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Augmented-reality telementoring for leg fasciotomy: a proof-of-concept study
  1. John McPherson1,2,
  2. C Kennedy1,3,
  3. G Slobogean1,4,
  4. R Hilsden1,5 and
  5. M Talbot6
  1. 1Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, Ontario, Canada
  2. 2Department of Surgery, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  3. 3Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
  4. 4R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
  5. 5Department of Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
  6. 6Royal Canadian Medical Service, Canadian Armed Forces, Montréal, Quebec, Canada

Abstract

Background Prolonged field care is required when casualty evacuation to a surgical facility is delayed by distance, weather or tactical constraints. This situation can occur in both civilian and military environments. In these circumstances, there are no established treatment options for extremity compartment syndrome. Telementoring by a surgeon may enable the local clinician to perform a fasciotomy to decompress the affected compartments.

Methods Six military clinicians were asked to perform a two-incision leg fasciotomy in synthetic models under the guidance of an orthopaedic surgeon located 380 km away. Communication occurred through commercially available software and smartglasses, which also allowed the surgeon to send augmented-reality graphics to the operators. Two blinded surgeons evaluated the specimens according to objective criteria. Control specimens were added to ensure the integrity of the evaluation process.

Results The six study participants were military physician assistants who had extensive clinical experience but had never performed a fasciotomy. The average duration of the procedure was 53 min. All six procedures were completed without major errors: release of all four compartments was achieved through full-length incisions in the skin and fascia. The only surgical complication was a laceration of the saphenous vein. All three control specimens were correctly assessed by the evaluators. None of the participants experienced adverse effects from wearing the smartglasses. Four dropped calls occurred, but the connection was re-established in all cases.

Conclusion All six surgical procedures were completed successfully. We attribute the dropped calls to a mismatch between the size of the graphic files and the available bandwidth. A better technical understanding of the software by the mentoring surgeon would have avoided this problem. Important considerations for future research and practice include protocols for dropped communications, surgical skills training for the operators and communication training for the surgeons.

  • telemedicine
  • orthopaedic & trauma surgery
  • trauma management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors MT, JM and GS conceived and designed the study. MT was the mentoring surgeon. CK and RH contributed to data acquisition. All authors contributed to data analysis and interpretation. JM and MT wrote the manuscript. All authors reviewed the manuscript for important intellectual content and approved the final version. Guarantor: JM.

  • Funding The study received internal funding from the Canadian Forces Surgeon General’s Research Fund and an indirect funding from the Build in Canada Innovation Program.

  • Disclaimer This article reflects the personal views of the authors. It does not represent the official position or policy of the Department of National Defence, the Canadian Armed Forces, or the Royal Canadian Medical Service.

  • Competing interests GS's effort for this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number K24AR076445. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Provenance and peer review Not commissioned; internally peer reviewed.