Nova Scotia surgeon gains new skills via ‘tele-proctoring’
September 29, 2022
Dr. Richard Spence, a general surgeon at Queen Elizabeth II Health Sciences Centre, in Halifax, wasn’t worried earlier this summer when faced with performing a surgical technique he had never attempted. Equipped with Rods & Cones smart glasses, he had a specialist in Amsterdam, 4,921 kilometres away, looking over his shoulder and providing guidance – virtually.
Dr. Hendrik Jaap Bonjer, professor of surgery and chair of the department of surgery at Amsterdam University Medical Center, was able to see on his computer screen exactly what Dr. Spence was seeing through his smart glasses. The Rods & Cones technology also transmitted a real-time feed from the laparoscopic camera.
“An interesting feature of the technology is that I was able to see my proctor’s computer screen through the lens in front of me,” said Dr. Spence. “That’s important because he can take a still image, and annotate it, to show me in real time where I should go and what I should try to avoid.” The system also supports bi-directional voice communication.
Meanwhile, on the other side of the Atlantic Ocean,“I felt like I was scrubbed in and standing on the other side of the table,” said Dr. Jaap Bonjer.
The system uses Wi-Fi connectivity – either 4G or 5G – with minimal lag time.
The light-weight headset and accessories are transported and neatly stored in a small suitcase weighing seven kilograms. One electrical cord extends from the case to keep the glasses and other electronic components charged and ready for use.
Peripheral devices include a camera that can provide a full 360-degree view of the OR and a device that can capture and transmit digital feeds from CTs, MRIs and EKGs.
While mostly used for distance proctoring in the OR, the portability of the technology also allows it to be used in the ICU or anywhere else in the hospital.
Established in 2017, Amsterdam-based Rods & Cones released its first product in 2019. “That’s when COVID was happening, so getting into ORs for proctoring was very restricted and the need for a solution to connect people remotely increased significantly,” noted Scott Solis, Rods & Cones managing director for North America. “We transitioned very quickly from a start-up to a scale-up organization.”
“Now, the remote expert supporting a person wearing the technology is truly within that OR because they have all the inputs to be able to support the surgeon,” said Solis.
According to Solis, who brought the Rods & Cones technology to Halifax and was in the OR during the tele-proctoring procedures, there are more than 1,000 Rods & Cones smart glasses in the field that have been used in more than 72 countries by 892 hospitals in Europe, North America and the Asia-Pacific market.
The use of the technology at Queen Elizabeth II Health Sciences Centre, part of N.S. Health, was prompted by two adrenalectomies Dr. Spence was scheduled to perform.
“The adrenal gland lives in what’s called the retroperitoneum, in the abdomen, so one of the most standard ways of approaching the adrenal gland is operating through the abdomen to get to the posterior compartment,” he explained. “It doesn’t really make much sense to go through one compartment to get to another compartment,” but Dr. Spence was hesitant to use the posterior approach with the patient lying on his or her abdomen that he learned during a fellowship in Toronto.
“That approach poses anesthetic as well as surgical challenges because if there is bleeding, it’s not easy to convert from a minimally invasive approach to open surgery.”
The alternative for which Dr. Jaap Bonjer has expertise has the patient on his or her side, but Dr. Spence had never attempted it. General surgery department head Dr. James Ellsmere provided an introduction to Dr. Bonjer, who proposed the use of the Rods & Cones technology.
In the absence of the distant proctoring technology, Dr. Spence would have had to perform the adrenalectomies transabdominally, or the two patients would have had to travel to Toronto.
“Bringing someone into the OR for collaborative cases is not that common, so this opens up opportunities to upskill our surgeons,” said Dr. Spence. “That’s exciting.”
“We have very competent surgeons across the province who would like some more proctoring to transition to more minimally invasive surgery – especially for colorectal surgeries – and this technology could enable that.”
The technology could also be used to train more Nova Scotia surgeons to perform bariatric surgery.
“We have a big backlog of patients on a waiting list for bariatric surgery and only two surgeons currently trained to perform it,” said Dr. Spence. “Giving our other surgeons across the province remote support using this technology would be a nice way to expand our bariatric program.”
The technology doesn’t always replace having someone physically present in the OR for mentoring, noted Dr. Spence. “It’s ideal though for experienced, competent surgeons who want to enhance their skill sets and improve the quality of care.”
The use of distance collaboration technologies isn’t limited to QE II Health Sciences Centre. Last year, the Jewish General Hospital in Montreal used Microsoft HoloLens headsets to connect with an interventional specialist in Toronto during the performance of a transcatheter aortic valve implantation, and earlier this year, surgeons in Rio de Janeiro used similar technology to connect with colleagues in the United Kingdom during a 27-hour procedure to separate conjoined twins.
Dr. Spence sees potential for increased use of the glasses at QE II, and in Nova Scotia generally, and is confident that efforts currently under way to acquire the technology will be successful.