Preoperative virtual stoma site marking in colorectal surgery: a pilot study exploring a telemedicine-based solution for limited-access settings

Abstract

Background Preoperative 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. Methods This 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. Results A 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. Conclusions A 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.