Hamza Hawa, Aboumarzouk Omar M, Al-Ansari Abdulla, Navkar Nikhil V
Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
J Med Internet Res. 2025 Feb 3;27:e63939. doi: 10.2196/63939.
Remote surgeons use telementoring technologies to provide real-time guidance during minimally invasive surgeries (MIS). Such technologies are continuously improving with the integration of dynamic augmented reality (AR) cues. This includes virtual overlays of hand gestures, pointers, and surgical tools onto the operating surgeon's view. The operating surgeon comprehends this augmented information to operate on the patient. Thus, understanding these dynamic AR cues (either during surgical training or live surgery) is crucial.
In this paper, we aimed to review the existing telementoring technologies that use dynamic AR cues during MIS. This review describes the MIS (including surgery type, specialty, procedure, and clinical trial), the telementoring system, the dynamic AR cues generated by these systems, and evaluation of the technology in terms of technical aspects, user perceptions, skills gained, and patient outcomes.
A scoping review was conducted using PubMed, Web of Science, Scopus, IEEE Xplore, and ACM Digital Library databases. The search terms included "telementoring," "minimally invasive surgery," and "augmented reality" without restrictions imposed on the publication year. Articles covering telementoring using dynamic AR cues during MIS, including laparoscopic and robot-assisted, were identified.
A total of 21 articles were included and categorized based on type of surgery, the telementoring technology used, and evaluation of the technology. Most of the articles reported on laparoscopic suturing performed using synthetic phantoms. Hand gestures and surgical tools were the most frequently used dynamic AR cues (10 articles on each cue), while the mentors and mentees primarily consisted of experienced surgeons and medical students. The studies assessing the telementoring technologies were either descriptive (7 articles) or analytical (14 articles) where it was compared against no cue, prerecorded visual cue, in-person guidance, audio cue, or static AR cue. Outcomes were measured mostly using skills gained (13 articles) and user perception about the telementoring system.
In general, telementoring using dynamic AR cues resulted in positive outcomes during MIS. In some cases, they were considered on par with conventional methods such as audio cues and in-person guidance. Further randomized controlled trials are required to objectively assess its clinical benefits.
远程外科医生在微创手术（MIS）期间使用远程指导技术提供实时指导。随着动态增强现实（AR）线索的整合，此类技术在不断改进。这包括将手势、指针和手术工具的虚拟叠加显示在主刀医生的视野上。主刀医生理解这些增强信息以对患者进行手术。因此，理解这些动态AR线索（无论是在手术训练期间还是在实际手术中）至关重要。
在本文中，我们旨在回顾在MIS期间使用动态AR线索的现有远程指导技术。本综述描述了MIS（包括手术类型、专业、手术步骤和临床试验）、远程指导系统、这些系统生成的动态AR线索，以及从技术方面、用户认知、获得的技能和患者结局等方面对该技术进行的评估。
使用PubMed、科学网、Scopus、IEEE Xplore和ACM数字图书馆数据库进行了一项范围综述。检索词包括“远程指导”“微创手术”和“增强现实”，对出版年份不设限制。识别出涵盖在MIS期间使用动态AR线索进行远程指导的文章，包括腹腔镜手术和机器人辅助手术。
共纳入21篇文章，并根据手术类型、使用的远程指导技术以及对该技术的评估进行了分类。大多数文章报道了使用合成模型进行的腹腔镜缝合。手势和手术工具是最常用的动态AR线索（每种线索各有10篇文章），而指导者和被指导者主要由经验丰富的外科医生和医学生组成。评估远程指导技术的研究要么是描述性的（7篇文章），要么是分析性的（14篇文章），后者将其与无线索、预先录制的视觉线索、现场指导、音频线索或静态AR线索进行了比较。结局大多使用获得的技能（13篇文章）和用户对远程指导系统的认知来衡量。
总体而言，在MIS期间使用动态AR线索进行远程指导产生了积极的结果。在某些情况下，它们被认为与音频线索和现场指导等传统方法相当。需要进一步进行随机对照试验以客观评估其临床益处。
