Elsevier

Arthroscopy Techniques

Volume 11, Issue 2, February 2022, Pages e203-e207
Arthroscopy Techniques

Technical Note
The Use of Telesurgery Mentoring and Augmented Reality to Teach Arthroscopy

https://doi.org/10.1016/j.eats.2021.10.008Get rights and content
Under a Creative Commons license
open access

Abstract

Surgical teaching methods may be enhanced with telesurgery mentoring technology through virtual, visual, and audio interactions in the operating room, irrespective of geographic restrictions. The use of telesurgery mentoring carries the potential for accelerated learning in arthroscopic and surgical education. A telesurgery platform enables the establishment of a global network of surgeons with the goal of bridging gaps in surgical training via an accessible, cost-effective communication pathway. Specifically, such a platform allows a local surgeon to deliver real-time and live virtual assistance to a remote surgeon over a standard internet connection and removes the geographic barriers that prevent the practice of high-quality surgical care, thereby expanding virtual surgical collaboration. The purpose of our study is to describe our technique of telesurgery mentoring using a telesurgery internet platform (SurgTime; www.surgtime.com) and its applicability to teaching arthroscopic surgery skills both within the United States and in developing countries across the globe.

Technique Video

Download : Download video (81MB)

Video 1. Remote surgical education or telesurgery mentoring is the process by which a remote surgeon can interact in real time with the operating surgeon via an accessible, cost-effective communication pathway. Using a telesurgery platform, the remote surgeon is able to give or receive live virtual assistance from another surgeon over a standard internet connection. The use of telesurgery mentoring has the potential to accelerate the learning curve in arthroscopic and surgical education. Telesurgery mentoring can facilitate the collaborative efforts of improving both arthroscopic and open surgical teaching methods through virtual, visual, and audio interactions in the operating room, regardless of geographic boundaries. We describe a telesurgery internet platform called SurgTime that connects the operating room to other surgeons, students, and industry representatives regardless of their geographic location and allows real-time and live interaction and surgical instruction. Our purpose is to describe the technique of telesurgery mentoring and augmented reality and its usefulness in teaching arthroscopic surgical skills both domestically and in developing countries. The patent-pending, Health Insurance Portability and Accountability Act (HIPAA)–compliant technology platform transmits livestream surgery to any computer or mobile device via the internet. The telesurgery tower is a standalone tower that can easily be wheeled into any operating room theater and connected to a standard arthroscopic tower. The tower consists of a television monitor connected to a computer (Dell) with a connection to the internet, in addition to an outside microphone and audio speakers with audio input-output capabilities. The tower connects SDI (serial digital interface) cables and other technology to an adjacent arthroscopic tower to display the same image that the arthroscopic surgeon is seeing intra-articularly via the internet connection to any computer or mobile device. There is also an outside camera (PTZOptics camera) attached to the telesurgery tower that displays the outside picture of the operative field so that there is a split screen enabling the viewer to see the outside field and the arthroscopic view of the joint at the same time. In addition, the telesurgery tower has proprietary equipment that allows the video picture from the arthroscopic tower to be transmitted to the telesurgery tower and to any other computer, tablet, or mobile device via a standard internet connection. The telesurgery platform does not interfere with or hinder the surgeon’s view of the arthroscopic tower. In addition, the connection to the telesurgery platform does not interfere in any way with the quality of the arthroscopic image projected onto the surgeon’s regular surgical tower. The telesurgery platform is a secure, Health Insurance Portability and Accountability Act (HIPAA)–compliant internet platform that uses proprietary software that is a cloud-based SaaS (software as a service) product that is licensed on a subscription basis and is centrally hosted. Once a surgeon or other health care professional creates an account, he or she then has the ability to view surgery generated from the platform and to share surgical videos with other surgeons and health care professionals. Next, the broadcasting surgeon can schedule a surgical procedure and invite up to 100 viewers simultaneously. Skilled surgeons can then stream their surgical procedures live in real time to a global audience. This platform is an intraoperative, live video platform that can be transmitted across the hallway or across the world via a standard internet connection. The ability to interact with other experienced surgeons and discuss difficult surgical cases with them in real time, in the operating room, is priceless. The telesurgery platform allows virtual communication for surgical collaboration, mentoring, and step-by-step instruction. The ability to virtually scrub in and give instructions from anywhere in the world connects clinicians and improves patient outcomes. The live telesurgery transmission can be used for one-on-one surgical instruction in a challenging case or for transmission to multiple surgeons simultaneously so that they can learn a new technique or refine their skills. Surgeons and other individuals can view and participate in real-time viewing from all parts of the world. Industry members can also log in remotely, and the virtual interaction through telesurgery allows representatives remote access to surgeons in the operating room to aid in the development of new technology. This interaction is unique and has the ability to change the landscape of surgical education. By harnessing technology, surgeons can work collectively and collaboratively with each other and industry members to share their experiences and best practices, improving patient care.

Cited by (0)

The authors report the following potential conflicts of interest or sources of funding: W.B.S. is founder and chief executive officer of Operation Arthroscopy, outside the submitted work; reports other support from Orthobullets, Mednition, Regroup, Berkeley Lights, and Bonjovi Medical, outside the submitted work; and has a patent pending for SurgTime. Full ICMJE author disclosure forms are available for this article online, as supplementary material.