Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies
Abstract Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telemento...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2020-05-01
|
| Series: | npj Digital Medicine |
| Online Access: | https://doi.org/10.1038/s41746-020-0284-9 |
| _version_ | 1827616244546666496 |
|---|---|
| author | Edgar Rojas-Muñoz Chengyuan Lin Natalia Sanchez-Tamayo Maria Eugenia Cabrera Daniel Andersen Voicu Popescu Juan Antonio Barragan Ben Zarzaur Patrick Murphy Kathryn Anderson Thomas Douglas Clare Griffis Jessica McKee Andrew W. Kirkpatrick Juan P. Wachs |
| author_facet | Edgar Rojas-Muñoz Chengyuan Lin Natalia Sanchez-Tamayo Maria Eugenia Cabrera Daniel Andersen Voicu Popescu Juan Antonio Barragan Ben Zarzaur Patrick Murphy Kathryn Anderson Thomas Douglas Clare Griffis Jessica McKee Andrew W. Kirkpatrick Juan P. Wachs |
| author_sort | Edgar Rojas-Muñoz |
| collection | DOAJ |
| description | Abstract Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient’s body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants’ years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios. |
| first_indexed | 2024-03-09T09:23:41Z |
| format | Article |
| id | doaj.art-146cab5b076f45adbbd80e907a649d84 |
| institution | Directory Open Access Journal |
| issn | 2398-6352 |
| language | English |
| last_indexed | 2024-03-09T09:23:41Z |
| publishDate | 2020-05-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Digital Medicine |
| spelling | doaj.art-146cab5b076f45adbbd80e907a649d842023-12-02T06:49:04ZengNature Portfolionpj Digital Medicine2398-63522020-05-01311910.1038/s41746-020-0284-9Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomiesEdgar Rojas-Muñoz0Chengyuan Lin1Natalia Sanchez-Tamayo2Maria Eugenia Cabrera3Daniel Andersen4Voicu Popescu5Juan Antonio Barragan6Ben Zarzaur7Patrick Murphy8Kathryn Anderson9Thomas Douglas10Clare Griffis11Jessica McKee12Andrew W. Kirkpatrick13Juan P. Wachs14School of Industrial Engineering, Purdue UniversityDepartment of Computer Science, Purdue UniversitySchool of Industrial Engineering, Purdue UniversityPaul G. Allen School of Computer Science and Engineering, University of WashingtonDepartment of Computer Science, Purdue UniversityDepartment of Computer Science, Purdue UniversitySchool of Industrial Engineering, Purdue UniversityDepartment of Surgery, School of Medicine, Indiana UniversityDepartment of Surgery, School of Medicine, Indiana UniversityDepartment of Surgery, School of Medicine, Indiana UniversityNaval Medical Center PortsmouthNaval Medical Center PortsmouthDepartment of Surgery, and the Regional Trauma Services, University of CalgaryDepartment of Surgery, and the Regional Trauma Services, University of CalgarySchool of Industrial Engineering, Purdue UniversityAbstract Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient’s body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants’ years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios.https://doi.org/10.1038/s41746-020-0284-9 |
| spellingShingle | Edgar Rojas-Muñoz Chengyuan Lin Natalia Sanchez-Tamayo Maria Eugenia Cabrera Daniel Andersen Voicu Popescu Juan Antonio Barragan Ben Zarzaur Patrick Murphy Kathryn Anderson Thomas Douglas Clare Griffis Jessica McKee Andrew W. Kirkpatrick Juan P. Wachs Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies npj Digital Medicine |
| title | Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies |
| title_full | Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies |
| title_fullStr | Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies |
| title_full_unstemmed | Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies |
| title_short | Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies |
| title_sort | evaluation of an augmented reality platform for austere surgical telementoring a randomized controlled crossover study in cricothyroidotomies |
| url | https://doi.org/10.1038/s41746-020-0284-9 |
| work_keys_str_mv | AT edgarrojasmunoz evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT chengyuanlin evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT nataliasancheztamayo evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT mariaeugeniacabrera evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT danielandersen evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT voicupopescu evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT juanantoniobarragan evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT benzarzaur evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT patrickmurphy evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT kathrynanderson evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT thomasdouglas evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT claregriffis evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT jessicamckee evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT andrewwkirkpatrick evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies AT juanpwachs evaluationofanaugmentedrealityplatformforausteresurgicaltelementoringarandomizedcontrolledcrossoverstudyincricothyroidotomies |