Virtual Pointer as a Telementoring Guidance Aid for Laparoscopic Surgical Training

Hannah Mcgowan¹, Yuanyuan Feng, MS¹, Azin Semsar, MS¹, Hamid Zahiri, DO², Adrian Park, MD², Andrea Kleinsmith, PhD¹, Helena Mentis, PhD¹. ¹University of Maryland Baltimore County, ²Anne Arundel Medical Center

INTRODUCTION: Effective means of telecommunication is pertinent for the surgical field, where transfer of knowledge is complex, i.e involves knowledge of procedure, anatomy and use of surgical instruments. We previously showed a Virtual Pointer system (VP) can aid in laparoscopic instructional learning in an onsite training situation. Here, we examine the effectiveness of using the VP in a telementoring setting, where guidance is provided remotely. Successful telementoring guidance may be beneficial for creating more realistic OR training settings.

METHODS AND PROCEDURES: We performed a counterbalanced, within subjects controlled experiment, comparing VP guidance in a colocated condition with a telementoring condition. Trainees were eight surgical residents. Trainees performed a simulated laparoscopic task on a physical model under the guidance of one trainer (attending surgeon). Trainee performance questionnaires (Global Rating Scale instrument) and trainer/trainee cognitive load questionnaires (PAAS scale) were distributed to trainer and trainees. Scores were rank transformed using ARTool in R (version 3.5.1). A two-way ANOVA test was run to analyze effect of condition and run order on performance and cognitive load scores. A one-way ANOVA test was run to examine score differences within runs.

The VP uses the Microsoft Kinect system and allows for real-time video telestration, enabling a trainer to point or draw free handedly over live laparoscopic video. In this study, we defined VP guidance in a colocated setting as the control and VP guidance in a telementoring condition, through use of a divider, as the experimental condition (Figure 1).

RESULTS: There is no effect of condition (co-located or telementoring) or an interaction effect of condition and run order on trainer’s perception of trainee performance and trainee/trainer cognitive load.

A significant effect of run order; however, illustrates increased perception of trainee performance as assessed by the trainer (p=0.002) (Figure 2) and significantly decreased trainee cognitive load over the runs (p=0.00018) (Figure 3).

CONCLUSION: Overall, there is no significant difference of performance or cognitive load scores between the co-located and telementoring conditions. A significant effect of run order on performance and cognitive load scores suggests that learning is observed in both conditions over time. From these results, we can conclude that use of the VP in the telementoring condition was as effective as in the co-located setting, which has previously been shown to increase trainee performance and understanding. Further studies are needed to objectively measure trainee’s performance and cognitive load in telementoring training conditions.