Archivio Italiano di Urologia e Andrologia 2016; 88, 3206

ORIGINAL PAPER

Telerounding & telementoring for urological procedures

Volkan Sen, Ozgu Aydogdu, Tarik Yonguc, Ibrahim Halil Bozkurt, Deniz Bolat

Izmir Bozyaka Training and Research Hospital, Department of Urology Izmir, Turkey.

Telemedicine is the use of medical infor-
mation exchanged from one site to anoth-

er via electronic communications to improve a patient’s clin-
ical health status. Telemedicine includes a growing variety
of applications and services using two-way video, email,
smart phones, wireless tools and other forms of telecommu-
nications technology. Starting out over forty years ago with
demonstrations of hospitals extending care to patients in
remote areas, the use of telemedicine has spread rapidly and
is now becoming integrated into the ongoing operations of
hospitals, specialty departments, home health agencies, pri-
vate physician offices as well as consumer’s homes and
workplaces. There’s also a current trend in the use of
telemedicine in urology. In the present paper we aimed to
review the recent literature about telemedicine and the use
of telerounding and telementoring in urological procedures. 

KEY WORDS: Telemedicine; Telementoring; Telerounding.

Submitted 23 February 2016; Accepted 3 March 2016 

Summary

No conflict of interest declared.

demonstrated high rates of patient satisfaction in tele-
rounding arm (4). Patients undergoing the following
laparoscopic procedures were offered participation in this
study: nephrectomy, partial nephrectomy, nephroureterec-
tomy, retroperitoneal lymph node dissection, partial
ureterectomy, and radical prostatectomy. Forty-five percent
of the patients assessed that their care was better because of
telerounding, 67% said that it should be a regular part of
patient care in the hospital, 86% could easily communicate
with their doctor using the telerounding system, 76%, if
hospitalized again, would feel comfortable with teleround-
ing, and 67% claimed that if their doctor was out of town
they would rather teleround with their doctor than be seen
by another doctor. There were no significant differences in
hospitalization time and complication rates between the
two arms.
Kau et al. were evaluated the telerounding system by lap-
top computers with built-in webcam and video conferenc-
ing software in 2008 (5). Ten physician, 14 nurses and 10
patients were included in the study; 90% of patients
agreed that they could easily communicate with their
physician using video-rounding system (VRS). All patients
strongly agreed that VRS should be a regular part of patient
care and that they would be comfortable using VRS if their
physician was unable to be in direct contact with them. All
physicians and nurses agreed that VRS was easy to use,
enhanced patient care, would be a comfortable alternative
if direct physician contact was not possible, and that it
should be a regular part of institutional care.
With the technological developments, the tablets had
begun to be used for telerounding. Kaczmarek et al. report-
ed the first study with tablet telerounding in 2012 (6).
Totally 32 postoperative patients (25 robotic partial
nephrectomy, 2 radical nephrectomy, 3 robotic-assisted
radical prostatectomy, 1 adrenalectomy and 1 nephroure -
terectomy) were evaluated in this study. Patients expressed
a high level of satisfaction with 91% of patients stating that
their care was better using telerounding and 97% of
patients stating that telerounding should be a regular part
of patient care in the hospital. Additionally, 94% of patients
stated that they could easily communicate with their doc-
tor over the telerounding system, 84% of patients agreed
that they would feel comfortable with telerounding daily if
they were hospitalized again and 81% of patients would
prefer telerounding communication with their doctor than
be directly seen by another doctor. The results of the tele-
rounding studies were summarized in Table 1. By the tech-
nological developments, telerounding systems have
become more cost-effective and more available and afford-

DOI: 10.4081/aiua.2016.3.206

INTRODUCTION
Telemedicine had come to the fore with the report by
Aronson SH at 1977 about telephone using (1).
Subsequent studies about telemedicine were performed on
e-mail (2, 3). Johansen MA et al. investigated whether the
parents of burns patients could capture suitable clinical
images with a digital camera and add the necessary text
information to enable the pediatric burns team to provide
follow-up care via email and they suggested that this tech-
nique could be used as a low-cost telemedicine service in
burns follow-up (2). Telerounding is described as remote
patient rounding by using computers, laptops, cameras
and tablets. It was firstly reported in 2004 by Ellison et al.
using a computer with a camera for telerounding installed
on a remotely controlled custom service robot platform
with 85 patients (3). They emphasized that the patients in
the telerounding arm demonstrated statistically substantial
improvements in ratings of examination thoroughness,
quality of discussions about medical information, postop-
erative care coordination, and attending physician avail-
ability. Further trials supported the findings of these stud-
ies and telemedicine has been also widely used in urology
clinics (4-6). The recent paper focused on the use of
telemedicine in urology practice. 

