Journal Article

Augmented reality surgical telementoring for leg fasciotomy

Kennedy, Christopher, Talbot, Max, Hilsden, Rich, McPherson, John, Slobogean, Gerard

2021

Overview

Background: Prolonged field care is required when casualty evacuation to a surgical facility is delayed by distance or tactical constraints. This can occur in both civilian and military environments, including remote locations in Canada. In these circumstances, there are no established treatment options for extremity compartment syndrome. One solution is to remotely mentor the tactical clinician to perform surgical compartment release. Methods: Six military clinicians were recruited to perform a 2-incision leg fasciotomy on a synthetic model under the remote guidance of an orthopedic surgeon. The operators wore smartglasses that allowed synchronous communication and the display of anatomic holograms in their field of view. Three control legs were created: 1 complete fasciotomy and 2 with major errors. The experimental and control legs were evaluated by 2 blinded surgeons according to criteria described by Kucera and colleagues. Results: All 6 study participants were Canadian Armed Forces physician assistants. They had extensive experience as military clinicians but minimal experience performing surgical procedures. None had performed a fasciotomy previously. The study was conducted over 3 days, during which bandwidth varied widely at the study site: ping ranged from 12 to 338 ms, download speed from 0.93 to 3.48 Mbps and upload speed from 0.44 to 0.64 Mbps. The mentor, located 300 km away from the study site, had a stable Internet connection with sufficient bandwidth. The average duration of the procedure was 53 minutes (standard deviation 12 min). All 6 procedures were completed without major errors: release of all 4 compartments was achieved through fulllength incisions in the skin and fascia. The only minor error was a laceration of the saphenous vein (n = 1). All 3 control specimens were correctly assessed by the evaluators. None of the participants experienced adverse effects from wearing the AR headset. Four dropped calls occurred. In all cases, the connection was reestablished, and the procedure was completed successfully. Conclusion: Despite limited bandwidth, we were able to successfully perform 2-incision leg fasciotomy in all cases. We attribute the dropped calls to a mismatch between the size of the graphic files and the available bandwidth. A better technical understanding of the software by the mentor would have avoided this problem. Important considerations for future research and practice include protocols for dropped communications, communications training for mentoring surgeons and surgical skills training for the operators.

• Publisher: CMA Impact, Inc
• Subject: Bandwidths / Surgeons