Surgical Telementoring Research Articles

The Impact of Surgical Telementoring on Reducing the Complication Rate in Endoscopic Endonasal Surgery of the Skull Base.

Pituitary adenomas represent the most common pituitary disorder, with an estimated prevalence as high as 20%, and they can manifest with hormone hypersecretion or deficiency, neurological symptoms from mass effect, or incidental findings on imaging. Transsphenoidal surgery, performed either microscopically or endoscopically, allows for a better extent of resection while minimising the associated risk in comparison to the transcranial approach. Endoscopy allows for better visualisation and improvement in tumour resection with an improved working angle and less nasal morbidity, making it likely to become the preferred surgical treatment for pituitary neoplasms. The learning curve can be aided by telementoring. We retrospectively analysed the clinical records of 94 patients who underwent an endoscopic endonasal resection of a pituitary neoplasm between the years 2011 and 2023 at Maribor University Medical Centre in Slovenia. Remote surgical telementoring over 3 years assisted with the learning curve. The proportion of complication-free patients significantly increased over the observed period (60% vs. 79%). A gradual but insignificant increase in the percentage of patients with improved endocrine function was observed. Patients' vision improved significantly over the observed period. By gaining experience, the extent of gross total tumour resection increased insignificantly (67% vs. 79%). Telementoring for the endoscopic endonasal approach to pituitary neoplasms enables low-volume centres to achieve efficiency, decreasing rates of postoperative complications and increasing the extent of tumour resection.

Understanding The Needs of Mentoring in Surgery to Guide the Design of Surgical Telementoring Systems

All along their careers, surgeons learn through mentoring, operating on patients side-by-side with expert surgeons. However, access to experts is more and more challenging as they are often located far from learners. Telementoring can increase the reach of mentors by supporting mentoring at a distance, but despite their potential, current systems remain rarely institutionalized. We investigate current surgical mentoring practices, to inform future design of telementoring systems in providing support for learning. In a field study, we observe 11 surgeries and conduct follow-up self-confrontation interviews with mentor-mentee pairs. Through Thematic Analysis, we find that the domain of surgery results in mentee's needs for reassurance regarding safety, being spared from workload and risk, both essential to support the acquisition of skills. Second, that mentors understand the situation primarily through the surgical site view but also through inspecting the mentee's posture and the patient's body. Thirdly, that mentors take physical distance as their presence limits mentees' autonomy development. We discuss the limits of current surgical telementoring systems and rethink their role as companions of onsite mentoring.

Technologies Used for Telementoring in Open Surgery: A Scoping Review.

Background: Telementoring technologies enable a remote mentor to guide a mentee in real-time during surgical procedures. This addresses challenges, such as lack of expertise and limited surgical training/education opportunities in remote locations. This review aims to provide a comprehensive account of these technologies tailored for open surgery. Methods: A comprehensive scoping review of the scientific literature was conducted using PubMed, ScienceDirect, ACM Digital Library, and IEEE Xplore databases. Broad and inclusive searches were done to identify articles reporting telementoring or teleguidance technologies in open surgery. Results: Screening of the search results yielded 43 articles describing surgical telementoring for open approach. The studies were categorized based on the type of open surgery (surgical specialty, surgical procedure, and stage of clinical trial), the telementoring technology used (information transferred between mentor and mentee, devices used for rendering the information), and assessment of the technology (experience level of mentor and mentee, study design, and assessment criteria). Majority of the telementoring technologies focused on trauma-related surgeries and mixed reality headsets were commonly used for rendering information (telestrations, surgical tools, or hand gestures) to the mentee. These technologies were primarily assessed on high-fidelity synthetic phantoms. Conclusions: Despite longer operative time, these telementoring technologies demonstrated clinical viability during open surgeries through improved performance and confidence of the mentee. In general, usage of immersive devices and annotations appears to be promising, although further clinical trials will be required to thoroughly assess its benefits.

Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring.

To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education. The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2). Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000. Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.

