Journal Article

Applying mixed reality technology to global surgery: a successful pilot program to expand surgical care in rural Uganda

Marin, Michael L, Williams, Hannah, Glerum, Katie, Divino, Celia M, Abasi, Unwana, Okello, Joseph Damoi, Zhang, Linda P, Cuva, Dylan, Huber, Hans Maxwell, Tufts, Lauren

2023

Overview

PurposeSurgical care in low-resource countries is limited by a lack of accessible, advanced surgical expertise. Training opportunities have historically been constrained by the availability of expert surgeons, lack of multidisciplinary teams and the high cost of in-person training. Recent developments in mixed-reality technology provide an exciting opportunity to expand the scope of surgical practice in low-resource settings. This paper reports on a pilot program using mixed-reality headsets to provide expert intraoperative guidance to a surgeon in rural Uganda.MethodsA high-speed fiber-optic cable line was run to a rural surgical center in Kyabirwa, Uganda. Surgeons at an academic tertiary care hospital in the United States and a surgeon in Uganda were trained to use a HoloLens™ mixed-reality headset. The Ugandan surgeon identified patients from his clinic who would benefit from subspeciality expertise. Cases were discussed at a virtual preoperative multidisciplinary conference and HoloLens™ headsets were used to provide remote intraoperative guidance.ResultsBetween September 2019 and October 2022, mixed-reality headsets were used to provide a Ugandan surgeon with expert intraoperative consultation in six cases, including four complex skin excisions and two exploratory laparotomies. The technology was successfully applied to each case and there were no postoperative complications. Suggested areas of improvement included increasing the precision of the annotation function, developing an adjustable headset to optimize surgeon ergonomics, and improving the camera’s ability to adjust to the overhead operating room lights.ConclusionsAdvances in digital technology can augment surgical care in low-resource settings. These developments can be cost-sparing and effective tools to exchange surgical knowledge and expand patient care.

• Publisher: Springer Nature B.V