A pilot study of surgical telementoring for leg fasciotomy. Issue 2 (10th October 2017)

• Record Type: Journal Article
• Authors: Talbot, Max; Harvey, E J; Berry, G K; Reindl, R; Tien, H; Stinner, D J; Slobogean, G
• Other Names: author non-byline.; Talbot Max author non-byline.; Harvey Edward J author non-byline.; Berry Gregory K author non-byline.; Reindl Rudolph author non-byline.; Tien Homer author non-byline.; Stinner Daniel J author non-byline.; Slobogean Gerard author non-byline.; Martineau Paul A author non-byline.; Weagle Valerie author non-byline.; Levesque Marie-julie author non-byline.; Schmid Joanne author non-byline.; Ip Wang-chun author non-byline.; Doyle Leilani author non-byline.; Berger Chris author non-byline.; Crummey Stephen author non-byline.; Couillard Mathieu author non-byline.
• Is Part Of: Journal of the Royal Army Medical Corps. Volume 164:Issue 2(2018)
• Page Start: 83
• Page End: 86
• Publication Date: 2017-10-10
• Subjects: trauma management -- telemedicine
• DOI: 10.1136/jramc-2017-000817
• Languages: English
• ISSNs: 0035-8665

Abstract

Abstract : Introduction: Acute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research. Methods: Three anaethetists and one critical care physician were recruited as operators. They were directed to perform a two-incision leg fasciotomy on a Thiel-embalmed cadaver under the guidance of a remotely located orthopaedic surgeon. The operating physician and the surgeon (mentor) were connected through software that allows for real-time supervision and the use of a virtual pointer overlaid onto the surgical field. Two experienced orthopaedic traumatologists independently assessed the adequacy of compartment decompression and the presence of iatrogenic complications. Results: 14 of 16 compartments (in four leg specimens) were felt to have been completely released. The first evaluator considered that the deep posterior compartment was incompletely released in two specimens. The second evaluator considered that the superficial posterior compartment was incompletely released in two specimens. The only complication was a large laceration of the soleus muscle that occurred during a period of blurred video signal attributed to a drop in bandwidth. Conclusions: This study suggests that surgical telementoring may enable physicians to safely perform two-incision leg fasciotomy in remote environments. This could improve the chances of limb salvage when compartment syndrome occurs far from surgical care. We found interobserver variation in the assessment of compartment release, which should be considered in the design of future research protocols.