Page 57 - GTM-3-1

Global Translational Medicine Remote surgical mentorship In Rwanda

they had received a memo from the Hospital President and its use in most complex thoracic procedures. Apple
©
Chief of Staff, highlighting the importance of buy-in from released the Vision Pro in the United States in February
local stakeholders. 2024 for the price of US$3,499, with limited availability.
This mixed-reality technology has the potential to allow
4. Comparative analysis of remote the surgeon to visualize key imaging intraoperatively
mentorship technologies without having to turn their head to look at a monitor, but
applications for remote learning remain to be explored and
Although the literature on remote thoracic surgery
mentorship is not extensive, alternate technologies have are seemingly limited based on the current capabilities
been employed for surgical training, each with their own of the Vision Pro. Finally, none of the aforementioned
®
advantages and disadvantages. A study by Ponsky et al. technologies, aside from VisitOR1 , were designed for
®
describes their experience trialing two different remote remote surgical training, unlike Rods&Cones .
“telemonitoring” technologies between Akron, Ohio, There has been a longstanding model of a visiting surgical
and Seattle, Washington. Their study compares the use expert or team traveling to a hospital site that wishes to
of store-bought equipment that connects the laparoscope develop a program or advance their surgical capabilities, but
to a Skype™ connection to a proprietary telementoring this is often for a limited period or does not provide sufficient
®
robot, Karl Storz Endoscopy-America, Inc. VisitOR1 . consistent. The described technology does not require
The technologies were then compared in various pediatric embedded equipment or structural remodeling, allowing for
surgical procedures, including a VATS lower lobectomy, deployment for relatively brief periods, such as during the
among others. Ultimately, they found the less expensive initiation process of a new surgical program. Once expertise
Skype TM technology to be inferior in its security and and mentorship are available locally, the technology could
telestrator abilities. 8 be used in additional scopes of practice. Intraoperative
11
mentorship is just one component of a multifaceted effort
Another alternative technology, Google Glass™ (Google,
Inc, Mountain View, Calif.), was first introduced in 2012 to educate the next generation of thoracic surgeons. This
technology can be transported by a single person for use
and costs approximately US$1,000. This technology uses in the clinic, the OR, or even the inpatient ward, spanning
a peripherally positioned camera and prism. The camera
can take photographs or videos to live-stream for teaching the entirety of perioperative care. Other initiatives include
purposes, while the prism provides a semitransparent classroom or conference-based learning, visitation to other
overlay on the wearer’s visual field by projecting a facilities for case observation, and expansion of access to
primary literature. As technologies for remote mentorship
computer-generated image directly onto the wearer’s continue to evolve, we are presented with an opportunity
retina. Sound is recorded and transmitted by means of a to transcend the limitations of traditional models, fostering
mastoid bone conductor and earpiece, allowing dialogue interactive, bi-directional learning that is essential to establish
between wearer and the remote viewer. Use of the Google and sustain comprehensive thoracic surgery globally.
Glass™ for surgical education has been demonstrated in
LMICs; however, its primary drawback is the potential Acknowledgments
9
for distraction. Google Glass™ can be distracting for the
surgeon, particularly if they are not used to wearing the None.
device. This can increase the risk of errors and complications Funding
during surgery. Additionally, certain editions of Google
Glass™ technology (e.g., Google Glass™ Enterprise) are no None.
longer being sold or supported by Google. Lastly, concerns
regarding patient confidentiality with transmission of audio Conflict of interest
and video content remain pertinent. James Maloney is a consultant for Ethicon, part of the
®
The Microsoft HoloLens 2 has also been applied in a Johnson & Johnson company. He has no relevant material
surgical context in the form of augmented reality for surgical or financial interests that relate to the research described in
navigation. It is largely used as a surgical aid aimed at this paper. The other authors declare no conflict of interest.
10
the visualization of medical data, blood vessel search, and Author contributions
targeting support for precise positioning of mechanical
elements, rather than for remote mentorship. Moreover, Conceptualization: James D. Maloney
despite improvement from its predecessor, the HoloLens 1, Writing – original draft: Jessica D. Blum
the headset remains relatively heavy (566 g), has a limited Writing – review & editing: Yayehyirad Mekonnen Ejigu,
field of view (52°), and a battery life of only 3 h, precluding Girma Tefera, James D. Maloney

Volume 3 Issue 1 (2024) 4 https://doi.org/10.36922/gtm.2795