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Ross RC, Stinner DJ. Letter to the Editor Regarding "Telemedicine-Guided Two-Incision Lower Leg Fasciotomy Performed by Combat Medics During Tactical Combat Casualty Care: A Feasibility Study". Mil Med 2024; 189:255-256. [PMID: 39083213 DOI: 10.1093/milmed/usae374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/18/2024] [Indexed: 09/01/2024] Open
Affiliation(s)
- Ryan C Ross
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Daniel J Stinner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Surgery, Blanchfield Army Community Hospital, Fort Campbell, TN 42223, USA
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Hamza H, Al-Ansari A, Navkar NV. Technologies Used for Telementoring in Open Surgery: A Scoping Review. Telemed J E Health 2024; 30:1810-1824. [PMID: 38546446 DOI: 10.1089/tmj.2023.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
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.
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Affiliation(s)
- Hawa Hamza
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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McKnight G, O'Reilly D, Guthrie H, Aye Maung N, Bull J, Bartels O, Baxter D. Lessons from the use of telemedicine in the austere military environment and the implications for deployed surgical teams. BMJ Mil Health 2024; 170:146-149. [PMID: 35393358 DOI: 10.1136/bmjmilitary-2021-002060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/20/2022] [Indexed: 11/04/2022]
Abstract
Over the last 20 years, there have been significant changes in UK surgical training. Civilian surgical training may no longer prepare military surgeons for the range of skills they require on operations. One method to address gaps in knowledge or experience is to use telemedicine to facilitate specialist consultations from UK-based specialists to deployed medical teams. In the UK Defence Medical Services (DMS), this capability is called real-time clinical support (RTCS). RTCS provides a direct audio-visual link from a deployed location anywhere in the world to a supporting medical specialist in the UK. RTCS is currently delivered via a combination of off-the-shelf hardware and commercially available software. This article will outline the current use of RTCS, with emphasis on deployed surgical teams in austere environments, and discuss the advantages and limitations of this capability. However, it must be emphasised that no technology can be a substitute for clinical training and experience. Although several limitations remain, the authors believe that RTCS offers potential benefits for the DMS and could be an important tool aiding deployed clinicians. It can also be argued that by engaging with the concept now, the DMS can shape future developments in this sphere.
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Affiliation(s)
| | - D O'Reilly
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Department of General Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - H Guthrie
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - N Aye Maung
- Army Special Operations Brigade, Aldershot, UK
| | - J Bull
- Department of Neurosurgery, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - O Bartels
- Medical Information Services, Defence Medical Services, Lichfield, UK
| | - D Baxter
- Department of Neurosurgery, Royal Centre for Defence Medicine, Birmingham, UK
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4
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Stark PW, Borger van der Burg BLS, van Waes OJF, van Dongen TTCF, Wouter, Casper M, Hoencamp R. Telemedicine-Guided Two-Incision Lower Leg Fasciotomy Performed by Combat Medics During Tactical Combat Casualty Care: A Feasibility Study. Mil Med 2024; 189:e645-e651. [PMID: 37703048 PMCID: PMC10898936 DOI: 10.1093/milmed/usad364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION During tactical combat casualty care, life- and limb-saving procedures might also be performed by combat medics. This study assesses whether it is feasible to use a head-mounted display (HMD) to provide telemedicine (TM) support from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. MATERIALS AND METHODS Nine combat medics were randomized into groups to perform a two-incision lower leg fasciotomy. One group used the Vuzix M400 and the second group used the RealWear HMT-1Z1. A third, control, group received no guidance. In the Vuzix M400 group and RealWear HMT-1Z1 group, a senior surgeon examined the results after the two-incision lower leg fasciotomy was finished to assess the release of compartments, possible collateral damage, and performance of the combat medics. In the control group, these results were examined by a surgical resident with expertise in two-incision lower leg fasciotomies. The resident's operative performance questionnaire was used to score the performance of the combat medics. The telehealth usability questionnaire was used to evaluate the usability of the HMDs as perceived by the combat medics. RESULTS Combat medics using an HMD were considered competent in performing a two-incision lower leg fasciotomy (Vuzix: median 3 [range 0], RealWear: median 3 [range 1]). These combat medics had a significantly better score in their ability to adapt to anatomical variances compared to the control group (Vuzix: median 3 [range 0], RealWear: median 3 [range 0], control: median 1 [range 0]; P = .018). Combat medics using an HMD were faster than combat medics in the control group (Vuzix: mean 14:14 [SD 3:41], RealWear: mean 15:42 [SD 1:58], control: mean 17:45 [SD 2:02]; P = .340). The overall satisfaction with both HMDs was 5 out of 7 (Vuzix: median 5 [range 0], RealWear: median 5 [range 1]; P = .317). CONCLUSIONS This study shows that it is feasible to use an HMD to provide TM support performance from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. The results of this study suggest that TM support might be useful for combat medics during tactical combat casualty care when performing life- and limb-saving procedures.
