Endoscopic surgery (ES)—a minimally invasive surgery introduced during the 1990s—has become popular worldwide. In Japan, the number of ESs has rapidly increased, especially since being covered by insurance. To date, ES has been undertaken at most hospitals and medical centers [1]. However, there are still differences in short-term and long-term outcomes among institutions and surgeons, depending on their experience (based on the volume of ESs undertaken) and the training environment [2–4]. Because the complicated techniques used in ES necessitate long learning curves [5, 6], an effective educational system should be devised and systematically conducted for surgeons unskilled in ES procedures, especially at low-volume institutions, to ensure patients’ safety.
Various approaches to educating new and inexperienced surgeons regarding ES have been reported, including the use of textbooks, published papers, videos, simulators, surrogate animals, and cadavers [7, 8]. Among them, high-quality videos of ES procedures, which allow surgeons to watch an operation recorded in progress, have great potential to enhance surgical education [9–12]. The conference, in which expert surgeons review ES videos and instruct the precise procedure to the audience, could not only improve the trainee’s surgical skill and knowledge, but educate the conference participants as well.
In the past, the Saga University Department of Surgery sent medical/surgical staff to affiliated institutions to educate their surgeons and staff. However, there are three problems with that approach to ES education. First, most affiliated institutions are small or medium-sized, and in some, the volume of ES is too small for training and education. Second, an expert surgeon cannot always supervise ES performed by trainees in affiliated institutions. Third, surgeons belonging to affiliated institutions are difficult to gather in one place for an educational conference because of the location of the institution. Therefore, the education for ES procedure for surgeons at affiliated institutions of Saga University was the urgent necessity.
Teleconference system has been applied to medicine for more than 30 years [13]. With the development of information technology, some authors have reported the teleconference and/or telemedicine using transmitted moving images in the early stage [14, 15]. However, it was impossible to avoid compression of images because of the limitation of transmitted information volume, resulting in decreasing the quality of moving images [16]. Therefore, the tele-education for ES could not has become popular. In 1999, Digital Video Transport System (DVTS), which is a remote conference system capable of transporting uncompressed high-quality videos without time delay or noise, was invented in Japan, and many remote conferences using DVTS has been conducted among leading institutions [17–20]. However, for a teleconference using DVTS, a special network condition, such as static IP address and 30Mbps high-speed band, needs to be established, and therefore small or medium-sized institutions are still difficult to easily join the teleconference with high-quality video,
Therefore, we planned more easily available surgical videoconferences using a teleconference system to assess the quality of ES performance and to educate the surgeons at each affiliated institution. We report the potential to establish a comfortable remote educational environment by combining the use of a general web conferencing system and a synchronized remote video playback system with annotation function that is shared via high-speed internet.