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Original research
International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations
  1. Emanuele Orru'1,
  2. Miklos Marosfoi1,
  3. Neil V Patel1,
  4. Alexander L Coon2,
  5. Christoph Wald3,
  6. Nicholas Repucci4,
  7. Patrick Nicholson5,
  8. Vitor M Pereira5,
  9. Ajay K Wakhloo1
  1. 1 Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  2. 2 Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
  3. 3 Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  4. 4 Research Administration, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  5. 5 Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Emanuele Orru', Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; surgeon.ema{at}gmail.com

Abstract

Background Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures.

Methods International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner.

Results All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution.

Conclusions International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.

  • aneurysm
  • flow diverter
  • angiography

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @dralexandercoon

  • Contributors Conception: EO, MM, NVP, VMP, AKW. Writing: EO, MM, NVP, CW, NR, VMP, PN, AKW. Review: EO, MM, NVP, ALC, CW, NR, VMP, PN, AKW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests VMP is a consultant for Stryker. ALC is a consultant and proctor for Stryker. AKW has a research grant from Philips Medical and serves as a consultant for Stryker.

  • Provenance and peer review Not commissioned; externally peer reviewed.