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Affiliation(s)
- P W Stark
- Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands
- Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands
| | | | - O J F van Waes
- Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands
| | - T T C F van Dongen
- Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands
| | - Wouter
- Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands
| | - Marnalg Casper
- Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands
| | - R Hoencamp
- Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands
- Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands
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Frenkel CH. Telesurgery's Evolution During the Robotic Surgery Renaissance and a Systematic Review of its Ethical Considerations. Surg Innov 2023; 30:595-600. [PMID: 37040578 DOI: 10.1177/15533506231169073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
While robotic-assisted surgery is in a Renaissance, telesurgery, facilitated by robotic technology, is evolving in the space between innovative and mainstream clinical practice. This article outlines the current utilization of robotic telesurgery and barriers to adoption, and it performs a systematic review of relevant ethical concerns. It illustrates how telesurgery can be developed to provide safe, equitable, and high quality surgical care.
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Affiliation(s)
- Catherine H Frenkel
- Division of Head and Neck Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Sandhu A, Bartels O, Booker RJ, Aye Maung N. Defence Medical Services telemedicine now: a successful pilot of video consultations and instant messaging support to firm base training. BMJ Mil Health 2023; 169:e68-e70. [PMID: 33461984 PMCID: PMC10176339 DOI: 10.1136/bmjmilitary-2020-001617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Telemedicine was pioneered in the Defence Medical Services (DMS) in 1998, since then the capabilities within the DMS have not advanced in step with advances in technology. We present our findings of a pilot of remote video consultation via Skype for MODNET during an arduous course held in the UK. METHOD Combat medical technician sick parades were live streamed via Skype to a Defence Primary Healthcare Medical Centre and medical officer (MO) support was delivered remotely. This process was augmented by the use of Pando for still images of wounds and infection sites in order to enhance decision making and situational awareness. RESULTS Over a 3-week period, 34 consultations carried out during sick parade required the input from a remote MO, of those 34% required a prescription from an MO. None of the presentations required a face-to-face consultation, and all patients received MO-led care remotely. CONCLUSION We have successfully demonstrated that video telemedicine consultations are safe, while simultaneously improving patient care, augmenting the distribution of medical assets and reducing costs.
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Affiliation(s)
| | - O Bartels
- SO1 Projects, Medical Information Systems, Joint Medical Group, London, UK
| | - R J Booker
- 3 Medical Regiment Senior Medical Officer and Project LARA Forward Instant Messaging Trial Lead, Preston, UK
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Merle G, Miclau T, Parent-Harvey A, Harvey EJ. Sensor technology usage in orthopedic trauma. Injury 2022; 53 Suppl 3:S59-S63. [PMID: 36182592 DOI: 10.1016/j.injury.2022.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 02/02/2023]
Abstract
Medicine in general is quickly transitioning to a digital presence. Orthopaedic surgery is also being impacted by the tenets of digital health but there are also direct efforts with trauma surgery. Sensors are the pen and paper of the next wave of data acquisition. Orthopaedic trauma can and will be part of this new wave of medicine. Early sensor products that are now coming to market, or are in early development, will directly change the way we think about surgical diagnosis and outcomes. Sensor development for biometrics is already here. Wellness devices, pressure, temperature, and other parameters are already being measured. Data acquisition and analysis is going to be a fruitful addition to our research armamentarium with the volume of information now available. A combination of broadband internet, micro electrical machine systems (MEMS), and new wireless communication standards is driving this new wave of medicine. The Internet of Things (IoT) [1] now has a subset which is the Internet of Medical Devices [2-5] permitting a much more in-depth dive into patient procedures and outcomes. IoT devices are now being used to enable remote health monitoring, in hospital treatment, and guide therapies. This article reviews current sensor technology that looks to impact trauma care.
