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Global Translational Medicine Remote surgical mentorship In Rwanda

published by Gouda and colleagues in The Lancet Global in thoracic surgery. The primary objective of this endeavor
Health revealed a 67% increase in disability-adjusted life- was to investigate the feasibility of establishing a remote
years (DALYs) due to NCDs in sub-Saharan Africa, from mentorship program in hopes of expanding bi-directional
90.6 million in 1990 – 151.3 million in 2017. In 2017, learning between Rwanda and the United States.
4
the leading causes of NCD burden were cardiovascular
®
disease (22.9 million) and neoplasms (16.9 million), both 3. Feasibility: Implementing Rods&Cones
of which include surgical intervention as an integral part in Rwanda
of their management. Specifically, lack of access to thoracic Rods&Cones is a health-care technology company based
®
surgery in sub-Saharan Africa is an urgent problem. In out of the Netherlands that offers a remote telepresence
2019, Africa had 124 thoracic surgeons, which translates to solution for medical environments that is adaptable to global
1.2 thoracic surgeons per 10 million population. 5 surgical support and is HIPAA- and GDPR-compliant. It
7
When educational demand and available resources are incorporates “smart glasses” and a digital remote assistance
incongruent, bright young people interested in pursuing platform to allow users to connect safely with an assisting
medicine or surgery are forced to seek training outside surgeon, product specialist, or other medical professional
of their home country. This cyclic process fuels existing anywhere in the world, in real-time. What is especially
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issues of “brain drain,” which is the emigration of highly noteworthy about Rods&Cones’ technology is its capacity
trained individuals from their home country. As a result, to access and integrate multiple views for the Remote Expert
newly trained providers do not return home to serve their to view from the comfort of home: (i) a direct surgeon view
communities. Efforts in capacity building and retention through the “smart glasses” worn by the operating surgeon
of local physicians are essential to combat existing issues (visOR), (ii) a Remote Expert-controlled live camera feed
of brain drain, and providing access to highly specialized situated in the OR that provides a broader perspective of
education is critical to this effort. If this problem is not the operating theater (panOR), and (iii) direct minimally
addressed and current educational methods are not invasive surgery tower input (mirrOR). Moreover, the
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updated, it is estimated that there will be a global deficit Rods&Cones audio system provides detailed auditory
of about 12.9 million skilled health professionals by 2035. 6 input and output, enhancing the mentor’s ability to provide
live feedback through audio and chat capabilities. It is a
2. The rise of remote mentorship lean, portable machine that does not require downtime for
OR construction or remodeling. Rods&Cones is currently
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As the volume and complexity of surgical needs increases, active at more than 1500 hospitals in over 100 countries
the global surgical community must develop strategies and has a robust live support network that is available to
to support individual surgeons, hospitals, and training users around the clock.
programs as they take on the challenge of expanding
the surgical workforce. Mentorship is the foundation With the goal of establishing feasibility of use of the
®
of surgical training and stands as a paramount focus for Rods&Cones technology for remote thoracic surgery
research and resource allocation when attempting to build mentorship, the senior author brought the technology on
surgical capacity. a surgical trip to King Faisal Hospital in Kigali, Rwanda
in August 2022 (Figure 1). Using a Stupnik Video Assisted
The COVID-19 pandemic served as an unexpected Thorascopic Surgery (VATS) Simulator, the team was able
catalyst for remote mentorship. As traditional avenues for to ensure sufficient internet bandwidth and troubleshoot
in-person mentorship faced abrupt limitations, necessity technological snags in an artificial setting (Figure 2). This
forced innovation in surgical education and training.
This unforeseen shift forced the rapid development A B
and adoption of telepresence technology, transforming
operating rooms (ORs) into classrooms accessible across
the globe. Surgeons worldwide swiftly embraced virtual
platforms such as Zoom, Microsoft Teams, and Facetime
to bridge geographical gaps and connect with mentees
remotely. During this age of unparalleled advancement
in remote mentorship, obstacles such as technological
limitations and infrastructural inadequacies came to light. ®
Herein, the authors describe one example of how advances Figure 1. Rods and cones hardware and software. (A) The Rods&Cones
MIS Kit for minimally invasive surgeries. (B) The smart glasses in-use
in remote mentorship technology can overcome existing and associated Remote Expert interface. The images were used with
barriers and aid in expanding the global surgical workforce permission (Source: https://rods-cones.com/mis-kit/).

Volume 3 Issue 1 (2024) 2 https://doi.org/10.36922/gtm.2795