Objective: Mentorship in laparoscopic surgery continues to evolve. Skills training outside of the operating room supplements, but does not supplant, hands-on training. Telementoring technology provides ways of training from a remote location that may augment self-directed learning with guided yet unobtrusive mentorship. Digital annotation with 2-way audio has been described as an effective telementoring method. An Augmented Reality Telementoring (ART) Platform has been developed that combines a laparoscopic training box positioned away from the surgical field that allows an expert to superimpose their instruments on the learner’s video interface. The ART Platform provides easy to understand, real-time guidance in both the simulation lab and operating room.
Description: The ART Platform consists of a portable laparoscopic box trainer and a two-way microphone. The video interface is outfitted with green-screen technology to facilitate interlacing the box image onto the real-time laparoscopic image. Instruments identical to those being used in the operating room are introduced into the box. The audio/video signals from the laparoscopic box simulator are then combined with the audio/video signals from the learner’s station, either in the simulation lab or operating room. These signals are fed into an audio/video filter, processor, and mixer via wired or wireless connection. The signal from the ART Platform is processed using a chromakey to remove the background color and superimposed onto the video feed from the operating room to create a hybrid image. This output image consists of the live intraoperative video overlaid with “ghost” instruments that are controlled by a surgical mentor. This realtime output image is then transmitted to both the mentor and learner.
Results: A fully functional prototype of the Augmented Reality Telementoring (ART) Platform has been constructed and tested in the simulated environment. Real-time expert telementoring of a novice performing laparoscopic partial tasks in a box trainer (intracorporeal suturing) has been demonstrated.
Conclusions: The Augmented Reality Telementoring platform provides a method for “hands-off” mentoring during laparoscopic procedures. Verbal teaching is augmented by specific visual cues by the trainer on the learner’s visual interface. This is the first demonstration of surgical telementoring using equivalent surgical instruments in a remotely positioned box trainer using chromakey technology. Further studies establishing the reliability and validity of the ART Platform are in progress.