***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose : To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair ( EVAR ) . Methods : According to a prospect ively design ed study protocol , 48 patients underwent EVAR :  the first 12 patients ( group A ) were treated at a secondary care center by an experienced interventionist , who was training the local team ; a further 12 patients ( group B ) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite ; and the last 24 patients ( group C ) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center . Telementoring was performed using 3 video sources ; images were transmitted using 4 ISDN lines . EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches , as well as for identifying the origins of the renal arteries , assessing the aortic neck , and monitoring the attachment of the stent-graft proximally and distally . Results : Average duration of telementoring was 2.1 hours during the first 12 patients ( group B ) and 1.2 hours for the remaining 24 patients ( group C ) . There was no difference in procedural duration ( 127±59 minutes in group A , 120±4 minutes in group B , and 119±39 minutes in group C ; p=0.94 ) or the mean time spent in the ICU ( 26±15 hours in group A , 22±2 hours in group B , and 22±11 hours for group C ; p=0.95 ) . The length of hospital stay ( 11±4 days in group A , 9±4 days in group B , and 7±1 days in group C ; p=0.002 ) was significantly different only for group C versus A ( p=0.002 ) . Only 1 ( 8.3 % ) patient ( in group A : EVAR performed by the experienced operator ) required conversion to open surgery because of iliac artery rupture . This was the only conversion ( and the only death ) in the entire study group ( 1/12 in group A versus 0/36 in groups B + C , p=0.31 ) . Conclusions : Telementoring for EVAR is feasible and shows promising results . It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine OBJECTIVE /HYPOTHESIS Teleproctored surgery projects a surgeon 's expertise to remote locations . The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current st and ard of care . STUDY DESIGN Prospect i ve . METHODS A study was conducted in a residency training program comparing  conventionally proctored endoscopic sinus surgery cases with teleproctored cases  , with the faculty surgeon supervising through audiovisual teleconferencing ( VTC ) in a control room 15 seconds from the operating room . RESULTS Forty-two control patients ( 83 sides ) and 45 teleproctored patients ( 83 sides ) were evaluated . There were no internal differences between groups regarding extent of polypoid disease , revision status , procedures per case , degree of difficulty , general or local anesthesia , or microdebrider use . There were no cases of visual disturbance , orbital ecchymosis or hematoma , or cerebrospinal fluid leak . Orbital fat herniation and blood loss were equal between groups . Three teleproctored cases required faculty intervention : two for surgical difficulty , one for VTC problems . Teleproctored cases took 3.87 minutes longer per side ( 28.54 vs. 24.67 min , P < .024 ) , a 16 % increase . This was thought to be a result of nuances of VTC proctoring . Residents had a positive learning experience , with nearly full control of the operating suite combined with remote supervision through telepresence . Faculty thought such supervision was safe but had concerns regarding personal skills maintenance . CONCLUSIONS Teleproctored endoscopic sinus surgery can be safely performed on selected cases with an acceptable increase in time . Teleproctored surgery with remote sites may continue to be safely investigated . Incorporating remote supervision through telepresence into the curriculum of surgical residency training requires further study To prospect ively evaluate the feasibility and safety of a novel , second‐generation telementoring interface ( Connect ™ ; Intuitive Surgical Inc. , Sunnyvale , CA , USA ) for the da Vinci robot Endovascular aortic grafting represents a minimally invasive approach to aortic aneurysm repair . The technique requires a variety of new skills and extensive training . Telemedicine enhances mentoring and technical support for surgeons performing the technique Few laparoscopic surgical experts exist relative to the number of surgeons needing training in laparoscopic surgical techniques . This study tested application of telemedicine technology in the mentoring of surgeons during laparoscopic cholecystectomy .  Our Surgical Telementoring Suite provided real-time audio and video telecommunication to the operating room . Data points for telementored laparoscopic cholecystectomy  ( TLC , n = 6 ) were compared to age and sex-matched controls having st and ard laparoscopic cholecystectomy ( SLC , n = 6 ) with mentors physically present in the operating room . TLC data were also compared between cases performed with a staff surgeon and resident as mentorees ( SRM , n = 3 ) , versus two residents as mentorees ( RRM , n = 3 ) . Data were analyzed with chi-square testing . The level of statistical significance was set at p < 0.05 . No major operative complications occurred in either group ( p > 0.05 ) . Total operative times were similar ( 92.2 + /- 18.4 minutes SLC vs. 94.7 + /- 25.3 minutes TLC , p > 0.05 ) . Additional data compared between SRM and RRM groups included time to establishment of a pneumoperitoneum of 12 - 15 mm Hg ( 7.0 + /- 6.1 minutes SRM vs. 6.7 + /- 2.9 minutes RRM ) , time to placement of all four trocars ( 13.0 + /- 3.6 minutes SRM vs. 10.3 + /- 3.1 minutes RRM , time to isolation and proximal clipping of the cystic duct ( 38.0 + /- 12.1 minutes SRM vs. 55.7 + /- 29.0 minutes RRM ) , and time to removal of the gallbladder ( 77.3 + /- 25.4 minutes vs. 77.7 + /- 27.5 minutes RRM ) . For all data points , p > 0.05 . We conclude that telementoring is a safe , effective method for teaching the techniques of LC . This is true for operating teams composed of surgical residents , with or without staff surgeons present BACKGROUND Virtual reality ( VR ) simulators for laparoscopy and endoscopy may be valuable tools for resident education . However , the cost of such training in terms of trainee and instructor time may vary depending upon whether an independent or proctored approach is employed . METHODS We performed a r and omized controlled trial to compare independent and proctored methods of proficiency-based VR simulator training .  Medical students were r and omized to independent or proctored training groups . Groups were compared with respect to the number of training hours and task repetitions required to achieve expert level proficiency on laparoscopic and endoscopic simulators . Cox regression modeling was used to compare time to proficiency between groups , with adjustment for appropriate covariates . RESULTS Thirty-six medical students ( 18 independent , 18 proctored ) were enrolled . Achievement of overall simulator proficiency required a median of 11 hours of training ( range , 6 - 21 hours ) . Laparoscopic and endoscopic proficiency were achieved after a median of 11 ( range , 6 - 32 ) and 10 ( range , 5 - 27 ) task repetitions , respectively . The number of repetitions required to achieve proficiency was similar between groups . After adjustment for covariates , trainees in the independent group achieved simulator proficiency with significantly fewer hours of training ( hazard ratio , 2.62 ; 95 % confidence interval , 1.01 - 6.85 ; p = 0.048 ) . CONCLUSIONS Our study quantifies the cost , in instructor and trainee hours , of proficiency-based laparoscopic and endoscopic VR simulator training , and suggests that proctored instruction does not offer any advantages to trainees . The independent approach may be preferable for surgical residency programs desiring to implement VR simulator training 
    Output:
    
Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring .