Low workload for pelvic neuromonitoring supported by teleconsulting: technical considerations and feasibility

Pelvic intraoperative neuromonitoring (pIONM) prevents functional disturbances after low anterior rectal resection. We investigated the workload of performing pIONM under telementoring conditions to catalyze translation into surgical practice.

Six patients with rectal cancer underwent nerve-sparing total mesorectal excision (TME) with laparoscopic or robot-guided pIONM. A telementoring system enables cross-reality interaction, with online communication between a briefed on-site surgeon at the operating room and a remote mentor at an external hospital. The validated NASA Task Load Index (NASA-TLX) was used to measure the workload for standardized pIONM.

The pIONM was installed and performed without any problems. It required a median 7 min stimulation time (range 7-10 min) and confirmed nerve-sparing TME in all six patients. Remote and on-site telepresence required a median 31 min (range 24-44 min), enabling adequate application training for a first-time user. The overall NASA-TLX-based workload realizing pIONM was a median 8.7 (range 3.3-16.3) points. There was no significant difference in TLX between on-site and remote surgeons (p = 0.180). Overall workload was highest for the first-time user but decreased upon repetition. Significantly higher values were found in the following subscales for the surgeon performing pIONM: physical demand (p = 0.002) and temporal demand (p = 0.03).

Initiation of pIONM supported by teleconsulting is feasible and requires a low workload.