Clinical evaluation of tele-endoscopy using UMTS cellphones

In the past years, various applications of telemedicine have been found. Especially teleconsulting or telementoring has been accepted as a possible answer to upcoming higher quality demands utilizing expert knowledge in everyday clinical routine. In this work we investigate whether video transmission based on universal mobile telecommunication system (UMTS) by means of arthroscopic videos is clinically reasonable. Secondly, we examine the quality of the enabling technology especially for consolidated diagnostics and telementoring.

Twenty arthroscopic video streams with a length of 60 s of each sequence, showing endoscopic craniomaxillofacial interventions such as arthroscopies of the temoporomandibular joint or endoscopic assisted open reductions of mandibular head fractures, were hosted on a server and analyzed on a UMTS cellphone. Each of the arthroscopic video sequences was independently evaluated by two consultants and a medical expert in TMJ surgery. Quality aspects such as identifiability of anatomical details, instruments, and tasks, and pathology were assessed in a questionnaire. Stability of transmission and breakdowns were also registered.

The median percentage of completely transmitted videos without interruption was 85 ± 12.5% (interquartile range, IQR). In 6.7% of all video transmissions, complete interruption resulted, requiring restart. Of anatomical structures, 60.7% were correctly identified, while in 39.3% an identification error was detected. Tasks and instruments were recognized in 92.4%. In 94.8%, pathologies could be correctly diagnosed.

The need for teleconsultation is given, since orientation in arthroscopy is difficult. UMTS-streamed endoscopic videos still have certain limitations regarding teleconsulting due to instability and delay. Nevertheless, the technology may currently be beneficial for teleteaching and could be used in the future in teleconsultation. Without affecting ongoing surgeries and with no special need for a lecture theater, this technology provides tele-education using standard hospital infrastructure.