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Affiliation(s)
- Géraldine Merle
- École Polytechnique de Montréal, Université de Montréal, Montréal, Canada
| | - Theodore Miclau
- Orthopaedic Trauma Institute, University of Calfornia, School of Medicine, Department of Orthopaedics, San Francisco, USA
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Mulita F, Verras GI, Anagnostopoulos CN, Kotis K. A Smarter Health through the Internet of Surgical Things. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22124577. [PMID: 35746359 PMCID: PMC9231158 DOI: 10.3390/s22124577] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 05/14/2023]
Abstract
(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.
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Affiliation(s)
- Francesk Mulita
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Department of Surgery, General University Hospital of Patras, 26504 Rio, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
| | | | | | - Konstantinos Kotis
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
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Abstract
Digital health principles are starting to be evident in medicine. Orthopaedic trauma surgery is also being impacted —indirectly by all other improvements in the health ecosystem but also in particular efforts aimed at trauma surgery. Data acquisition is changing how evidence is gathered and utilized. Sensors are the pen and paper of the next wave of data acquisition. Sensors are gathering wide arrays of information to facilitate digital health relevance and adoption. Early adaption of sensor technology by the nonlegacy health environment is what has made sensor driven data acquisition so palatable to the normal health care system. As it applies to orthopaedic trauma, current sensor driven diagnostics and surveillance are nowhere near as developed as in the larger medical community. Digital health is being explored for health care records, data acquisition in diagnostics and rehabilitation, wellness to health care translation, intraoperative monitoring, surgical technique improvement, as well as some early-stage projects in long-term monitoring with implantable devices. The internet of things is the next digital wave that will undoubtedly affect medicine and orthopaedics. Internet of things (loT) devices are now being used to enable remote health monitoring and emergency notification systems. This article reviews current and future concepts in digital health that will impact trauma care.
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McPherson J, Kennedy C, Slobogean G, Hilsden R, Talbot M. Augmented-reality telementoring for leg fasciotomy: a proof-of-concept study. BMJ Mil Health 2022:bmjmilitary-2021-001975. [PMID: 35131888 DOI: 10.1136/bmjmilitary-2021-001975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prolonged field care is required when casualty evacuation to a surgical facility is delayed by distance, weather or tactical constraints. This situation can occur in both civilian and military environments. In these circumstances, there are no established treatment options for extremity compartment syndrome. Telementoring by a surgeon may enable the local clinician to perform a fasciotomy to decompress the affected compartments. METHODS Six military clinicians were asked to perform a two-incision leg fasciotomy in synthetic models under the guidance of an orthopaedic surgeon located 380 km away. Communication occurred through commercially available software and smartglasses, which also allowed the surgeon to send augmented-reality graphics to the operators. Two blinded surgeons evaluated the specimens according to objective criteria. Control specimens were added to ensure the integrity of the evaluation process. RESULTS The six study participants were military physician assistants who had extensive clinical experience but had never performed a fasciotomy. The average duration of the procedure was 53 min. All six procedures were completed without major errors: release of all four compartments was achieved through full-length incisions in the skin and fascia. The only surgical complication was a laceration of the saphenous vein. All three control specimens were correctly assessed by the evaluators. None of the participants experienced adverse effects from wearing the smartglasses. Four dropped calls occurred, but the connection was re-established in all cases. CONCLUSION All six surgical procedures were completed successfully. We attribute the dropped calls to a mismatch between the size of the graphic files and the available bandwidth. A better technical understanding of the software by the mentoring surgeon would have avoided this problem. Important considerations for future research and practice include protocols for dropped communications, surgical skills training for the operators and communication training for the surgeons.
