Telestration and Augmented Reality in Minimally Invasive Surgery

Nickel, Felix; Cizmic, Amila; Chand, Manish

doi:10.1001/jamasurg.2021.3604

Cited by 25 publications

(14 citation statements)

References 7 publications

(26 reference statements)

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“…The higher collaborative gaze convergence indicates that the gaze of trainer and trainee converged more during the task [ 19 ]. One important purpose of telestration systems like the iSurgeon is to help a novice to see what an expert sees [ 15 – 17 ]. The higher collaborative gaze convergence indicates that this purpose of the iSurgeon was achieved in the study.…”

Section: Discussionmentioning

confidence: 99%

“…The verbal instructions were standardised for all participants and were delivered in a simple and standardized way. For the instruction with AR, the iSurgeon system [ 15 – 17 ] was used in addition to verbal instructions. Apart from that additional usage of the iSurgeon to telestrate hand gestures, there were no differences in the training between both instruction modalities.…”

Section: Methodsmentioning

confidence: 99%

“…A newly developed AR tool called iSurgeon allows using the instructor’s own hand to project gestures in real-time onto the laparoscopic screen and provide visual guidance. Pointing at the target structures or demonstration of the correct execution of the movement becomes effortless and very concise [ 15 – 17 ]. Previous studies have shown that using the system for instruction can lead to time savings and fewer mistakes while performing basic tasks [ 16 , 18 , 19 ].…”

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confidence: 99%

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Telestration with augmented reality improves surgical performance through gaze guidance

et al. 2023

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Background In minimally invasive surgery (MIS), trainees need to learn how to interpret the operative field displayed on the laparoscopic screen. Experts currently guide trainees mainly verbally during laparoscopic procedures. A newly developed telestration system with augmented reality (iSurgeon) allows the instructor to display hand gestures in real-time on the laparoscopic screen in augmented reality to provide visual expert guidance (telestration). This study analysed the effect of telestration guided instructions on gaze behaviour during MIS training. Methods In a randomized-controlled crossover study, 40 MIS naive medical students performed 8 laparoscopic tasks with telestration or with verbal instructions only. Pupil Core eye-tracking glasses were used to capture the instructor’s and trainees’ gazes. Gaze behaviour measures for tasks 1–7 were gaze latency, gaze convergence and collaborative gaze convergence. Performance measures included the number of errors in tasks 1–7 and trainee’s ratings in structured and standardized performance scores in task 8 (ex vivo porcine laparoscopic cholecystectomy). Results There was a significant improvement 1–7 on gaze latency [F(1,39) = 762.5, p < 0.01, ηp2 = 0.95], gaze convergence [F(1,39) = 482.8, p < 0.01, ηp2 = 0.93] and collaborative gaze convergence [F(1,39) = 408.4, p < 0.01, ηp2 = 0.91] upon instruction with iSurgeon. The number of errors was significantly lower in tasks 1–7 (0.18 ± 0.56 vs. 1.94 ± 1.80, p < 0.01) and the score ratings for laparoscopic cholecystectomy were significantly higher with telestration (global OSATS: 29 ± 2.5 vs. 25 ± 5.5, p < 0.01; task-specific OSATS: 60 ± 3 vs. 50 ± 6, p < 0.01). Conclusions Telestration with augmented reality successfully improved surgical performance. The trainee’s gaze behaviour was improved by reducing the time from instruction to fixation on targets and leading to a higher convergence of the instructor’s and the trainee’s gazes. Also, the convergence of trainee’s gaze and target areas increased with telestration. This confirms augmented reality-based telestration works by means of gaze guidance in MIS and could be used to improve training outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Telestration with augmented reality improves surgical performance through gaze guidance

et al. 2023

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“…18 Technological advances in MIS training have gone even further, allowing live streaming of the surgeon's hands on the operative screen, enabling direct, live instructions and guidance. 5 Telestration provides geographically independent mentoring and feedback remotely through enhanced communication, including verbal instruction and images or videoconferencing. 5 By enabling direct expert instruction without the need for an expert to be present on site, telestration could provide a solution to the logistic challenges of in-person ICKT training.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] However, maintaining a laboratory is expensive, and specially trained teachers are in short supply as a resource. During the COVID-19 pandemic, 5 in-person instruction has been reduced to almost zero. Instead, model learning via video instruction (VID) has suddenly become omnipresent and now forms an integral part of medical education.…”

