Background: Tele-mentoring facilitates the transfer of surgical knowledge. The objective of this work is to develop a tele-mentoring framework that enables a specialist surgeon to mentor an operating surgeon by transferring information in a form of surgical instruments' motion required during a minimally invasive surgery. Method:A tele-mentoring framework is developed to transfer video stream of the surgical field, poses of the scope and port placement from the operating room to a remote location. From the remote location, the motion of virtual surgical instruments augmented onto the surgical field is sent to the operating room. Results:The proposed framework is suitable to be integrated with laparoscopic as well as robotic surgeries. It takes on average 1.56 s to send information from the operating room to the remote location and 0.089 s for vice versa over a local area network. Conclusions:The work demonstrates a tele-mentoring framework that enables a specialist surgeon to mentor an operating surgeon during a minimally invasive surgery. K E Y W O R D Saugmented reality, minimally invasive surgeries, tele-mentoring, telemedicine | INTRODUCTIONAs surgery has evolved from open to minimally invasive, the framework of tele-mentoring technologies has largely remained the same. [1][2][3] It still involves basic exchange of audio and annotated video messages, and lacks augmentation of information pertaining to surgical tool motion and tool-tissue interaction. 4,5 In an operating room setup of minimally invasive surgery (MIS), the surgeon operates on a patient using surgical instruments inserted through small incisions. These surgical instruments can either be manually operated (such as laparoscopic instruments) or robotically actuated.Along with instruments, a scope (camera) is also inserted inside the patient's body to visualise the interaction of surgical instruments' tooltips with the tissue. In the case of manual MIS, the surgeon This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background Tele-mentoring during surgery facilitates the transfer of surgical knowledge from a mentor (specialist surgeon) to a mentee (operating surgeon). The aim of this work is to develop a tele-mentoring system tailored for minimally invasive surgery (MIS) where the mentor can remotely demonstrate to the mentee the required motion of the surgical instruments. Methods A remote tele-mentoring system is implemented that generates visual cues in the form of virtual surgical instrument motion overlaid onto the live view of the operative field. The technical performance of the system is evaluated in a simulated environment, where the operating room and the central location of the mentor were physically located in different countries and connected over the internet. In addition, a user study was performed to assess the system as a mentoring tool. Results On average, it took 260 ms to send a view of the operative field of 1920 × 1080 resolution from the operating room to the central location of the mentor and an average of 132 ms to receive the motion of virtual surgical instruments from the central location to the operating room. The user study showed that it is feasible for the mentor to demonstrate and for the mentee to understand and replicate the motion of surgical instruments. Conclusion The work demonstrates the feasibility of transferring information over the internet from a mentor to a mentee in the form of virtual surgical instruments. Their motion is overlaid onto the live view of the operative field enabling real-time interactions between both the surgeons.

Pre-operative imaging has been used earlier to guide traditional surgical navigation systems. There has been a lot of effort in the last decade to integrate augmented reality into the operating room to help surgeons intra-operatively. An augmented reality (AR) based navigation system provides a clear three-dimensional picture of the interested areas over the patient to aid surgical navigation and operations, which is a promising approach. The goal of this study is to review the application of AR technology in various fields of surgery and how the technology is used for its performance in each field. Assessment of the available AR assisted navigation systems being used for surgery is reviewed in this paper. Furthermore, a discussion about the required evaluation and validation metric for these systems is also presented. The paper comprehensively reviews the literature since the year 2008 for providing relevant information on applying the AR technology for training, planning and surgical navigation. It also describes the limitations which need to be addressed before one can completely rely on this technology for surgery. Thus, additional research is desirable in this emerging field, particularly to evaluate and validate the use of AR technology for surgical navigation.

Background Robotic scope assistant systems are used to visualise and navigate the operative field during a laparoscopic surgery. The objective of this work is to design a surgical scope adapter that enables control of different scope types (zero‐degree, angulated, and articulated), and can be connected to any six degree‐of‐freedom robotic manipulator for usage as a robotic scope assistant system. Methods A surgical scope adapter compatible with different camera heads and scope types was designed and prototyped. The technical performance of the scope adapter was evaluated and a user study was conducted to assess the human‐in‐the‐loop control. Results All the subjects were able to navigate the simulated operative field. The scope adapter permits continuous motion to explore the operative field as well as intermittent motion to accurately focus on the targeted anatomical landmarks. Conclusion The modular and generic nature of the surgical scope adapter may enable its usage across different minimally invasive surgeries.