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Affiliation(s)
- John McPherson
- Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, Ontario, Canada.,Department of Surgery, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - C Kennedy
- Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, Ontario, Canada.,Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - G Slobogean
- Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, Ontario, Canada.,R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Hilsden
- Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, Ontario, Canada.,Department of Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - M Talbot
- Royal Canadian Medical Service, Canadian Armed Forces, Montréal, Quebec, Canada
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Galvao Neto M, Jerez J, Brunaldi VO, Cabrera D, Benavides C, Moreno M, Romero G, Guiatara D, Abu Dayyeh BK. Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure. Obes Surg 2021; 31:5486-5493. [PMID: 34664148 PMCID: PMC8523006 DOI: 10.1007/s11695-021-05757-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023]
Abstract
Background and Aims The COVID‐19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician’s ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG). Methods Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition. Results All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves. Conclusions The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic. Graphical abstract ![]()
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Affiliation(s)
- Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | - Jonathan Jerez
- Diagnostic and Therapeutic Gastroenterology Amazon Region, Puyo, Ecuador
| | - Vitor Ottoboni Brunaldi
- Center for Digestive Endoscopy, Surgery and Anatomy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, Brazil.
| | - David Cabrera
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Christian Benavides
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Monica Moreno
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Ginesio Romero
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Daniela Guiatara
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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The potential impact of 5G telecommunication technology on ophthalmology. Eye (Lond) 2021; 35:1859-1868. [PMID: 33731893 PMCID: PMC7968572 DOI: 10.1038/s41433-021-01450-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
Advances in information and communication technology (ICT) are having an increasing impact on the practice of ophthalmology. Successive generations of 4G networks have provided continued improvements in bandwidth and download speeds. Fibre-optic networks were promised as the next step in the development of a faster and more reliable network. However, due to considerable delays in their widespread implementation, original expectations have not been met. Currently, the new 5G network is on the verge of widespread release and aims to offer previously unparalleled bandwidth, speed, reliability and access. This review aims to highlight the potential profound impact near instantaneous communication (the 5G network) may have on ophthalmology and the delivery of eyecare to the global population. Conversely, if the new network fails to deliver as intended, the wireless network itself may become yet another obstacle to adopting next-generation technologies in eyecare.
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13
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Grall P, Ferri J, Nicot R. Surgical training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery - Part I. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:411-422. [PMID: 33524605 DOI: 10.1016/j.jormas.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Many technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols. METHODS This article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice. RESULTS The results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias. CONCLUSION Surgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side. This first part therefore reviews, open field camera, telemedicine and 3D printing. This systematic review is registered on PROSPERO.
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Affiliation(s)
- Patrick Grall
- University of Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
| | - Joël Ferri
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
| | - Romain Nicot
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
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Park JP, Montreuil J, Nooh A, Martineau PA. Telemedicine-guided forearm emergency decompressive fasciotomy for compartment syndrome. J Telemed Telecare 2020; 29:28-32. [DOI: 10.1177/1357633x20964359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction We highlight the utility of telemedicine and telementoring for the management of orthopaedic emergencies using a case of forearm compartment syndrome following a penetrating trauma in a northern Inuit community in Nunavik, Quebec, Canada. Methods & Results As in many cases of compartment syndrome in rural settings, the patient was at a high risk of developing irreversible complications. A prompt diagnosis followed by an emergency decompressive fasciotomy was warranted. Using telemedicine and telementoring guidance, the diagnosis of compartment syndrome was made, and the patient’s volar compartment was successfully decompressed by a local emergency physician in a timely manner. Subsequently, the patient was able to be safely transferred to a level 1 trauma centre for further surgical management. This included a second-look operative exploration, irrigation and debridement, completion of volar fasciotomy and ulnar nerve decompression. No complications were seen. Discussion Our experience highlights two important clinical implications. First, telemedicine can be successfully implemented to facilitate clinical diagnosis of surgical emergencies in the rural setting. Second, telementoring can effectively allow surgeons to guide physicians remotely to perform emergency decompressive fasciotomy, which can help salvage the affected limb and significantly decrease the risk of debilitating complications.
