Preliminary design and evaluation of a remote tele-mentoring system for minimally invasive surgery

Abstract

Background Tele-mentoring during surgery facilitates the transfer of surgical knowledge from a mentor (specialist surgeon) to a mentee (operating surgeon). The aim of this work is to develop a tele-mentoring system tailored for minimally invasive surgery (MIS) where the mentor can remotely demonstrate to the mentee the required motion of the surgical instruments. Methods A remote tele-mentoring system is implemented that generates visual cues in the form of virtual surgical instrument motion overlaid onto the live view of the operative field. The technical performance of the system is evaluated in a simulated environment, where the operating room and the central location of the mentor were physically located in different countries and connected over the internet. In addition, a user study was performed to assess the system as a mentoring tool. Results On average, it took 260 ms to send a view of the operative field of 1920 × 1080 resolution from the operating room to the central location of the mentor and an average of 132 ms to receive the motion of virtual surgical instruments from the central location to the operating room. The user study showed that it is feasible for the mentor to demonstrate and for the mentee to understand and replicate the motion of surgical instruments. Conclusion The work demonstrates the feasibility of transferring information over the internet from a mentor to a mentee in the form of virtual surgical instruments. Their motion is overlaid onto the live view of the operative field enabling real-time interactions between both the surgeons.

Evaluation of user‐interfaces for controlling movements of virtual minimally invasive surgical instruments

“…A minimally invasive tele-mentoring system may be used for both laparoscopic as well as robotic surgery. 13,17 In such a case, the Touch Haptic Device may be suitable as it performs equivalently for both types of surgery. The choice of the user interface for tele-mentoring may also depend upon other aspects, such as cost and size.…”

“…To evaluate the user interfaces for surgical tele-mentoring during a MIS, a tele-mentoring framework proposed by Shabir et al 13,17 was used for the experiments in our study. The setup at the mentee's site (representing the operating room) captures the position of the incision points, the orientation and position of the scope, and the video feed acquired from the scope camera (representing the view of the operating field).…”

“…SpaceMouse was used to control the motion of laparoscopic instruments to assess the tele-mentoring between mentor and mentee. Shabir et al 13,17 Robotic Touch haptic device Touch haptic device was used to control the motion of virtual robotic instruments to assess the tele-mentoring between mentor and mentee.…”

“…The mentee mentally grasps these visual cues (augmented on the operating field) and performs the surgical substep as demonstrated by the mentor. The study performed by Shabir et al 17 shows that a path (projected on a two-dimensional operative field) defined by the mentor's virtual surgical instrument movement when compared to a predefined path varies with Dynamic Time Warping (DTW) distance of 1176.5 � 331.8. Dynamic Time Warping distance is a similarity measure between two paths 18 and is used to assess the similarity between the paths defined by motions of surgical instruments.…”

“…[21][22][23] These studies included quantification of humanmachine interactions via user-interfaces for tele-robotic surgery, 21 comparison of user interfaces of robotic surgical platforms based on degrees-of-freedom and force feedback, 22 and perception and interpretation of the transmitted operating field video on different visualization interfaces for tele-mentoring. 23 Though, the notion of using a user interface to control virtual surgical instrument motion for tele-mentoring has been explored and demonstrated in both laparoscopic 12,13,17,24 and robotic surgery, [13][14][15]17 why a particular user interface was empirically chosen to use in previous telementoring studies is not reasoned. Considering the variety of existing off-the-shelf user interface systems, it is a priority to compare, understand, and quantify the effectiveness, efficiency, and usability of such different user interfaces for tele-mentoring applications in MIS.…”