Surgical tele-mentoring using a robotic platform: initial experience in a military institution

BackgroundSurgical tele-mentoring leverages technology by projecting surgical expertise to improve access to care and patient outcomes. We postulate that tele-mentoring will improve surgeon satisfaction, procedural competence, the timeliness of operative intervention, surgical procedure efficiency, and key intra-operative decision-making. As a first step, we performed a pilot study utilizing a proof-of-concept tele-mentoring process during robotic-assisted surgery to determine the effects on the perceptions of all members of the surgical team.MethodsAn IRB-approved prospective feasibility study to determine the safety and efficacy of remote surgical consultation to local surgeons utilizing robotic surgery technology in the fields of general, urology, gynecology and thoracic surgery was performed. Surgical teams were provided a pre-operative face-to-face orientation. During the operation, the mentoring surgeon was located at the same institution in a separate tele-mentoring room. An evaluation was completed pre- and post-operatively by the operative team members and mentor.ResultsFifteen operative cases were enrolled including seven general surgery, four urology, one gynecology and three thoracic surgery operations. Surveys were collected from 67 paired survey respondents and 15 non-paired mentor respondents. Participation in the operation had a positive effect on participant responses regarding all questions surveyed (p < 0.05) indicating value to tele-mentoring integration. Connectivity remained uninterrupted with clear delivery of audio and visual components and no perceived latency. Participant perception of leadership/administrative support was varied.ConclusionsSurgical tele-mentoring is safe and efficacious in providing remote surgical consultation to local surgeons utilizing robotic surgery technology in a military institution. Operative teams overwhelmingly perceived this capability as beneficial with reliable audio-visual connectivity demonstrated between the main operative room and the Virtual Medical Center. Further study is needed to develop surgical tele-mentoring to improve patient care without geographic limitations during times of peace, war and pandemic outbreaks.

Remote Interactive Surgery Platform (RISP): Proof of Concept for an Augmented-Reality-Based Platform for Surgical Telementoring.

The "Remote Interactive Surgery Platform" (RISP) is an augmented reality (AR)-based platform for surgical telementoring. It builds upon recent advances of mixed reality head-mounted displays (MR-HMD) and associated immersive visualization technologies to assist the surgeon during an operation. It enables an interactive, real-time collaboration with a remote consultant by sharing the operating surgeon's field of view through the Microsoft (MS) HoloLens2 (HL2). Development of the RISP started during the Medical Augmented Reality Summer School 2021 and is currently still ongoing. It currently includes features such as three-dimensional annotations, bidirectional voice communication and interactive windows to display radiographs within the sterile field. This manuscript provides an overview of the RISP and preliminary results regarding its annotation accuracy and user experience measured with ten participants.

Augmented Reality in Breast Surgery Education

Introduction: Augmented reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning-aided processing, and visualization is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality, virtual reality, or extended reality will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse. Methods: This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible. Conclusion: Surgical telementoring and impalpable tumors noninvasive localization are two examples that can have success in the future provided the improvements in both data transformation and infrastructures are capable to overcome the current challenges and limitations.

28. The Role of XR Technology in the Field of Plastic Surgery Training

Background: While early innovations are often disruptive and met with resistance, adoption of new technologies occurs when the benefits become readily apparent. Recently, eXtended Reality (XR) is gaining momentum as surgical training use cases are being explored. XR consists of a user wearing a head-mounted display (HMD) that blends the physical and digital world for enhanced visualization, communication, and understanding. To understand the potential impact of this novel educational tool, the receptiveness of resident and attending plastic surgeons must first be assessed for its usefulness and useability. Methods: Michigan Medicine Plastic Surgeons watched recorded XR interventions concurrently piloted within the department and completed a survey assessing applications for: (1) remote consultation; (2) surgical tele-mentoring; (3) pre-operative planning to visualize patient-specific anatomy. Recordings were stored for future educational purposes. Results: In total, 11 attending and 10 resident physicians (21/44, 48%) responded to the survey. Attendings were more willing to use, and most optimistic about, the value of remote consultation; residents were most optimistic about surgical tele-mentoring. Both attendings and residents considered the HoloLens2 unnecessarily complex (60% & 56% respectively). Simpler device interventions, such as with the Iristick, were rated more favorably for usability. In all Iristick interventions, attendings were more confident than residents in their ability to use the devices without technical support (72% vs 45%, respectively). Conclusion: Attendings were overall more receptive than residents to the integration of XR in Plastic Surgery training. Responses suggest residents are under an increased cognitive load, and novel processes may be perceived as stress-inducing if trainees are the intended wearer of HMD. Residents appreciated XR technology for its value of increased visibility in the operating room, paralleling the added benefit of viewing cases remotely and asynchronously for case preparation. Residents noted the Hawthorne effect, whereby an attending wearing a HMD during an operation was more inclined to verbalize tacit knowledge that might have gone unnoted in the absence of a recording device. Selecting the most valuable use cases and executing it with the most usable technology, in a process that is mindful of role stress, is paramount to advancing Residency education efforts.