Section: Introductionmentioning

confidence: 99%

Learning of Intracorporal Knot Tying in Minimally Invasive Surgery by Video or Expert Instruction

et al. 2022

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Introduction: Minimally invasive surgery skill laboratories are indispensable in training, especially for complex procedural skills such as intracorporal suturing and knot tying (ICKT). However, maintaining a laboratory is expensive, and specially trained teachers are in short supply. During the COVID-19 pandemic, in-person instruction has reduced to almost zero, while model learning via video instruction has become an integral part of medical education. The aim of this study was to compare the learning effectiveness and efficiency of ICKT by laparoscopically inexperienced medical students through video versus direct expert instruction. Materials and Methods: A secondary analysis of two randomized controlled trials was performed. We drew data from students who trained in ICKT with expert instruction (EXP, n=30) and from students who trained via video instruction (VID), n=30). A laparoscopic box trainer including laparoscope was used for ICKT. Objective Structured Assessment of Technical Skills (OSATS), knot quality, and total ICKT time were the parameters for assessment in this study. Proficiency criteria were also defined for these parameters. Results: Students in the EXP group performed significantly better in OSATS-PSC and knot quality compared to students in the VID group, with no difference in task time. Of the students who reached the proficiency criteria for OSATS-PSC and knot quality, those in the EXP group required fewer attempts to do so than those in the VID group. Students in both groups improved significantly in all parameters over the first hour of evaluation. Conclusion: For the laparoscopically inexperienced, training in ICKT through expert instruction presents an advantage compared to video-based self-study in the form of faster understanding of the procedure and the associated consistent implementation of good knot quality. Both teaching methods significantly improved participants’ ICKT skills.

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Remote proctoring during structural heart procedures: Toward a widespread diffusion of knowledge using mixed reality

Ascione,

Rossini,

Schiavi

et al. 2024

Cathet Cardio Intervent

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BackgroundDespite its wide diffusion in surgical procedures, very few experiences are reported so far about the possible applications of remote proctoring (RP) in structural heart interventions.AimsOur aim was to demonstrate the feasibility, safety, and efficacy of RP during transcatheter edge‐to‐edge repair using a mixed reality‐based head‐mounted display (HMD).MethodsTwo users (a doctor and a proctor), wearing HMDs, were connected through a 5G network, allowing them to share audio and video signals. During the procedure, the proctor was located in a contiguous room, without any direct connection with the operator. The primary endpoint was noninferiority of HMD‐mediated interaction if compared with direct in‐person interaction. It was assessed using an operator−proctor interaction test based on six questions asked by the doctor to the proctor on six key procedural steps.ResultsBetween September 2021 and April 2022, nine patients were enrolled in the study (15 clips delivered). The primary endpoint was reached in 9/15 clips implanted (60%). The first three failures were due to a chat software problem, and the others were linked with a 5G network malfunction. However, the HMD and its mixed reality tools were well tolerated by the operators, and no interference with the procedure was registered in any of the cases.ConclusionsIn our experience, RP during structural heart interventions is feasible and efficacious. Wearing the HMD is comfortable and does not affect safety and effectiveness of interventional procedures. However, especially if considering a wide geographic use of this tool, a stable internet connection is imperative.

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Telestration and Augmented Reality in Minimally Invasive Surgery

Cited by 25 publications

References 7 publications

Telestration with augmented reality improves surgical performance through gaze guidance

Telestration with augmented reality improves surgical performance through gaze guidance

Learning of Intracorporal Knot Tying in Minimally Invasive Surgery by Video or Expert Instruction

Remote proctoring during structural heart procedures: Toward a widespread diffusion of knowledge using mixed reality

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