- Email: [email protected]
Addition of a telestrator for teaching during video-based procedures
Otolaryngology–Head and Neck Surgery (2010) 143, 159-160
CLINICAL TECHNIQUES AND TECHNOLOGY
Addition of a telestrator for teaching during video-based procedures Scott Ferguson, and Brendan C. Stack, Jr., MD, Little Rock, AR No sponsorships or competing interests have been disclosed for this article.
A
low-cost telestrator, or video illustrator, has been developed to annotate live video feeds of surgical procedures (endoscopic or microscopic) performed in operating rooms equipped with a video tower. This device has been integrated into existing operating room video towers to be cost-effective. Similar technology is present in the operating room on the da Vinci Robotic Surgery platform (Intuitive Surgical, Sunnyvale, CA) and occasionally may be part of state of the art auditoria that can receive live surgical video feed. This concept of overwriting video feed has existed for over a decade, as made famous by John Madden, a color commentator for coverage of National Football League games. The telestrator consists of a laptop computer (Model VGNTXN15P; Sony Corporation, New York, NY) equipped with a PCMCIA TV tuner card (Model AverTV Card bus MCE [E502]; AVerMedia USA, Milpitas, CA, www.avermedia-usa.com// AVerTV/Product/ProductDetail.aspx?Id⫽458), annotation software (Slide Mate 2008, version 4.12; YPG Soft, Köln, Germany, slidemate.ypgsoft.com), and a wireless mouse (Model Air Mouse Go; Movea, Inc., Milpitas, CA, www. gyration.com/index.php/us/products/in-air-micekeyboards/ go-air-mouse.html) (Fig 1). These items are the minimum necessary equipment used in our prototype. Equipment from alternative manufacturers may be considered for substitution according to cost and availability. The video signal from the surgical camera unit (Model 1188HD SDC Ultra; Stryker, San Jose, CA) is fed to the tuner card via the S-video output. The live video is displayed on the laptop monitor by the software provided with the video card listed previously. The annotation software runs simultaneously with the live video and allows the user to apply annotation over the live video display. Conventionally, the commentator (or in our case the surgery attending) has a slate and a “pencil” that allow the commentator’s comments or illustrations to be projected onto a display layered over the video feed. An innovation we have added is a wireless mouse, which reduces the need for bulky equipment for the commentator and is more easily placed into the sterile field or used off field. The Gyration mouse features motion-sensing technology that eliminates not only wires but also the need for the mouse pad. The
Figure 1 tower.
Telestrator equipment integrated into a Stryker video
motion-sensing technology allows the user to control the cursor with hand motions. The blended video (live ⫹ mark up) is sent out via the video graphics array (VGA) output from the laptop to the surgical monitor, which is incorporated into the video tower. The blended video could also be fed to a videorecording device (video tower) to capture the video with the associated annotation. There have been limited reports of leveraging current digital technology for surgical instruction and consultation, both onsite and long distance.1-5 The potential applications of this add-on technology for instruction on operative procedures include endoscopic sinus and skull base surgery, head and neck aerodigestive endoscopy, endoscopic minimally invasive neck procedures, and microscopic otologic procedures (Fig 2). This incremental addition to operative video may help instructors communicate anatomical points of interest to their students with increased precision. Additionally, students of surgery may find greater clarity in the operative instruction they receive
Received December 15, 2009; accepted December 23, 2009.
0194-5998/$36.00 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2009.12.043
160
Otolaryngology–Head and Neck Surgery, Vol 143, No 1, July 2010 Corresponding author: Brendan C. Stack, Jr., MD, 4301 W. Markham St., #543, Little Rock, AR 72205. E-mail address: [email protected].
Author Contributions Scott Ferguson, technical support, writing; Brendan C. Stack, Jr., idea, writing, editing.
Disclosures Competing interests: None. Sponsorships: None.
Figure 2 Display image of telestrator being used in resident instruction during an endoscopic parathyroid procedure. The left inferior parathyroid is circled.
from their instructors. Enhanced patient safety during supervision of residents by this method is another theoretical advantage for the use of this technology. Finally, recordings of teaching sessions may be reviewed later for reinforcement of principles or used as a record of surgical proficiency.
Author Information From the University Hospital of Arkansas (Mr. Ferguson) and the Department of Otolaryngology–Head and Neck Surgery (Dr. Stack), University of Arkansas for Medical Sciences, Little Rock, AR.
References 1. Moore RG, Adams JB, Partin AW, et al. Telementoring of laparoscopic procedures: initial clinical experience. Surg Endosc 1996;10: 107–10. 2. Rosser JC, Wood M, Payne JH, et al. Telementoring. A practical option in surgical training. Surg Endosc 1997;11:852–5. 3. Micali S, Virgili G, Vannozzi E, et al. Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases. J Endourol 2000;14:493– 6. 4. Rafiq A, Moore JA, Zhao X, et al. Digital video capture and synchronous consultation in open surgery. Ann Surg 2004;239:567–73. 5. Schneider A, Wilhelm D, Doll D, et al. Wireless live streaming video of surgical operations: an evaluation of communication quality. J Telemed Telecare 2007;13:391– 6.