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Affiliation(s)
- J Patrick Park
- Department of Orthopaedic Surgery, McGill University Health Center, Canada
| | - Julien Montreuil
- Department of Orthopaedic Surgery, McGill University Health Center, Canada
| | - Anas Nooh
- Department of Orthopaedic Surgery, McGill University Health Center, Canada
| | - Paul A Martineau
- Department of Orthopaedic Surgery, McGill University Health Center, Canada
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Rojas-Muñoz E, Lin C, Sanchez-Tamayo N, Cabrera ME, Andersen D, Popescu V, Barragan JA, Zarzaur B, Murphy P, Anderson K, Douglas T, Griffis C, McKee J, Kirkpatrick AW, Wachs JP. Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies. NPJ Digit Med 2020; 3:75. [PMID: 32509972 PMCID: PMC7242344 DOI: 10.1038/s41746-020-0284-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Maria Eugenia Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Daniel Andersen
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | - Voicu Popescu
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Ben Zarzaur
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Patrick Murphy
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Kathryn Anderson
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | | | | | - Jessica McKee
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
| | - Andrew W. Kirkpatrick
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB Canada
- Canadian Forces Medical Services, Ottawa, ON Canada
| | - Juan P. Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
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16
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Behmanesh A, Sadoughi F, Mazhar FN, Joghataei MT, Yazdani S. Tele-orthopaedics: A systematic mapping study. J Telemed Telecare 2020; 28:3-23. [PMID: 32393139 DOI: 10.1177/1357633x20919308] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. METHODS In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. RESULTS We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. DISCUSSION Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
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Affiliation(s)
- Ali Behmanesh
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Centre, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Yazdani
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rojas-Muñoz E, Cabrera ME, Lin C, Sánchez-Tamayo N, Andersen D, Popescu V, Anderson K, Zarzaur B, Mullis B, Wachs JP. Telementoring in Leg Fasciotomies via Mixed-Reality: Clinical Evaluation of the STAR Platform. Mil Med 2020; 185:513-520. [PMID: 32074347 DOI: 10.1093/milmed/usz234] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Point-of-injury (POI) care requires immediate specialized assistance but delays and expertise lapses can lead to complications. In such scenarios, telementoring can benefit health practitioners by transmitting guidance from remote specialists. However, current telementoring systems are not appropriate for POI care. This article clinically evaluates our System for Telementoring with Augmented Reality (STAR), a novel telementoring system based on an augmented reality head-mounted display. The system is portable, self-contained, and displays virtual surgical guidance onto the operating field. These capabilities can facilitate telementoring in POI scenarios while mitigating limitations of conventional telementoring systems.
Methods
Twenty participants performed leg fasciotomies on cadaveric specimens under either one of two experimental conditions: telementoring using STAR; or without telementoring but reviewing the procedure beforehand. An expert surgeon evaluated the participants’ performance in terms of completion time, number of errors, and procedure-related scores. Additional metrics included a self-reported confidence score and postexperiment questionnaires.
Results
STAR effectively delivered surgical guidance to nonspecialist health practitioners: participants using STAR performed fewer errors and obtained higher procedure-related scores.
