title: Virtual interactive presence for real-time, long-distance surgical collaboration during complex microsurgical procedures.
abstract: OBJECTIVE
  The shortage of surgeons compels the development of novel technologies that geographically extend the capabilities of individual surgeons and enhance surgical skills. The authors have developed "Virtual Interactive Presence" (VIP), a platform that allows remote participants to simultaneously view each other's visual field, creating a shared field of view for real-time surgical telecollaboration.
  
  
  METHODS
  The authors demonstrate the capability of VIP to facilitate long-distance telecollaboration during cadaveric dissection. Virtual Interactive Presence consists of local and remote workstations with integrated video capture devices and video displays. Each workstation mutually connects via commercial teleconferencing devices, allowing worldwide point-to-point communication. Software composites the local and remote video feeds, displaying a hybrid perspective to each participant. For demonstration, local and remote VIP stations were situated in Indianapolis, Indiana, and Birmingham, Alabama, respectively. A suboccipital craniotomy and microsurgical dissection of the pineal region was performed in a cadaveric specimen using VIP. Task and system performance were subjectively evaluated, while additional video analysis was used for objective assessment of delay and resolution.
  
  
  RESULTS
  Participants at both stations were able to visually and verbally interact while identifying anatomical structures, guiding surgical maneuvers, and discussing overall surgical strategy. Video analysis of 3 separate video clips yielded a mean compositing delay of 760 ± 606 msec (when compared with the audio signal). Image resolution was adequate to visualize complex intracranial anatomy and provide interactive guidance.
  
  
  CONCLUSIONS
  Virtual Interactive Presence is a feasible paradigm for real-time, long-distance surgical telecollaboration. Delay, resolution, scaling, and registration are parameters that require further optimization, but are within the realm of current technology. The paradigm potentially enables remotely located experts to mentor less experienced personnel located at the surgical site with applications in surgical training programs, remote proctoring for proficiency, and expert support for rural settings and across different counties.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Alabama;
authors.forename: Mahesh B
authors.initials: MB
authors.lastname: Shenai
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Barton L
authors.initials: BL
authors.lastname: Guthrie
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D002102:Cadaver; D003199:Computer Systems; D003299:Cooperative Behavior; D004210:Dissection; D006801:Humans; D008866:Microsurgery / Q000379:methods* / Q000706:statistics & numerical data; D009493:Neurosurgery / Q000379:methods* / Q000706:statistics & numerical data; D010870:Pineal Gland / Q000601:surgery; D012984:Software; D017216:Telemedicine; D014584:User-Computer Interface
keywords: IU = Indiana University; LDVIP = long-distance VIP; SD-VIP = short-distance VIP; UAB = University of Alabama at Birmingham; VIP = virtual interactive presence; collaboration; microsurgical procedure; telecommunication; virtual interactive presence