I only perform rarely where I would feel the need of expert hands literally, but in the future, CMAS telerobotics might even be able to help with those specialized surgeries.”

In the next few months, CMAS will undertake a new telerobotic surgery initiative that will augment what can be offered with telementoring. This initiative will eventually allow the surgeon to not only give direct advice but to actually take an active part in the surgery with the use of telerobotics.

The capability to do real-time remote teaching and telementoring has been made feasible through state-of-the-art, multimedia teleconferencing equipment. CMAS has the ability to broadcast or receive data from any ISDN, ATM, or IP-VPN connected operating room or classroom in the country. And to facilitate this distant educator role, the Centre has appointed faculty members from across Canada and internationally.

Dr. Daniel Birch, assistant director at CMAS, says, “It would be more than a little challenging to assist each of the surgeons we have trained in person. But telementoring allows us to offer that assistance without leaving our home site. We use video and audio links, as well as the use of the telestrator. This set up offers the surgeon the presence of an expert, when he may not even have a colleague to help with surgery at his home site. And that’s a huge advantage, it allows surgeons a great and safe way to integrate the new procedure into their practice.”

CMAS is literally on the cutting-edge in this area. A systematic/routine program for surgical telementoring in advanced minimal access techniques exists nowhere else in Canada.