Observational studyTechniques in coloproctology2025
Preoperative virtual stoma site marking in colorectal surgery: a pilot study exploring a telemedicine-based solution for limited-access settings.
Observational study in Techniques in coloproctology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundPreoperative stoma site marking by a wound, ostomy, and continence nurse (WOCN) or colorectal surgeons significantly reduces stoma-related complications. Limited access to WOCNs or colorectal surgeons, especially in rural or emergency settings, remains a barrier to optimal care. This study evaluated the feasibility and spatial accuracy of a novel telemedicine-based protocol for stoma site marking before colorectal surgery in settings with limited specialist access. The primary outcome was the spatial distance between the in-person and virtual markings. Accuracy was classified as exact same point, within < 1 cm, 1-2 cm, or > 2 cm.
methodsThis prospective observational pilot study was planned in a tertiary academic medical center. Healthy adult volunteers with no prior abdominal surgery were enrolled in the study. Each participant underwent two independent stoma markings: one by an in-person WOCN and another by a different WOCN using standardized patient photographs taken in standing, sitting, supine, and bending positions, with an acetate grid for anatomical calibration.
resultsA total of 876 paired stoma site markings were obtained from 247 volunteers. Exact concordance between virtual and in-person markings was observed in 19.3% of cases. An additional 39.2% of virtual markings were located within 1 cm of the reference point, and 22.1% were within 1-2 cm. The remaining 19.4% deviated by more than 2 cm from the in-person marking. Overall, 80.6% of virtual markings fell within 2 cm of the in-person reference, demonstrating a high level of spatial concordance between the two methods.
conclusionsA standardized virtual stoma site marking protocol demonstrated high concordance with in-person assessment. This telemedicine-based strategy may be a feasible alternative in settings lacking colorectal specialists and could help optimize perioperative stoma care. The main limitations are inclusion of healthy volunteers rather than surgical patients. Real-world application and clinical outcome impact remain to be validated.
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