How telemedicine will transform surgery

By Dr. Samuel R. Browd 4 minute Learn

All through the historical past of recent surgery, coaching has been achieved as a one-to-one apprenticeship within the working room. Excessive-volume surgical coaching packages provide the most effective alternatives to see surgery and expertise uncommon circumstances. However the problem is most surgical coaching packages solely take a handful of candidates per yr.

For example, Seattle’s College of Washington Division of Neurological Surgery, the place I work, solely takes three candidates per yr for its seven-year coaching program. Residents study the total breadth of neurosurgery subspecialities from 20 school members in 16 amenities: vascular, cranium base, tumor, backbone, practical, trauma, and pediatrics. With about 7,000 operations a yr throughout our total coaching program, our residents graduate having participated in 2,000-3,000 operations starting as observers and later as assistants.

Neurosurgery is an effective instance of how location, measurement, repute and accessible coaching slots dictate the spreading of surgical information. Because the demand for surgery grows and our means to save lots of lives continues to progress, a limiting issue is on the market of extremely certified surgeons, particularly in rural areas of the US and underserved areas of the world.

The period of COVID-19 has seen a fast evolution and acceptance of telemedicine for main care and even specialty work like mine. I see about 95% of my pediatric neurosurgical sufferers by way of telemedicine as we focus on their signs, pathology, and potential surgical interventions. It really works stunning properly and has lowered the burden of care for a lot of households for whom taking off work or touring to see the physician is a big and expensive proposition, particularly if it must occur repeatedly.

Dr, Samuel Browd, this text’s creator, seems down a microscope whereas performing an operation–together with his view streamed to surgeons in Australia by way of Microsoft Groups. [Photo: Erin Hooper, Seattle Children’s Hospital]

What was not as apparent initially throughout this era was the affect these rising telecommunication instruments might have on coaching surgeons and conducting operations. Wouldn’t it be attainable to show surgeons-in-training to advanced procedures no matter location, background, or entry to world-class mentorship? Is telemedicine/telesurgery the reply to democratize the surgical studying expertise and convey the most effective surgeons to communities across the globe? I imagine now the reply is undoubtedly sure.

A brand new strategy to surgical coaching

Simply earlier than the beginning of 2020, a proficient colleague in Adelaide, Australia, Dr. Xenia Doorenbosch, requested me if I’d proctor her by a surgery I had grow to be an professional on through the years. The operation known as a selective dorsal rhizotomy (SDR), the place the surgeon rigorously cuts choose nerves that come off the spinal twine to deal with a situation widespread in youngsters with cerebral palsy known as spasticity (excessive muscle tone). Sufferers who bear this surgery can stroll higher afterwards and reside extra independently with out the profound bodily constraints they’d earlier than. It’s one in every of my favourite operations as a result of it’s so extremely life-changing for the children and their households.

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The view of Dr. Browd’s surgery in Australia (with random cute wallaby within the background). [Photo: Dr. Xenia Doorenbosch]

Over the past decade, we’ve taught the approach to our pediatric neurosurgery fellows at Seattle Kids’s Hospital and different pediatric groups throughout the nation and overseas. On this explicit occasion, the pandemic halted our plans to journey to Australia to coach Dr. Doorenbosch. Nor might she come to Seattle. We pivoted and commenced to discover utilizing Microsoft Groups to live-stream the surgical video and allow my digital presence within the working room 7,000 miles away.

From my Seattle workplace, I watched a reside feed from the working room microscope in Adelaide over Groups. I talked forwards and backwards with Dr. Doorenbosch and made strategies as I noticed the process unfold: “I’d minimize that. Perhaps go away that nerve alone. Usually, I’d take a bit extra over there.” It was as if I used to be within the working room offering steerage. There have been moments once I instinctively reached out to seize an instrument solely to comprehend I used to be midway around the globe. The software program I all the time related to enterprise conferences was permitting my group to information our Australian colleagues by their first SDR process, in real-time, 18.5 time zones aside.

After six hours of surgery, I went residence and had dinner with my household. My two children have been wholly unimpressed with my day, as they’d simply video-chatted with their grandparents and cousins in Florida. However for me, it was a very pivotal expertise. Think about the flexibility to take professional surgical information and share it with colleagues and trainees anyplace on the planet on-demand or real-time, reside within the second.

Surgical coaching goes digital

Whereas being current by way of telesurgery is new and novel, we are able to anticipate the evolution of this expertise will occur rapidly. The situation goes like this. You’re early in coaching, you need to learn to take out a herniated disc in a affected person’s lumbar backbone. You don a VR headset, pull up the case from a library to first watch the operation being finished from the surgeon’s perspective. Commentary and annotations of the anatomy are overlaid to your studying and also you observe the process from minimize to pores and skin closure. The educational surgeon advance to a digital anatomy surroundings with real looking surgical devices deployed within the scene. It’s no totally different than what pilots do right this moment in simulation coaching: Simulate earlier than you go reside.

Telemedicine is rising, and whereas it’s nonetheless early, telesurgery will develop permitting the democratization of surgery by entry to coaching, mentorship, and dissemination of surgical information. The flexibility to coach repeatedly on actual circumstances, on-demand will broaden entry to surgery and enhance coaching world-wide. The earlier we allow the digital evolution within the working room and empower surgeons with expertise the higher.