TELEROUNDING IN UROLOGY
In 2007 a large multi-institutional randomized study by
Ellison et al., included 270 patients; 134 in the robotic tele-
rounding arm and 136 patients in bedside round arm,

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207Archivio Italiano di Urologia e Andrologia 2016; 88, 3

Telerounding & telementoring in urology

able. In recent years especially the tablets has an advantage
of lower purchase cost, widespread availability, uncompli-
cated setup. Increased device portability inherent to its
light weight and small size allows the device to be easily
carried between floors and clinical locations. 
The increased patients’ satisfaction in Kaczmarek’s study
could be explained by these reasons. These studies
showed us the telerounding system has potential benefit
for the physician as well as the patient. Doctors can gain
convenience and flexibility with the potential for oversee-
ing more patients. The average time of about 5 minutes is
enough to facilitate communication and patient satisfac-
tion. But we wish to emphasize that any telerounding sys-
tems could not replace the bedside rounding, they should
be only an additional visits for bedsides rounds.

TELEMENTORING IN UROLOGY
Advances in technology have opened new avenues for
long-distance communication through telemedicine.
With this technology, an expert surgeon can observe and
actively supervise a procedure performed by a trainee
surgeon at another institution. Telementoring is an
application of telemedicine that involves the remote
guidance of procedures when the operator has limited
experience with the technique. The first instances of
transcontinental urologic telesurgery performed using
the da Vinci system was reported by Sterbis et al. in
porcine model at 2007 (7). Nephrectomy was success-
fully performed in 4 animals without any complication.
Robot-assisted radical prostatectomy (RARP) has a long
learning curve. In recent studies this curve was report-
ed in experienced open surgeons as 8 to 20 operations
(8-10). This curve is higher in trainee surgeons therefore
mentoring of trainee surgeons has become more impor-
tant to ensure that they attain sufficient skill without
compromising the safety of their initial patients.
Mentoring is usually done face-to-face, which presents
practical difficulties when the mentor and trainee
belong to different institutions. A telementoring system
for robot-assisted surgery was firstly tested by Hinata et
al. in 30 patients which avoids expensive and time-con-
suming travel by mentors (11). They found that the
perioperative outcome of RARP performed with tele-
mentoring was not inferior to direct mentoring.

CONCLUSION
These studies showed us that the telerounding system
has potential benefit for the physician as well as the

patient. Doctors can gain convenience and flexibility
with the potential for overseeing more patients. However
we wish to emphasize that any telerounding system
could not replace the bedside rounding, but they should
be only additional visits to bedsides rounds. The tele-
mentoring system for urological procedures seems to be
reliable and feasible, however further comprehensive
studies including larger patient cohorts are needed. 

REFERENCES
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Ellison et al, 2004 Ellison et al, 2007 Kau et al, 2008 Kaczmarek et al, 2012
Number of patients 85 270 10 32
Rate of patients who assessed that their care was better because of telerounding 42.4%* 45% 60% 91%
Rate of patients who said that it should be a regular part of patient care in the hospital 76.9% 67% 100% 97%
Rate of patients who could easily communicate with their doctor using the telerounding system 80.8% 86% 90% 94%
Rate of patients who, if hospitalized again, would feel comfortable with telerounding 66,6% 76% - 84%
Rate of patients who claimed that if their doctor was out of town they would rather teleround 
with their doctor than be seen by another doctor 19.2%** 67% 100% 81%
*: 53.9% patients answered this queston as ‘not sure’.

Table 1. 
Summary of studies for telerounding systems.

Correspondence
Volkan Sen, MD (Corresponding Author) - sen_volkan@yahoo.com 
Ozgu Aydogdu, MD - ozgucan@yahoo.com
Tarik Yonguc, MD - tyonguc@gmail.com
Ibrahim Halil Bozkurt, MD - ihalilbozkurt@yahoo.com
Deniz Bolat, MD - drbolat@hotmail.com
Department of Urology, Izmir Bozyaka Training and Research Hospital, 
Izmir, Turkey 

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