Design and Implementation of a Web-Based System for Intraoperative Consultation Francisco Tamariz Æ Ronald Merrell Æ Irinel Popescu Æ Daniel Onisor Æ Y. Flerov Æ Cosmin Boanca Æ Vladimir Lavrentyev Æ Azhar Rafiq Published online: 3 January 2009 Ó Socie ´te ´ Internationale de Chirurgie 2008 Abstract Background With the use of electronic information dis- tribution and telecommunication technologies, surgical teleconsultation is possible as a vehicle for consulting with experts remotely without their physical presence in the operating room (OR). This study evaluated real-time tele- consultation from the OR to remote consultants in the Russian Research Center of Surgery, Moscow, Russia and the Fundeni Clinical Hospital, Bucharest, Romania. Methods We evaluated the effectiveness of teleconsulta- tion using a secure website interface where consultants could navigate through multimedia-based electronic doc- umentation of a surgical procedure and identify the anatomic landmarks underlying the need for consultation. Additionally, management of a remote camera view by consultants was evaluated. Results Fifteen thyroidectomies and parathyroidectomies were studied to confirm by teleconsultation the identity of 22 recurrent laryngeal nerves (RLNs). There was no Internet connectivity interruption or dropped signal, and the bandwidth was consistently greater than 1 Mbps. Consultants spent an average of 6 min to review an average of 35 min of surgical records to identify the 22 RLNs. Conclusions This study validated a system for real-time teleconsultation using web-based surgical records. In addition, the ability of the consultant to manage the camera view remotely without interrupting the surgical procedure was confirmed. Introduction The operating room (OR) is by design a place isolated for patient privacy, sterility, and preserving the focus of the surgical team on the task at hand. However, this isolation can limit the ability to share the surgical environment with other clinicians physically removed from the operating room for the purposes of teaching, consulting, and general collaboration. Surgeons were early adapters of video-conferencing techniques, as noted in 1965 when DeBakey offered a live demonstration from Houston, Texas to colleagues in Switzerland using analog television and satellite transmis- sion [1]. Additionally, the use of teleconferencing to provide effective mentoring between the surgeon in the OR and the physically removed consulting surgeon has been validated. Such use of technology and telecommunications qualifies the definition of telemedicine [2]. With the evolution of surgical procedures to include minimally invasive techniques, the ability to share video images from the surgical field has become more feasible with the use of tools such as the endoscopic camera. Early application in urologic techniques and cholecystectomy demonstrated the possibility of applying surgical image transmission to telemedicine [3–6]. Telemedicine in the operating room can support distant mentoring of newly trained surgeons, as was shown by F. Tamariz Á R. Merrell Á C. Boanca Á V. Lavrentyev Á A. Rafiq (&) Virginia Commonwealth University, Richmond, VA 23284, USA e-mail: arafiq@vcu.edu I. Popescu Á D. Onisor Fundeni Clinical Hospital, Bucharest, Romania Y. Flerov Russian Research Center of Surgery, Moscow, Russia 123 World J Surg (2009) 33:448–454 DOI 10.1007/s00268-008-9858-4