Shenai Mahesh B, Tubbs R Shane, Guthrie Barton L, Cohen-Gadol Aaron A
Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Alabama;
J Neurosurg. 2014 Aug;121(2):277-84. doi: 10.3171/2014.4.JNS131805. Epub 2014 Jun 6.
The shortage of surgeons compels the development of novel technologies that geographically extend the capabilities of individual surgeons and enhance surgical skills. The authors have developed "Virtual Interactive Presence" (VIP), a platform that allows remote participants to simultaneously view each other's visual field, creating a shared field of view for real-time surgical telecollaboration.
The authors demonstrate the capability of VIP to facilitate long-distance telecollaboration during cadaveric dissection. Virtual Interactive Presence consists of local and remote workstations with integrated video capture devices and video displays. Each workstation mutually connects via commercial teleconferencing devices, allowing worldwide point-to-point communication. Software composites the local and remote video feeds, displaying a hybrid perspective to each participant. For demonstration, local and remote VIP stations were situated in Indianapolis, Indiana, and Birmingham, Alabama, respectively. A suboccipital craniotomy and microsurgical dissection of the pineal region was performed in a cadaveric specimen using VIP. Task and system performance were subjectively evaluated, while additional video analysis was used for objective assessment of delay and resolution.
Participants at both stations were able to visually and verbally interact while identifying anatomical structures, guiding surgical maneuvers, and discussing overall surgical strategy. Video analysis of 3 separate video clips yielded a mean compositing delay of 760 ± 606 msec (when compared with the audio signal). Image resolution was adequate to visualize complex intracranial anatomy and provide interactive guidance.
Virtual Interactive Presence is a feasible paradigm for real-time, long-distance surgical telecollaboration. Delay, resolution, scaling, and registration are parameters that require further optimization, but are within the realm of current technology. The paradigm potentially enables remotely located experts to mentor less experienced personnel located at the surgical site with applications in surgical training programs, remote proctoring for proficiency, and expert support for rural settings and across different counties.
外科医生短缺促使开发新技术，以在地理上扩展个体外科医生的能力并提高手术技能。作者开发了“虚拟互动临场感”（VIP）平台，该平台允许远程参与者同时查看彼此的视野，创建用于实时手术远程协作的共享视野。
作者展示了VIP在尸体解剖期间促进远程协作的能力。虚拟互动临场感由配备集成视频捕获设备和视频显示器的本地和远程工作站组成。每个工作站通过商用电话会议设备相互连接，实现全球点对点通信。软件将本地和远程视频源合成，为每个参与者显示混合视角。为进行演示，本地和远程VIP站分别位于印第安纳州印第安纳波利斯和阿拉巴马州伯明翰。使用VIP在一具尸体标本上进行了枕下开颅和松果体区显微手术解剖。对任务和系统性能进行主观评估，同时使用额外的视频分析对延迟和分辨率进行客观评估。
两个站点的参与者在识别解剖结构、指导手术操作和讨论总体手术策略时能够进行视觉和口头互动。对3个独立视频片段的视频分析得出平均合成延迟为760±606毫秒（与音频信号相比）。图像分辨率足以清晰显示复杂的颅内解剖结构并提供交互式指导。
虚拟互动临场感是实时、远程手术远程协作的可行模式。延迟、分辨率、缩放和配准是需要进一步优化的参数，但属于当前技术范畴。该模式有可能使远程专家指导手术现场经验不足的人员，应用于手术培训项目、远程监考以确保熟练程度，以及为农村地区和不同县提供专家支持。