CLINICAL TECHNIQUES AND TECHNOLOGY
Addition of a telestrator for teaching during video-based procedures Scott Ferguson, and Brendan C. Stack, Jr., MD, Little Rock, AR No sponsorships or competing interests have been disclosed for this article.
A
low-cost telestrator, or video illustrator, has been developed to annotate live video feeds of surgical procedures (endoscopic or microscopic) performed in operating rooms equipped with a video tower. This device has been integrated into existing operating room video towers to be cost-effective. Similar technology is present in the operating room on the da Vinci Robotic Surgery platform (Intuitive Surgical, Sunnyvale, CA) and occasionally may be part of state of the art auditoria that can receive live surgical video feed. This concept of overwriting video feed has existed for over a decade, as made famous by John Madden, a color commentator for coverage of National Football League games. The telestrator consists of a laptop computer (Model VGNTXN15P; Sony Corporation, New York, NY) equipped with a PCMCIA TV tuner card (Model AverTV Card bus MCE [E502]; AVerMedia USA, Milpitas, CA, www.avermedia-usa.com// AVerTV/Product/ProductDetail.aspx?Id⫽458), annotation software (Slide Mate 2008, version 4.12; YPG Soft, Köln, Germany, slidemate.ypgsoft.com), and a wireless mouse (Model Air Mouse Go; Movea, Inc., Milpitas, CA, www. gyration.com/index.php/us/products/in-air-micekeyboards/ go-air-mouse.html) (Fig 1). These items are the minimum necessary equipment used in our prototype. Equipment from alternative manufacturers may be considered for substitution according to cost and availability. The video signal from the surgical camera unit (Model 1188HD SDC Ultra; Stryker, San Jose, CA) is fed to the tuner card via the S-video output. The live video is displayed on the laptop monitor by the software provided with the video card listed previously. The annotation software runs simultaneously with the live video and allows the user to apply annotation over the live video display. Conventionally, the commentator (or in our case the surgery attending) has a slate and a “pencil” that allow the commentator’s comments or illustrations to be projected onto a display layered over the video feed. An innovation we have added is a wireless mouse, which reduces the need for bulky equipment for the commentator and is more easily placed into the sterile field or used off field. The Gyration mouse features motion-sensing technology that eliminates not only wires but also the need for the mouse pad. The
Figure 1 tower.
Telestrator equipment integrated into a Stryker video
motion-sensing technology allows the user to control the cursor with hand motions. The blended video (live ⫹ mark up) is sent out via the video graphics array (VGA) output from the laptop to the surgical monitor, which is incorporated into the video tower. The blended video could also be fed to a videorecording device (video tower) to capture the video with the associated annotation. There have been limited reports of leveraging current digital technology for surgical instruction and consultation, both onsite and long distance.1-5 The potential applications of this add-on technology for instruction on operative procedures include endoscopic sinus and skull base surgery, head and neck aerodigestive endoscopy, endoscopic minimally invasive neck procedures, and microscopic otologic procedures (Fig 2). This incremental addition to operative video may help instructors communicate anatomical points of interest to their students with increased precision. Additionally, students of surgery may find greater clarity in the operative instruction they receive
Received December 15, 2009; accepted December 23, 2009.
0194-5998/$36.00 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2009.12.043
160
Otolaryngology–Head and Neck Surgery, Vol 143, No 1, July 2010 Corresponding author: Brendan C. Stack, Jr., MD, 4301 W. Markham St., #543, Little Rock, AR 72205. E-mail address: [email protected].
Author Contributions Scott Ferguson, technical support, writing; Brendan C. Stack, Jr., idea, writing, editing.
Disclosures Competing interests: None. Sponsorships: None.
Figure 2 Display image of telestrator being used in resident instruction during an endoscopic parathyroid procedure. The left inferior parathyroid is circled.
from their instructors. Enhanced patient safety during supervision of residents by this method is another theoretical advantage for the use of this technology. Finally, recordings of teaching sessions may be reviewed later for reinforcement of principles or used as a record of surgical proficiency.
Author Information From the University Hospital of Arkansas (Mr. Ferguson) and the Department of Otolaryngology–Head and Neck Surgery (Dr. Stack), University of Arkansas for Medical Sciences, Little Rock, AR.
References 1. Moore RG, Adams JB, Partin AW, et al. Telementoring of laparoscopic procedures: initial clinical experience. Surg Endosc 1996;10: 107–10. 2. Rosser JC, Wood M, Payne JH, et al. Telementoring. A practical option in surgical training. Surg Endosc 1997;11:852–5. 3. Micali S, Virgili G, Vannozzi E, et al. Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases. J Endourol 2000;14:493– 6. 4. Rafiq A, Moore JA, Zhao X, et al. Digital video capture and synchronous consultation in open surgery. Ann Surg 2004;239:567–73. 5. Schneider A, Wilhelm D, Doll D, et al. Wireless live streaming video of surgical operations: an evaluation of communication quality. J Telemed Telecare 2007;13:391– 6.