Generational Change in Liver Transplantation: Challenges and Opportunities Following a National Survey

Robotic single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) requires meticulous duodenal dissection, which is a technically demanding step. Traditional proctoring faces barriers, including limited availability, travel requirements and substantial costs. Teleproctoring may provide an effective approach to accelerate skill acquisition and overcome these limitations.

Retrospective observational study evaluating the association between teleproctoring implementation and changes in operative performance during robotic SADI-S procedures performed by a single surgeon in Madrid. Procedures were divided into pre-teleproctoring (n = 10) and teleproctored (n = 10, including 4 proctored and 6 post-teleproctoring) groups. Remote guidance was provided from Orlando using the Proximie® platform with bidirectional audiovisual communication and real-time telestration. The primary outcome was duodenal dissection time.

Baseline characteristics were comparable between groups. Duodenal dissection time decreased significantly from 31.0 ± 3.2 minutes pre-teleproctoring to 12.6 ± 2.8 minutes in the teleproctored group (P < .0001), representing a 59.2% reduction. Performance improvement was maintained in the post-teleproctoring phase (12.7 ± 2.7 minutes), demonstrating sustained skill acquisition. No complications or 30-day readmissions occurred in either group.

In this preliminary observational study, the implementation of teleproctoring was associated with a significant reduction in duodenal dissection time in SADI-S procedures, and sustained improvement was suggestive of effective transfer of knowledge. These findings are hypothesis-generating and require confirmation through prospective, randomized studies. Remote surgical guidance may represent a scalable solution for education in complex robotic metabolic bariatric procedures, overcoming barriers to expert mentorship.