Maxillofacial Surgery 5.0: a new paradigm in telemedicine for distance surgery, remote assistance, and webinars.

Background: Telemedicine can provide valuable strategies to deliver high-quality training to young doctors and students, as well as to discuss complex clinical cases and follow patients. However, in many cases, similar benefits are limited by the costs due to the expensive hardware resources and optimal infrastructure required. This study presents a novel protocol to improve the accessibility of telemedicine services into a modern hospital department. The protocol is referred to as "SEF" (Smart videosurgery, Easy teleteaching, Fast teleassistance) and was developed in an Oral and Maxillofacial Surgery department. The aims of this study were: 1) to provide a solution to the high initial costs of the configuration of a telemedicine network; 2) to support the simultaneous transmission of multiple video streams; 3) to adopt a modular architecture that amplifies the distance of transmission on the basis of the network infrastructure (department, academic hospital, city, region), thus permitting distance delivery of visual content without any quality loss.

Methods: A local Wi-Fi network was created to connect a wireless presentation device with smartphones, laptops, tablets, and a visualization platform represented by an interactive whiteboard (IWB), allowing to display multiple video streams at the same time. The SEF Project was applied during nine operations and a sample of 90 students (10 students for each procedure) was chosen to evaluate the impact of distance telementoring on their learning performance, in contrast with traditional surgical education.

Results: The interface was successfully tested in all surgeries without any quality loss for their whole duration. High resolution and fluidity were confirmed in the recorded clips as well. The impact of telementoring system was assessed by groups of 10 students for each procedure who were administered a questionnaire, and a total satisfaction index of 9/10 was achieved.

Conclusions: SEF protocol appeared to be a stable and highly customizable interface, and has the potential to empower many centers with accessible telehealth systems.