Real-time 3D scans of cardiac surgery using a single optical-see-through head-mounted display in a mobile setup

Microsoft HoloLens 2 (HL2) is often found in research and products as a cutting-edge device in Mixed Reality medical applications. One application is surgical telementoring, that allows a remote expert to support surgeries in real-time from afar. However, in this field of research two problems are encountered: First, many systems rely on additional sensors to record the surgery in 3D which makes the deployment cumbersome. Second, clinical testing under real-world surgery conditions is only performed in a small number of research works. In this article, we present a standalone system that allows the capturing of 3D recordings of open cardiac surgeries under clinical conditions using only the existing sensors of HL2. We show difficulties that arose during development, especially related to the optical system of the HL2, and present how they can be solved. The system has successfully been used to record surgeries from the surgeons point of view and the obtained material can be used to reconstruct a 3D view for evaluation by an expert. In a preliminary study, we present a recording of a captured surgery under real-world clinical conditions to expert surgeons which estimate the quality of the recordings and their overall applicability for diagnosis and support. The study shows benefits from a 3D reconstruction compared to video-only transmission regarding perceived quality and feeling of immersion.

Co-axial Projective Imaging for Augmented Reality Telementoring in Skin Cancer Surgery.

Telemedicine has the potential to overcome the unequal distribution of medical resources worldwide. In this study, we report the second-generation co-axial projective imaging (CPI-2) system featured with orthotopic image projection for augmented reality surgical telementoring. The CPI-2 system can acquire surgical scene images from the local site, transmit them wirelessly to the remote site, and project the virtual annotations drawn by a remote expert with great accuracy to the surgical field. The performance characteristics of the CPI-2 system are quantitatively verified in benchtop experiments. The ex vivo study that compares the CPI-2 system and a monitor-based telementoring system shows that the CPI-2 system can reduce the focus shift and avoid subjective mapping of the instructions from a monitor to the real-world scene, thereby saving operation time and achieving precise teleguidance. The clinical feasibility of the CPI-2 system is validated in teleguided skin cancer surgery. Our ex vivo and in vivo experiment results imply the improved performance of surgical telementoring, and the clinical utility of deploying the CPI-2 system for surgical interventions in resource-limited settings. The CPI-2 system has the potential to reduce healthcare disparities in remote areas with limited resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10439-022-03000-4.

A Smarter Health through the Internet of Surgical Things.

(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.

Object Tracking Based Surgical Incision Region Encoding using Scalable High Efficiency Video Coding for Surgical Telementoring Applications

Object Tracking Based Surgical Incision Region Encoding using Scalable High Efficiency Video Coding for Surgical Telementoring Applications

Coaxial Visual Photochromic Marking System for Surgical Telementoring

Coaxial Visual Photochromic Marking System for Surgical Telementoring

Opportunities and Challenges of Smartglass-Assisted Interactive Telementoring

The widespread adoption of wearables, extended reality, and metaverses has accelerated the diverse configurations of remote collaboration and telementoring systems. This paper explores the opportunities and challenges of interactive telementoring, especially for wearers of smartglasses. In particular, recent relevant studies are reviewed to derive the needs and trends of telementoring technology. Based on this analysis, we define what can be integrated into smartglass-enabled interactive telementoring. To further illustrate this type of special use case for telementoring, we present five illustrative and descriptive scenarios. We expect our specialized use case to support various telementoring applications beyond medical and surgical telementoring, while harmoniously fostering cooperation using the smart devices of mentors and mentees at different scales for collocated, distributed, and remote collaboration.