Conclusions
This work validates STAR as a viable surgical telementoring platform, which could be further explored to aid in scenarios where life-saving care must be delivered in a prehospital setting.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
| | - Maria Eugenia Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, 185 East Stevens Way NE, Seattle, WA 98195
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Natalia Sánchez-Tamayo
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
| | - Dan Andersen
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Voicu Popescu
- Department of Computer Science, Purdue University, 305 N. University St., West Lafayette, IN 47907
| | - Kathryn Anderson
- Sydney and Lois Eskenazi Hospital, 720 Eskenazi Ave, Indianapolis, IN 46202
| | - Ben Zarzaur
- School of Medicine, Indiana University, 340 West 10th St., Suite 6200, Indianapolis, IN 46202
| | - Brian Mullis
- School of Medicine, Indiana University, 340 West 10th St., Suite 6200, Indianapolis, IN 46202
| | - Juan P Wachs
- School of Industrial Engineering, Purdue University, 315 N. Grant St., West Lafayette, IN 47907
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Harris TE, DeLellis SF, Heneghan JS, Buckman RF, Miller GT, Magee JH, Vasios WN, Nelson KJ, Kane SF, Choi YS. Augmented Reality Forward Damage Control Procedures for Nonsurgeons: A Feasibility Demonstration. Mil Med 2020; 185:521-525. [DOI: 10.1093/milmed/usz298] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 02/01/2023] Open
Abstract
Abstract
Introduction
This article presents an emerging capability to project damage control procedures far forward for situations where evacuation to a formal surgical team is delayed. Specifically, we demonstrate the plausibility of using a wearable augmented reality (AR) telestration device to guide a nonsurgeon through a damage control procedure.
Methods
A stand-alone, low-profile, commercial-off-the-shelf wearable AR display was utilized by a remotely located surgeon to synchronously guide a nonsurgeon through proximal control of the distal external iliac artery on a surgical manikin. The manikin wound pattern was selected to simulate a rapidly exsanguinating junctional hemorrhage not controllable by nonsurgical means.
Results
This capability demonstration displayed successful use of AR technology, telecommunication, and procedural training and guidance in a single test pilot. The assisted physician assistant was able to rapidly control the simulated external iliac artery injury on this model. The telestration system used was commercially available for use with available civilian cell phone, wireless and satellite networks, without the need for dedicated high-speed networks.
Conclusions
A nonsurgeon, using a wearable commercial on-visual-axis telestration system, successfully performed a damage control procedure, demonstrating the plausibility of this approach.
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Affiliation(s)
- Tyler E Harris
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310
| | - Stephen F DeLellis
- United States Army Special Operations Command (USASOC), 2929 Desert Storm Drive, Fort Bragg, NC 28303
| | - Jerry S Heneghan
- BioMojo, LLC, 11010 Lake Grove Blvd. Ste 100-234, Morrisville, NC 27560
| | - Robert F Buckman
- Operative Experience Inc., 500 Principio Pkwy W Suite 900, North East, MD 21901
| | - Geoffrey T Miller
- Telemedicine and Advanced Technology Research Center (TATRC), United States Army Medical Research and Materiel Command (USAMRMC), Building 1054 Patchel Street, Fort Detrick, MD 21702
| | - J Harvey Magee
- Telemedicine and Advanced Technology Research Center (TATRC), United States Army Medical Research and Materiel Command (USAMRMC), Building 1054 Patchel Street, Fort Detrick, MD 21702
| | - William N Vasios
- United States Army Special Operations Command (USASOC), 2929 Desert Storm Drive, Fort Bragg, NC 28303
| | - Kenneth J Nelson
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310
| | - Shawn F Kane
- Joint Special Operations Medical Training Center, Building 5-3845 Combat Medic Road, Fort Bragg, NC 28310
| | - Y Sammy Choi
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310
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Choufani C, Barbier O, Demoures T, Mathieu L, Rigal S. Evaluation of a fellowship abroad as part of the initial training of the French military surgeon. BMJ Mil Health 2020; 167:168-171. [PMID: 32015183 DOI: 10.1136/jramc-2019-001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
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Affiliation(s)
- Camille Choufani
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - O Barbier
- Orthopedic and Traumatology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - T Demoures
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - S Rigal
- Department of Traumatology and Orthopedics, HIA Percy, Clamart, France
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Merle G, Comeau-Gauthier M, Tayari V, Kezzo MN, Kasem C, Al-Kabraiti F, Laverdiere C, Xereas G, Harvey EJ. Comparison of Three Devices to Measure Pressure for Acute Compartment Syndrome. Mil Med 2020; 185:77-81. [PMID: 32074299 DOI: 10.1093/milmed/usz305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Acute compartment syndrome (ACS) is a well-recognized and common emergency. Undiagnosed ACS leads to muscle necrosis, limb contracture, intractable pain, and may even result in amputation. METHODS Three devices (Synthes, Stryker, and MY01) were compared in a pre-clinical rat abdominal compartment syndrome simulation. Simultaneous measurements of intracompartmental pressures allowed concurrent comparison among all devices. RESULTS Large variations from the reference values are seen with the Synthes and Stryker devices. Variances are large in these two devices even under ideal conditions. The MY01 device was the truest indicator of reference pressure in this ACS model (over 600% more accurate). CONCLUSIONS The MY01 device was the most accurate device in tracking pressure changes in this rat model of abdominal compartment syndrome.
