Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies

Edgar Rojas-Muñoz,Patrick Murphy,Clare Griffis,Juan Antonio Barragan,Voicu Popescu,Ben Zarzaur,Natalia Sanchez-Tamayo,Juan P Wachs,Maria Eugenia Cabrera,Chengyuan Lin,Daniel Andersen,Andrew W Kirkpatrick,Jessica Mckee,Thomas Douglas,Kathryn Anderson

doi:10.1038/s41746-020-0284-9

Abstract

Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient’s body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants’ years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios.

Highlights

And adequate treatment is an essential factor in the survival of critically injured patients[1], in the prehospital setting[2,3]
To address the shortcomings of telestrator-based or AR tabletbased telementoring platforms, this paper evaluates, in a simulated austere scenario, the next-generation system for telementoring with augmented reality (STAR)
By using the device’s onboard camera to transmit a view of the operating field, our system eliminated the need of external cameras that could encumber the medics who work in austere settings[23]

Summary

INTRODUCTION

And adequate treatment is an essential factor in the survival of critically injured patients[1], in the prehospital setting[2,3]. A remote mentor annotates a live video of the mentee’s operating field using lines and icons that encode surgical instructions[16] These annotations are visualized by the local mentee on a nearby display. In AR telementoring, three-dimensional (3D) computer-generated objects are superimposed into the field of view of the mentee, in real time, which avoids focus shifts[21] In most of these AR-based approaches, tablets between the patient and the mentee are used to display the medical guidance, placed in a fixed position in the operating field[19,20]. Most telestrator-based or AR tablet-based telementoring platforms are not designed to provide point of injury (POI) care Such platforms are neither self-contained nor portable: they require multiple pieces of hardware to operate (e.g. external cameras, screens, computers, brackets), which would.

RESULTS

Rojas-Muñoz et al 3

DISCUSSION

METHODS

Findings

Participants