Evaluation of augmented reality technology in global urologic surgery

BACKGROUND

The COVID-19 pandemic drastically reduced opportunities for surgical skill sharing between high-income and low to middle-income countries. Augmented reality (AR) technology allows mentors in one country to virtually train a mentee in another country during surgical cases without international travel. We hypothesize that AR technology is an effective live surgical training and mentorship modality.

METHODS

Three senior urologic surgeons in the US and UK worked with four urologic surgeon trainees across the continent of Africa using AR systems. Trainers and trainees individually completed post-operative questionnaires evaluating their experience.

RESULTS

Trainees rated the quality of virtual training as equivalent to in-person training in 83% of cases (N = 5 of 6 responses). Trainers reported the technology's visual quality as "acceptable" in 67% of cases (N = 12 of 18 responses). The audiovisual capabilities of the technology had a "high" impact in the majority of the cases.

CONCLUSION

AR technology can effectively facilitate surgical training when in-person training is limited or unavailable.

Stone disease in low-middle income countries. Could augmented reality have a role in its management?

Urolithiasis is a global phenomenon. Cystolithiasis is common in parts of Africa due to low protein intake and dehydration from endemic diarrhoeal illnesses. Nephrolithiasis is less prevalent than in high income countries, probably due to a variety of lifestyle issues, such as a more elemental diet, higher physical activity and less obesity. Although renal stones are less common in low-middle income countries (LMICs), the social and economic impacts of nephrolithiasis are still considerable; many stones present late or with complications such as upper urinary tract obstruction or urosepsis. These may lead to the development of chronic kidney disease, or end-stage renal failure in a small proportion of cases, conditions for which there is very poor provision in most LMICs. Early treatment of nephrolithiasis by the least invasive method possible can, however, reduce the functional consequences of urinary stone disease. Although ESWL is uncommon, and endoscopic interventions for stone are not widespread in most of Africa, percutaneous nephrolithomy and ureteroscopic renal surgery are viable techniques in those regional centres with infrastructure to support them. Longitudinal mentoring has been shown to be a key step in the adoption of these minimally invasive procedures by local surgeons, something that has been difficult during the COVID-19 pandemic due to travel restriction. Augmented reality (AR) technology is an alternative means of providing remote mentoring, something that has been trialled by Urolink, the MediTech Trust and other global non-governmental organisations during this period. Our preliminary experience suggests that this is a viable technique for promulgating skills in LMICs where appropriate connectivity exists to support remote communication. AR may also have long term promise for decreasing the reliance upon short-term surgical visits to consolidate competence, thereby reducing the carbon footprint of global surgical education.

Kidney Stone Surgery: Assessing Public Interest and Evaluating Social Media Content

An increasing number of patients are utilizing the internet to answer their medical questions. Given the lack of verified stone treatment resources on the web, we sought to evaluate online interest in kidney stone surgical interventions and assess the quality of the most popular resources on social media. Google Trends was used to evaluate public interest in different kidney stone interventions between March 2016 - February 2021 and reported as search volume index (SVI). Next, the social-analysis tool BuzzSumo was used to identify stone surgery content online on the social media platforms YouTube, Instagram, Twitter, Reddit, and Twitter. To evaluate the quality of health information presented in the online resources the DISCERN instrument was employed by three individual raters. Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL) and Extracorporeal shock wave lithotripsy (ESWL) were identified as the top search terms on Google Trends with mean SVI's of 47.75, 42.98, and 45.74 respectively (P = 0.012). On YouTube, URS, PCNL, and ESWL had 12,549, 116,222, and 20,717 views respectively. Nine articles and fifteen videos were chosen for analysis using the DISCERN tool with a mean score of 2.82 and 2.27 respectively among three independent evaluators. The result of our study suggests that online users are interested in URS but engaged more often with PCNL content on social media platforms. We found that the quality of online resource related to stone surgery highlights the need for involvement of urologists in the creation of engaging high-quality content and accurate information sharing in a social media driven society.