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The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study
Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions,...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott, Williams & Wilkins
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623848/ https://www.ncbi.nlm.nih.gov/pubmed/26422331 http://dx.doi.org/10.1097/TA.0000000000000829 |
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author | Kirkpatrick, Andrew W. Tien, Homer LaPorta, Anthony T. Lavell, Kit Keillor, Jocelyn Wright Beatty, Heather E. McKee, Jessica Lynn Brien, Susan Roberts, Derek J. Wong, Jonathan Ball, Chad G. Beckett, Andrew |
author_facet | Kirkpatrick, Andrew W. Tien, Homer LaPorta, Anthony T. Lavell, Kit Keillor, Jocelyn Wright Beatty, Heather E. McKee, Jessica Lynn Brien, Susan Roberts, Derek J. Wong, Jonathan Ball, Chad G. Beckett, Andrew |
author_sort | Kirkpatrick, Andrew W. |
collection | PubMed |
description | Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS: An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the “Cut Suit”) was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS: There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION: Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures. |
format | Online Article Text |
id | pubmed-4623848 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Lippincott, Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-46238482015-11-30 The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study Kirkpatrick, Andrew W. Tien, Homer LaPorta, Anthony T. Lavell, Kit Keillor, Jocelyn Wright Beatty, Heather E. McKee, Jessica Lynn Brien, Susan Roberts, Derek J. Wong, Jonathan Ball, Chad G. Beckett, Andrew J Trauma Acute Care Surg TAC Plenary Papers Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS: An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the “Cut Suit”) was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS: There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION: Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures. Lippincott, Williams & Wilkins 2015-11 2015-09-29 /pmc/articles/PMC4623848/ /pubmed/26422331 http://dx.doi.org/10.1097/TA.0000000000000829 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share thework provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | TAC Plenary Papers Kirkpatrick, Andrew W. Tien, Homer LaPorta, Anthony T. Lavell, Kit Keillor, Jocelyn Wright Beatty, Heather E. McKee, Jessica Lynn Brien, Susan Roberts, Derek J. Wong, Jonathan Ball, Chad G. Beckett, Andrew The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title_full | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title_fullStr | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title_full_unstemmed | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title_short | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
title_sort | marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: a pilot study |
topic | TAC Plenary Papers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623848/ https://www.ncbi.nlm.nih.gov/pubmed/26422331 http://dx.doi.org/10.1097/TA.0000000000000829 |
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