Artificial Intelligence–based Computed Tomography Processing Framework for Surgical Telementoring of Congenital Heart Disease

Congenital heart disease (CHD) is the most common birth defect, accounting for one-third of all congenital birth defects. As with complicated intracardiac structural abnormalities, CHD is usually treated with surgical repair, and computed tomography (CT) is the main examination method for diagnosis of CHD and also provides anatomical information to surgeons. Currently, there exists a serious shortage of professional surgeons in developing countries. Compared with developed countries where large hospitals and cardiovascular disease centers have professional surgical teams with rich treatment experience, surgeons in developing countries and remote areas suffer from lack of professional surgical skills resulting with low surgical quality and high mortality. Recently, surgical telementoring has been popular to tackle the above problems, in which less-skilled surgeons can get real-time guidance from skilled surgeons remotely through audio and video transmission. However, there still exists difficulties in applying telementoring to CHD surgeries including high resource consumption on medical data transmission and storage, large image noise, and inconvenient and inefficient discussion between surgeons on CT. In this article, we proposed a framework with an image compression module, an image denoising module, and an image segmentation module based on CT images in CHD. We evaluated the above three modules and compared them with existing works, respectively, and the results show that our methods achieve much better performance. Furthermore, with 3D printing, VR technology, and 5G communications, our framework was successfully used in a real case study to treat a patient who needed surgical treatment.

Surgical Telementoring and Surginars with Added Virtual Layer using 5G Network

Healthcare sector has always been a key sector for social and economic well-being of any nation and since COVID-19 pandemic it has gained a center stage. Human resources are at the core of health care system. However, there is an acute shortage of doctors, nurses, and other health care workers. Brunt of scarce human resource is starker at specialization level. 5G network may provide a solution to this problem by human resource capacity building in some of the most complex areas of medical science. It may also provide an access to surgical expertise distributed globally. The low latency, high volume and high-speed data transfer allows sharing live surgical feed which may enhance the learning and assistance process. Hence, a synergy is achieved of physical and virtual world and a potential business model can be developed in such ecosystem. This work explores the requirements, architecture, implementation strategy, roles, and responsibilities of various stakeholders etc. to provide surgical expertise on a 5G network.

Educational value of surgical telementoring.

Educating surgeons is a time‐consuming process. In addition to theoretical knowledge, the practical tasks of surgical procedures must be mastered. Translation of such knowledge from mentor to mentee may be efficiently done by surgical telementoring (ST). This is a review on surgical telementoring. Recent technological advances have made this tool in surgical education more available and applicable but future applications of ST have to be wisely guided by high‐quality trials.

Surgical telementoring: Feasibility, applicability, and how to.

Surgical training does not end at the conclusion of residency training. Expansions in medical technology and surgical technique have created a steep learning curve for the young attending surgeon. The emergence of intraoperative telementoring has allowed experienced surgeons to guide learners through complex surgical cases remotely with the assistance of streaming video technology. Here, we describe the basics of telementoring, financial and legal considerations, and recommend hardware specifications for optimal use.

A Wearable Augmented Reality Navigation System for Surgical Telementoring Based on Microsoft HoloLens.

This paper reports a new type of augmented reality (AR) system that integrates a Microsoft HoloLens device with a three-dimensional (3D) point tracking module for medical training and telementored surgery. In this system, a stereo camera is used to track the 3D position of a scalpel and transfer its coordinates wirelessly to a HoloLens device. In the scenario of surgical training, a virtual surgical scene with pre-recorded surgical annotations is superimposed with the actual surgical scene so that the surgical trainee is able to operate following virtual instructions. In the scenario of telementored surgery, the virtual surgical scene is co-registered with the actual surgical scene so that the virtual scalpel remotely mentored by an experienced surgeon provides the AR guidance for the inexperienced on-site operator. The performance characteristics of the proposed AR telementoring system are verified by benchtop experiments. The clinical applicability of the proposed system in telementored skin grafting surgery and fasciotomy is validated in a New Zealand rabbit model. Our benchtop and in vivo experiments demonstrate the potential to improve surgical performance and reduce healthcare disparities in remote areas with limited resources.

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

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.