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Affiliation(s)
- Geraldine Merle
- McGill University Health Center Research Institute, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4.,Department of Surgery, McGill University, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4
| | - Marianne Comeau-Gauthier
- McGill University Health Center Research Institute, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4
| | - Vahid Tayari
- NXTSens Inc., 85 St Paul St West, Montreal, QC H2Y3V4
| | | | - Chrouk Kasem
- NXTSens Inc., 85 St Paul St West, Montreal, QC H2Y3V4
| | | | - Carl Laverdiere
- McGill University Health Center Research Institute, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4
| | - George Xereas
- NXTSens Inc., 85 St Paul St West, Montreal, QC H2Y3V4
| | - Edward J Harvey
- McGill University Health Center Research Institute, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4.,Department of Surgery, McGill University, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC H3G1A4.,NXTSens Inc., 85 St Paul St West, Montreal, QC H2Y3V4
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21
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Rojas-Muñoz E, Cabrera ME, Lin C, Andersen D, Popescu V, Anderson K, Zarzaur BL, Mullis B, Wachs JP. The System for Telementoring with Augmented Reality (STAR): A head-mounted display to improve surgical coaching and confidence in remote areas. Surgery 2020; 167:724-731. [PMID: 31916990 DOI: 10.1016/j.surg.2019.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The surgical workforce particularly in rural regions needs novel approaches to reinforce the skills and confidence of health practitioners. Although conventional telementoring systems have proven beneficial to address this gap, the benefits of platforms of augmented reality-based telementoring in the coaching and confidence of medical personnel are yet to be evaluated. METHODS A total of 20 participants were guided by remote expert surgeons to perform leg fasciotomies on cadavers under one of two conditions: (1) telementoring (with our System for Telementoring with Augmented Reality) or (2) independently reviewing the procedure beforehand. Using the Individual Performance Score and the Weighted Individual Performance Score, two on-site, expert surgeons evaluated the participants. Postexperiment metrics included number of errors, procedure completion time, and self-reported confidence scores. A total of six objective measurements were obtained to describe the self-reported confidence scores and the overall quality of the coaching. Additional analyses were performed based on the participants' expertise level. RESULTS Participants using the System for Telementoring with Augmented Reality received 10% greater Weighted Individual Performance Score (P = .03) and performed 67% fewer errors (P = .04). Moreover, participants with lower surgical expertise that used the System for Telementoring with Augmented Reality received 17% greater Individual Performance Score (P = .04), 32% greater Weighted Individual Performance Score (P < .01) and performed 92% fewer errors (P < .001). In addition, participants using the System for Telementoring with Augmented Reality reported 25% more confidence in all evaluated aspects (P < .03). On average, participants using the System for Telementoring with Augmented Reality received augmented reality guidance 19 times on average and received guidance for 47% of their total task completion time. CONCLUSION Participants using the System for Telementoring with Augmented Reality performed leg fasciotomies with fewer errors and received better performance scores. In addition, participants using the System for Telementoring with Augmented Reality reported being more confident when performing fasciotomies under telementoring. Augmented Reality Head-Mounted Display-based telementoring successfully provided confidence and coaching to medical personnel.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Maria E Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, West Lafayette, IN
| | - Daniel Andersen
- Department of Computer Science, Purdue University, West Lafayette, IN
| | - Voicu Popescu
- Department of Computer Science, Purdue University, West Lafayette, IN
| | | | - Ben L Zarzaur
- School of Medicine, Indiana University, Indianapolis, IN
| | - Brian Mullis
- School of Medicine, Indiana University, Indianapolis, IN
| | - Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN.
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