Page 56 - GTM-3-1

Global Translational Medicine Remote surgical mentorship In Rwanda

involved having the operating surgeon manipulate the that can interact in real-time are manifold, including but
VATS simulator under the guidance of a “Remote Expert” not limited to identification of key structures, modification
who could assist in troubleshooting. The Remote Expert of surgical technique, and indication of device and suture
was initially in the same room with the operator but placement. When asked for direct feedback, one learner,
eventually transitioned to providing live technical feedback who is also a local pediatric cardiac surgeon, provided the
from a separate part of the hospital. The surgical team following:
spent 2 days using the VATS simulator to troubleshoot “Using the Rods&Cones technology while
®
®
issues both immediately related to Rods&Cones devices performing pediatric cardiac surgery, we managed to
as well as internet connectivity issues. interact with a remote mentor without interrupting
®
After simulation, the Rods&Cones technology was the flow of surgery nor compromising the safety
progressed to intraoperative testing, initially within King for the patient. With a mentor surgeon clearly seeing
Faisal Hospital, subsequently from a remote site in Kigali, the operating field and guiding the mentee, we
and ultimately, from across the Atlantic Ocean. The Remote demonstrated that in cases when the two surgeons
Expert was able to tune in at 4 am central standard time can’t be in the same operating room together it’s
from the US to view the procedure in real-time and interact possible to learn and consult. I personally look
with the team performing pediatric cardiac surgery being forward to using the technology in the future
conducted in Kigali, Rwanda, manipulating multiple views when I have cases that I have not performed or are
of the operative field to facilitate complete visualization challenging without someone experienced around.”
without drawing attention from surgical proceedings The surgical team performed four procedures with
(Figure 3). The benefits of having a remote surgeon mentor the Rods&Cones technology while in-country and two
®
additional procedures with transatlantic live interaction.
One of the two remote procedures was more successful due
to issues maintaining robust internet connectivity. King
Faisal Hospital’s internet technology team was intimately
involved with testing in the OR suites and with establishing
WiFi boosting devices to increase signal strength.
Challenges associated with the implementation of this
technology at King Faisal Hospital were non-negligible.
The primary concern was difficulty in establishing and
maintaining adequate hospital internet connectivity. This
was overcome by boosting Wi-Fi signal, as previously
mentioned, to meet internet upload and download
requirements of 24 Mbps and 7 Mbps, respectively. Having
a Rods&Cones on-site expert, such as a scrub nurse or
®
other supportive staff, is essential as they can champion
Figure 2. Rods&Cones® feasibility trial using Stupnik VATS simulator. its use and provide in-person technologic support,
demonstrating the value added relative to the effort
required and promoting buy-in from the surgical teams.
Concerns related to headset comfort also arose as one of
the surgeons had to remove the headset intraoperatively
while wearing it for a longer time. In addition, the cost of
®
implementing Rods&Cones technology could render it
prohibitive without the support of government funding,
charitable aid, or private sector investments.
For those considering implementation of a remote
mentorship technology, it is also worth mentioning
that additional education was required for staff to be
comfortable with transmission of in-line feeds from the
laparoscopy tower and echo machine to the Rods&Cones
®
Figure 3. Example of Remote Expert user interface showing a pediatric
cardiac surgery conducted in Kigali, Rwanda with remote guidance from system. Moreover, on the first day the team was attempting
Madison, Wisconsin. to set-up the technology, they were not allowed to start until

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