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+++++++++++++++++++++++++++++++++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: MINIMALLY INVASIVE PROCEDURES ❯ K E E PI N G CU R R E NT WITH new techniques is important for any surgeon. Yet it can be challeng- ing to receive advanced training in your own practice. Innovative technol- ogy, such as telementoring, is making it more convenient to stay up to date, while also networking with other surgeons. Telementoring mirrors the educa- tion methods surgeons receive during residency. Teaching hospitals follow a model where residents learn to perform surgery under the guidance of other surgeons. Once in their own practice, it's more difficult for surgeons to receive the one-on-one training necessary to learn new techniques. With telementoring, a mentor surgeon guides another through a surgical pro- cedure via telepresence technology. The mentor takes part in the surgery through a computer connected to a mobile monitor in the mentee surgeon's operating room. Through the mobile monitor, the mentor can observe the surgery from above or laparoscopically, talk to the mentee in real time, instruct with a laser pointer, and draw out ideas on-screen to explain technical points that may arise. While technology is a key component of telementoring — it's only one part. The mentee surgeon must have a basis of knowledge and experience with the procedure being learned. Additionally, the dialogue before the procedure between the surgeons supports a successful outcome. This approach not only benefits indi- vidual surgeons, it can also help hospitals start new service lines. Instead of hiring specialized surgeons in areas such as bar- iatrics or laparoscopic hernias, surgeons can be trained through telementoring. A good example of telementoring in practice is gastric electrical stimula- tion (GES), or gastric stims. This new technology is indicated for patients with gastroparesis, a condition characterized by chronic nausea, vomiting and/or abdominal pain that does not respond to medical therapy. An electrical stimula- tion device 1 , similar to a pacemaker, is implanted laparoscopically above the patient's abdominal muscle under the skin to stimulate the stomach. While 70% of patients report resolution of symptoms post surgery, others experience no respite. * To predict who would respond favorably, surgeons can perform a tempo- rary stim. During this outpatient procedure, surgeons place probes endoscopically in the stomach, then attach them to a stimulator device patients wear around their neck or on their abdomen, which mimics the operation of the gastric stim device. If the temporary stim offers relief, the surgeon has a good indication the patient would benefit from a permanent one. Gastric stims are a relatively new approach to treating gastroparesis, so surgeons may not be familiar with how to perform the insertion. As one of only a few surgeons implanting these devices in children, through telementoring I've been training surgeons and gastroenterologists to perform both temporary and permanent stim procedures. Currently, telementoring is in its infancy, but it's built on the mentor-mentee relationship used in teaching hospitals around the world. Now that same relation- ship and learning can continue throughout a surgeon's career, making medical innova- tions more accessible. Todd Ponsky, MD, is a Pediatric Surgeon for Akron Children's Hospital and is board certified in Surgery and Pediatric Surgery by the American Board of Surgery. ■ 1 Note: The gastric electrical stimu- lation device used for treating drug refractory gastroparesis received special approval from the FDA in 1999 under the Humanitarian Device Exemption (HDE). Currently, the Enterra® neurostimulator from Medtronic is the only GES device available on the market. * Source: Abell T., McCallum R.W., Hocking M., Koch K., Abrahamsson H., LeBlang I., Lindberg G., Konturek J., Nowak T., Quigley E.M.M., Tougas G., Starkebaum W. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology, 2003; 125:421-428; see also Forster J., Sarosiek I., Delcore R., Lin Z., Raju G.S., McCallum R.W. Gastric pacing — a novel surgical treatment for gastroparesis. Am J Surg, 2001; 182:676-681. Innovation in the OR: Telementoring and Gastric Electrical Stimulation By Todd Ponsky, MD 2 0 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ M A R C H /A P R I L 2 0 1 4