Using Virtual Augmented Reality to Remotely Proctor Overseas Surgical Outreach: Building Long-Term International Capacity and Sustainability

Abstract

Background: Cleft lip affects one in 700 children globally, and the prevalence far surpasses capacity to deliver cleft care in underresourced and endemic regions. A hands-on educational presence is needed to promote overseas surgical autonomy, build overseas capacity, and ensure a sustained clinical and educational infrastructure. The goal of this study was to build and assess an augmented reality educational platform that allows a remote yet virtual interactive presence to transfer cleft surgery knowledge/skills to overseas colleagues. Methods: A prospective study assessing a 13-month overseas augmented reality–based cleft surgery curriculum was conducted. Three semiannual site visits engaged two Peruvian surgeons in evidence-based didactics, on-site cleft surgery, and familiarization with the augmented reality platform. During 10 remote augmented reality visits, a surgeon stationed in United States guided the same Peruvian surgeons through cleft surgery. Quarterly assessments of the Peruvian surgeons were performed using visual analogue scale questionnaires. Results: Visual analogue scale scores by both the remote and overseas surgeons demonstrated significant, progressive improvement in all facets of cleft lip repair throughout the curriculum. Site visits preferentially built capacity for cleft diagnosis and preoperative counseling (p < 0.001), principles of repair (p < 0.001), repair technique (p < 0.02) and intraoperative decision-making (p < 0.001). Remote sessions preferentially developed understanding of cleft operative design/anthropometry (p < 0.04), cleft anatomy (p < 0.01), and operative efficiency (p < 0.001). At 30-month follow-up, no children with cleft lip required transfer to tertiary care centers. Conclusion: A curriculum that combines on-site training and augmented reality–based hands-on remote teaching can build sustained capacity of comprehensive cleft care in underresourced areas.

Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training

“…Augmented reality remains the next step in telementoring in ophthalmology whereby symbols and pointers can be overlaid over the live feed to further assist the student surgeon. As described by Vyas et al, 19 cleft lip surgery was performed remotely from California to 2 Peruvian surgeons treating cleft lip. This combined remote yet live and interactive digital presence so that expert surgeons could use pointers and simultaneously annotate diagrams to enhance the trainee surgeons' experience.…”

Considerations for resuming global surgery outreach programs during and after the coronavirus disease 2019 (COVID-19) pandemic

“…47 Remote augmented reality training has also been utilized to improve the performance of surgeons on skills such as cleft diagnosis, counseling, and surgical technique. 48 Such interventions have the dual benefit of surpassing travel restrictions and developing local capacity, a primary goal of most GSOPs. By developing a solid collaborative foundation prior to a trip experience, stakeholders will be able to ensure the success of well-J o u r n a l P r e -p r o o f planned trips in the future once pandemic restrictions have been withdrawn.…”

Sustainable Cleft Care: A Comprehensive Model Based on the Global Smile Foundation Experience

“…Augmented reality was used in 17 of 43 primary cleft lip repairs. Overall, both the remote and overseas surgeons reported a positive trend in preoperative counseling and diagnosis as well as operative design, anatomy, decision-making and efficiency, and principles and techniques of cleft lip repair (Vyas et al, 2020). In doing so, GSF aspires for continuity of training and reinforcement of its commitment to sustainable cleft care.…”