The Potential in Augmented Reality Surgery

University of Alabama at Birmingham orthopedic surgeon Brent Ponce, MD, compares the augmented reality technology used during a recent shoulder replacement surgery to the technology that shows at-home football viewers the first-down and scrimmage lines on their TVs.

“The technology puts your hands in the surgical field like line markers on a football field,” he says. “They’re not really there, but you can see exactly where they are.”

The technology he’s describing is called VIPAAR, short for Virtual Interactive Presence And Augmented Reality. It was developed at UAB less than 10 years ago, and allows for real-time, two-way, interactive video conferencing.

During the Sept. 12 shoulder replacement surgery using the technology, Dr. Ponce wore Google Glass, which allowed a live video stream of the surgical field to be sent to his colleague, Phani Dantuluri, MD, in Atlanta. Dr. Dantuluri was able to offer a virtual hand by using the VIPAAR platform to superimpose a projection of his hands onto the heads up display of the Google Glass.VIPAAR surgery-8

The shoulder replacement surgery was just a trial of using VIPAAR along with Google Glass — as an experienced surgeon specializing in shoulders, Dr. Ponce did not require Dr. Dantuluri’s assistance for the procedure. However, it provided Dr. Ponce with insight into the potential uses for a technology he had been testing out for a while.

At the Birmingham VA Medical Center, Dr. Ponce had conducted a prospective study using the VIPAAR technology during 15 shoulder arthroscopies. The procedures were performed by third- and fifth-year residents, with Dr. Ponce monitoring the procedure remotely from the surgeon's lounge, able to virtually put his hands in the surgical field when needed or to point out a structure or potential issue.

To Dr. Ponce, being able to remotely (and sterilely) place his hands in front of the residents allowed him to communicate better than if he was in the OR physically. "When I'm next to the resident, I have to stop the case to show them something or use directions like 'on the right' or 'five o'clock,'" he says. Using VIPAAR, he is able to demonstrate proper technique by moving his own hands and point out structures or the next destination exactly without having to describe it verbally. "I found I can communicate more effectively remotely," he says.

Dr. Ponce sees VIPAAR's augmented reality technology as having the potential to improve later-year resident training by providing both hands-on learning and close-at-hand supervision for those who have advanced beyond simulators but who may not be ready to perform the procedure solo. "They have to do the actions if they're going to learn," he says. "This way, they have the autonomy but also the safety net."

Dr. Ponce says the technology could also be used to provide guidance to any surgeon learning a new procedure, such as a surgeon working with a new implant device. "There's a real learning curve with new devices, even if you're an experienced surgeon, you're still doing that particular type of case for the first time," he says. "I could see [the device manufacturer] using VIPAAR to help a physician get comfortable using the new device."

The combination of VIPAAR and a video conferencing tool like Google Glass could also be used to provide needed help when a surgeon runs into trouble during a procedure. It's technology Dr. Ponce wished he had when he was serving in Iraq as an orthopedic surgeon. A soldier under his care suffered a gunshot injury and required vascular surgery. Fortunately, a vascular surgeon was present, but it underscored for Dr. Ponce the potential benefits of being able to quickly connect to a specialist remotely. VIPAAR could allow a surgeon to get help when needed without stopping or delaying the surgery. "This could be a real lifeline — the ability to dial a friend for assistance," he says.

Ultimately, surgery is a service industry, says Dr. Ponce, and if there's a technology that could increase care quality, decrease the risk of complications and increase efficiencies, it should be used. He believes augmented reality systems like VIPAAR to be that technology.

More Articles on New Technology:

How Google Glass Can Make Wrong-Side Surgery a True "Never Event"
How Bed-Tracking Technology Allowed Mt. Sinai Medical Center to Reduce Admission Wait Times
What New York Digital Health Accelerator's First-Year Results Reveal About the Health IT Market 

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