JOURNAL OF THE INTERNATIONAL SOCIETY FOR TELEMEDICINE AND EHEALTH Boedeker D, et al, J Int Soc Telemed eHealth 2017;5(GKR):e13 1 A DEMONSTRATION OF THE FIRST TIME USE OF THE VITOM TO PROVIDE POST LACERATION REPAIR FOLLOW UP USING TELEMEDICINE TECHNOLOGY - A USEFUL METHODOLOGY FOR FAR FORWARD SURGICAL TELEMENTORING David Boedeker 1 , Kartik Shenoy MD 2 , Michael Wadman MD 3 , Todd Hall SSG 4 , Chad Branecki MD 3 , Ben Boedeker MD 5 1 Columbia University Mailman School of Public Health, New York, USA 2 Temple University, Philadelphia, USA 3 University of Nebraska Medical Center, Omaha, USA 4 Landstuhl Regional Medical Center, Landstuhl, Germany 5 University of the Incarnate Word School of Medicine, San Antonio, USA Abstract Surgical care must often be provided in remote areas where surgical subspecialists are not available. Telemedicine offers a means of linking a specialist with a remote medical provider to virtually provide the highest level of expertise. This paper describes the first known clinical usage of the Vitom exoscope to transmit images from a remote site to a specialty care provider for surgical evaluation. The Vitom is a low cost, portable endoscopic solution for linking remote general medical providers with specialists in tertiary care centres. This system has high potential utility for the far forward battlefield area. Keywords: Vitom; telemedicine; remote surgery Introduction Telemedicine has been deployed to provide specialty care to remote or austere sites for both civilian and military uses. 1-5 An example of such use would be rapid assessment of a hand injury by a hand specialist in a tertiary care centre achieved through the use of telemedicine linking to the remote primary care provider. This communication could allow the specialist to guide the care plan or coordinate evacuation of the patient for surgical repair. The United States military introduced a formal orthopaedic teleconsultation program in 2007 and performed a retrospective review of cases from this system between April 2009 and December 2012. 6 They reported that over half of all injuries generating a consult involved the upper extremity with hand injuries contributing more than any other anatomic area. 5 An imaging system is necessary to support telemedicine. Such telemedicine imaging capabilities may not be commonly in place at rural practice (or site of injury) locations. Due to the common availability of cell phones which are capable of sending an image, that communications modality could be useful in supporting telemedicine for hand injury. A small study with cell phones was performed in rural Australia which demonstrated that images of hand injuries could be transmitted by cell phone image and the images were reported by the investigators to have been valuable in describing the lesion to the distant referral site as opposed to just a verbal description. 2,3 This study was an example of a very low cost telemedicine communication system. 2,3 This paper describes the first known use of the Vitom endoscopic microscope (Karl Storz Endoscopy America, Inc. El Segundo, CA) to provide surgical microscopy images of a hand wound for telemedicine care. The Vitom is approximately the weight of a standard cell phone. Its small weight and cubic size make it ideal to support military telemedical wound imaging at far forward areas. (Figure 1) Figure 1. Vitom endoscopic microscope (Karl Storz Endoscopy America, Inc. El Segundo, CA).